This protocol is intended to be a general outline only. The physician reserves the right to either advance or delay this protocol as deemed necessary. If so, this should be done by direct communication with the therapist, or in writing on the therapy referral form given to the patient on the day of surgery.

General Post-Operative Guidelines

  • For medium tears (1-3 cm) of the rotator cuff, physical therapy should begin between at 2 weeks post-op.
  • Patient will perform the following exercises as instructed by physician, starting on day of surgery: pendulum exercises, shoulder shrugs, elbow flexion/extension, and grip strengthening.  Patient may also be allowed to begin activity such as stationery bike for cardiovascular fitness.
  • For the first 4 weeks, patient will wear sling with abduction wedge at all times except for bathing. Abduction wedge can be removed at 4 weeks, with sling to be worn for all standing and walking activities for another 2 weeks.
  • Patient will perform regular icing for pain and inflammation control.

Week 2 – 6: Patient seen 3x/week
Precautions: No AROM shoulder elevation for first 16 weeks.
ROM Guidelines: PROM flexion to 140° supine, full scaption.
ER to 55° w/arm abducted to 45° by end of Week 4.
ER to 65° w/arm abducted to 45° by end of Week 6.

  • Continue above exercises
  • Supine PROM for flexion, scaption, ER, and IR to belly
  • Supine cane exercises for flexion
  • Supine cane exercises for ER at 45° abduction
  • Grade 1-2 glenohumeral joint mobilization, scapular isometrics in sidelying
  • Soft tissue mobilization (parascapular, cervical) as indicated
  • Postural exercises: scapular clock, retraction, depression, etc.
  • Lawnmowers, “robbery,” and table lifts
  • Pulley AAROM exercises in sitting for flexion and scaption
  • Active IR with arm hanging at side in neutral position and elbow extended

Week 6-10: Patient seen 2x/week or as indicated

Precautions: No anti-gravity AROM
Goals by Week 8: Full supine PROM in all directions, IR to table

  • Continue above exercises
  • Apply e-stim to parascapular muscles and/or posterior cuff if needed
  • Prone scapular retraction and shoulder extension to neutral
  • Sidelying ER AROM to neutral
  • At Week 7, isometric flex, ext, add, abd, ER, and IR at side using 50% of patient’s effort
  • At Week 8, AAROM ER at 90° abduction in supine
  • PROM horiz add and posterior capsule stretch

Week 10-12: Patient seen 1-2x/week

Goals by Week 12: Full IR ROM, increased parascapular strength

  • Towel stretch for IR ROM if needed
  • Sidelying ER AROM past neutral
  • Gravity-neutral AROM on table for flexion and abduction
  • Supine serratus anterior ROM
  • Prone mid trap strengthening
  • Pulley-resisted shoulder retraction and extension

Week 12-16: Patient seen 1-2x/week

Goals by end of Week 16: Full AROM without scapular substitution

  • Wall walking for flexion and abduction
  • At Week 14, initiate