U W H e a lth S p o rts R e h a b i l it a ti o n
Rehabilitation Guidelines
for Type I and Type II Rotator Cuff Repair
and Isolated Subscapularis Repair
The anatomic configuration of the
shoulder joint (glenohumeral joint)
is often compared to that of a golf
ball on a tee. This is because the
articular surface of the round humeral
head is approximately four times
greater than that of the relatively flat
shoulder blade face (glenoid fossa)1.
This configuration provides less boney
stability than a truer ball and socket
joint, like the hip. The stability and
movement of the shoulder is controlled
primarily by the rotator cuff muscles,
with assistance from the ligaments,
glenoid labrum and capsule of the
shoulder. The rotator cuff is a group
of four muscles: subscapularis,
supraspinatus, infraspinatus and teres
minor (Figure 1).
Rotator cuff tears can occur from
repeated stress or from trauma.
Throwing a baseball can create up to
750 newtons of distractive force on the
shoulder2. This places a significant
amount of stress on the rotator cuff
while trying to dissipate this force. This
stress and force may be even greater if
there is improper form or mechanics
while throwing. This repeated stress
may lead to rotator cuff tears. Rotator
cuff trauma also may result from
falling on your arm, bracing your
arm in an accident, arm tackling in
football or any large sudden force
applied to the arm. Most rotator cuff
tears involve the supraspinatus and/
Back View
Front View
Supraspinatus
Infraspinatus
Teres
Minor
Subscapularis
Figure 1Rotator cuff anatomy
Image property of Primal Pictures, Ltd., primalpictures.com. Use of this image without authorization from Primal Pictures, Ltd. is prohibited.
Bursal surface of the
supraspinatus tendon
Articular surface of the
supraspinatus tendon
Greater
tuberosity
Glenoid fossa
Humeral head
Figure 2. Coronal MRI Image of the Supraspinatus Note the black line of the bursal surface and
articular surface. In this normal shoulder this tendon continues all the way to the greater
tuberosity, the attachment site on the humerus. When there is a rotator cuff tear these black lines
will become disrupted before reaching the greater tuberosity.
or the infraspinatus. Occasionally
isolated tears of the subscapularis
can occur. This usually results from
trauma rotating the shoulder outward.
The rotator cuff tendons also undergo
some degeneration with age. This
process alone can lead to rotator cuff
tears in older patients. Patients over
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6 2 1 S ci e n c e D ri v e • M a dis o n , W I 5 3 7 1 1 • u ws p o rtsm e dici n e . o rg
Rehabilitation Guidelines for Rotator Cuff and Isolated Subscapularis Repair
Figure 3Coronal MRI image of an articular
surface tear of the supraspinatus. Note the
top black line has maintained continuity but
the undersurface black line is disrupted.
Figure 4Coronal MRI image of a full
thickness tear of the supraspinatus. Note the
white fluid present where the dark tendon
should be.
50 years of age are more susceptible to
sustaining a significant rotator cuff tear
from trauma3.
2
Rotator cuff tears can be classified in
various ways. The first classification is
a partial thickness or a full thickness
tear. Normal tendon thickness is 9 to 12
mm. Partial thickness tears start on one
surface of the tendon, but do not progress
through the depth of the tendon. These
can be bursal surface tears or articular
sided tears . Figure 2 shows the normal
anatomy of the bursal and articular
side of the rotator cuff. Bursal surface
tears occur on the outer surface of the
tendon and may be caused by repetitive
impingement. Articular sided tears
(Figure 3) occur on the inner surface of
the tendon, and are most often caused by
internal impingement or tensile stresses
related to overhead sports. Full thickness
or complete tears (Figure 4) extend
from one surface of the tendon all the
way through to the other surface of the
tendon. Full thickness tears are often
caused by trauma, such as falling on
the arm. Since a portion of the tendon
is completely disrupted, there also will
be some tendon retraction. Retraction is
movement of the tendon away from its
insertion point back toward the muscle.4
After determining the type of tear, a
classification system is used to assess the
size of the tear. Type I tears are tears less
than 2 cm in width and Type II tears are
greater than 2 cm.
Surgical repair of a rotator cuff tear can
be done arthroscopically or with a miniopen procedure. A 2007 review published
in The Journal of Bone and Joint Surgery
stated that equally successful outcomes
can be attained from either technique5.
The primary goal of a rotator cuff repair
is to restore the normal anatomy by
approximating the rotator cuff tendon
back to its normal attachment site on the
greater tuberosity of the humerus. This
is done by passing sutures through the
tendon and then tying the tendon down
to suture anchors that have been placed
in the humerus. Prior to bringing the
tendon back to its insertion, the edges of
the tear may need to be brought together,
referred to as side-to-side repair or
convergence (Figure 5).
Not all rotator cuff tears are repairable.
A tear may be un-repairable if the tear is
too large, there is too much retraction, or
the tissue quality is too poor. The degree
of success for tears that are repaired is
related to various factors, including tear
size, the number of tendons involved,
patient age, associated injuries and post
operative rehabilitation6, 7.
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation Guidelines for Rotator Cuff and Isolated Subscapularis Repair
A
B
C
Figure 5Rotator cuff repair technique using anchors and sutures. The tear (A) is approximated.
Then suture anchors are placed on both sides of the tear (B and C). Finally the tendon is
approximated back to the bone with various suture patterns to decrease focal stress.
Rehabilitation is vital to regaining
motion, strength and function of the
shoulder after surgery. Initially patients
will use a sling to protect the repair
site and allow healing of the tendon
back to the bone. During this time,
passive motion exercises are started to
prevent the shoulder from getting stiff
and losing mobility. The rehabilitation
program will gradually progress to
more strengthening and control type
exercises. The rehabilitation guidelines
will vary depending on the size of the
3
tear and quality of the tendon. The
rehabilitation guidelines for Type I and
Type II tears of the supraspinatus or
infraspinatus and isolated subscapularis
tears are presented below in a criterion
based progression. General time frames
are given for reference to the average,
but individual patients will progress at
different rates depending on their age,
associated injuries, pre-injury health
status, rehabilitation compliance and
injury severity.
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation Guidelines for Type I Rotator Cuff Repair
TYPE I TEARS
PHASE I (Surgery to 2 weeks after surgery)
Appointments
• Rehabilitation appointments begin within 1 week of surgery
Rehabilitation Goals
• Reduce pain and swelling in the post-surgical shoulder
• Maintain active range of motion of the elbow, wrist and neck
• Protect healing of repaired tissues
Precautions
• Use sling continuously except while doing therapy
• Relative rest to reduce inflammation
Suggested Therapeutic
Exercise
• Elbow, wrist and neck active range of motion
• Ball squeezes
• Passive range of motion for shoulder flexion and abduction (between 0° and 50°)
Cardiovascular Fitness
• Walking and/or stationary bike with sling on
• No treadmill
• Avoid running and jumping due to the forces that can occur at landing
Progression Criteria
• 14 days after surgery
PHASE II (begin after meeting Phase I criteria, usually 2 weeks after surgery)
4
Appointments
• Rehabilitation appointments are 2 times per week
Rehabilitation Goals
• Controlled restoration of passive and active assistive range of motion
• Activate shoulder and scapular stabilizers in a protected position of 0° to 30° of shoulder
abduction
• Correct postural dysfunctions
Precautions
• Continue use of the sling for the first 4 weeks
• Wean out of the sling slowly based on the safety of the environment during weeks 5 and 6
• Discontinue use of the sling by the end of week 6
• No active abduction for the first 8 weeks in order to protect the repair
Suggested Therapeutic
Exercise
• Passive and active assistive range of motion for the shoulder in all cardinal planes
(shoulder abduction should be passive only)
• Begin active range of motion for shoulder flexion and rotation at 4 weeks
• Gentle shoulder mobilizations as needed
• Isometric internal and external rotator cuff strengthening in non-provocative positions with
the shoulder in 0° to 30° of abduction
• Scapular strengthening with the arm in neutral
• Cervical spine and scapular active range of motion
• Postural exercises
• Core strengthening
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation
Rehabilitation
Guidelines Guidelines
for Rotatorfor
Cuff
Type
andI Rotator
Isolated Cuff
Subscapularis
Repair
Repair
Cardiovascular Fitness
• Walking and stationary bike
• No treadmill or stairmaster
• Avoid running and jumping until the athlete has full rotator cuff strength in a neutral
position due to forces that can occur at landing
Progression Criteria
• The patient can progress to phase III when they have achieved full passive range of motion
(equal to the uninvolved side) and normal (rated 5/5) strength for the shoulder internal
rotators and external rotators at 0° of shoulder abduction
• Usually 5 weeks after surgery
PHASE III (begin after meeting Phase II criteria, usually 5-7 weeks after surgery)
5
Appointments
• Rehabilitation appointments are 1 time per week
Rehabilitation Goals
• Full shoulder active range of motion in all planes
• Normal (rated 5/5) strength for shoulder internal rotators and external rotators with the
shoulder in 0° of abduction
• Correct any postural dysfunction
Precautions
• No active shoulder abduction for the first 8 weeks after surgery
• Dr. Orwin’s, Dr. Dunn’s and Dr. Baer’s patients should avoid external resistance (bands or
weights) for shoulder abduction or supraspinatus strengthening for the first 9 to 10 weeks
after surgery; Dr. Scerpella’s patients should avoid external resistance for 12 weeks.
• Begin strengthening the supraspinatus very gradually by ensuring that the exercises are
pain free and do not include long lever arms that will significantly change the torque
throughout the motion
Suggested Therapeutic
Exercise
• Shoulder internal rotation and external rotation with theraband or weights that begin at 0°
of shoulder abduction - gradually increase shoulder abduction as strength improves
• Open kinetic chain shoulder rhythmic stabilizations in supine at 90° of shoulder elevation
(eg. stars or alphabet exercises)
• Gentle closed kinetic chain shoulder and scapular stabilization drills
• Proprioceptive neuromuscular facilitation patterns
• Side lying shoulder flexion
• Begin shoulder abduction in side lying (gravity eliminated)
• Scapular strengthening
• Active, active assistive, and passive range of motion at the shoulder as needed
• Core strengthening
• Begin trunk and hip mobility exercises
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation
Rehabilitation
Guidelines Guidelines
for Rotatorfor
Cuff
Type
andI Rotator
Isolated Cuff
Subscapularis
Repair
Repair
Cardiovascular Fitness
• Walking and stationary bike
• No treadmill, stairmaster or swimming
• Avoid running and jumping until the athlete has full rotator cuff strength in a neutral
position due to forces that can occur at landing
Progression Criteria
• Full shoulder active range of motion (equal to the uninvolved shoulder) and normal
(rated 5/5) strength for shoulder internal rotators and external rotators at 30° of
shoulder abduction
PHASE IV (begin after meeting Phase III criteria, usually 12 weeks after surgery)
6
Appointments
• Rehabilitation appointments are 1 time every 2 to 3 weeks
Rehabilitation Goals
• Normal (rated 5/5) rotator cuff strength and endurance at 90° of shoulder abduction and
scaption
• Advance proprioceptive and dynamic neuromuscular control retraining
• Correct postural dysfunctions with work and sport specific tasks
• Develop strength and control for movements required for work or sport
Precautions
• Post-rehabilitation soreness should alleviate within 12 hours of the activities
Suggested Therapeutic
Exercise
• Multi-plane shoulder active range of motion with a gradual increase in the velocity of
movement while making sure to assess scapular rhythm
• Shoulder mobilizations as needed
• Rotator cuff strengthening in 90° of shoulder abduction and overhead (beyond 90° of
shoulder abduction)
• Scapular strengthening and dynamic neuromuscular control in open kinetic chain and
closed kinetic chain positions
• Core and lower body strengthening
• About 15 weeks after surgery, begin education in sport specific biomechanics with a very
initial program for throwing that includes low velocity throws, focusing on movement
control (air throws and light toss)
Cardiovascular Fitness
• Walking, stationary bike, and stairmaster
• No treadmill or swimming
• May begin light jogging and running if the patient has normal (rated 5/5) rotator cuff
strength in neutral and normal shoulder active range of motion
Progression Criteria
• Full shoulder active range of motion in all planes and multi-plane movements
• Normal (rated 5/5) strength at 90° of shoulder abduction
• Negative impingement signs
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation
Rehabilitation
Guidelines Guidelines
for Rotatorfor
Cuff
Type
andI Rotator
Isolated Cuff
Subscapularis
Repair
Repair
PHASE V (begin after meeting Phase IV criteria, usually 16 to 17 weeks after surgery)
7
Appointments
• Rehabilitation appointments are once every 2 to 3 weeks
Rehabilitation Goals
• Normal (rated 5/5) rotator cuff strength at 90° of shoulder abduction
• Normal (rated 5/5) supraspinatus strength
• Advance proprioceptive and dynamic neuromuscular control retraining
• Correct postural dysfunctions with work and sport specific tasks
• Develop strength and control for movements required for work or sport
• Develop work capacity cardiovascular endurance for work and/or sport
Precautions
• Post-rehabilitation soreness should alleviate within 12 hours of the activities
Suggested Therapeutic
Exercise
• Multi-plane shoulder active range of motion with a gradual increase in the velocity of
movement while making sure to assess scapular rhythm
• Shoulder mobilizations as needed
• Rotator cuff strengthening in 90° of shoulder abduction as well as in provocative
positions and work/sport specific positions, including eccentric strengthening, endurance
and velocity specific exercises
• Scapular strengthening and dynamic neuromuscular control in overhead positions and
work/sport specific positions
• Work and Sport specific strengthening
• Core and lower body strengthening
• Throwing program, swimming program or overhead racquet program as needed
Cardiovascular Fitness
• Design to use work or sport specific energy systems
Progression Criteria
• The patient may return to sport after receiving clearance from the orthopedic surgeon
and the sports rehabilitation provider. Return to sport decisions are based on meeting the
goals of this phase
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation Guidelines for Type II Rotator Cuff Repair
TYPE II TEARS
PHASE I (Surgery to 2 weeks after surgery)
Appointments
• Rehabilitation appointments begin within 7 to 10 days after surgery
Rehabilitation Goals
• Reduce pain and swelling in the post-surgical shoulder
• Maintain active range of motion of the elbow, wrist and neck
• Protect healing of repaired tissues
Precautions
• Use sling continuously
• Relative rest to reduce inflammation
Suggested Therapeutic
Exercise
• Elbow, wrist and neck active range of motion
• Ball squeezes
• Passive shoulder range of motion between 0° and 50° for flexion and abduction
Cardiovascular Fitness
• Walking and stationary bike with sling on
• Avoid running and jumping due to the forces that can occur at landing
Progression Criteria
• 14 days after surgery
PHASE II (begin after meeting Phase I criteria, usually 2 weeks after surgery)
8
Appointments
• Rehabilitation appointments are 2 times per week
Rehabilitation Goals
• Controlled restoration of shoulder passive range of motion
• Activate shoulder and scapular stabilizers in a protected position of 0° to 30° of shoulder
abduction
• Correct postural dysfunctions
Precautions
• Dr. Baer and Dr.Orwin’s patients may begin to wean out of the sling slowly during weeks 5
and 6, Discontinue the use of the sling by the end of week 6.
• Dr. Dunn and Dr. Scerpella’s patients must wear the sling for at least 6 weeks and begin
weaning out of the sling in week 7.
• No active shoulder motion in order to protect repaired tissues
Suggested Therapeutic
Exercise
• Codman’s exercises
• Shoulder passive range of motion in all cardinal planes using a cane, pulleys, and/or table
slides
• Scapular squeezes
• Cervical spine and scapular active range of motion
• Postural exercises
• Core strengthening
Cardiovascular Fitness
• Walking, stationary bike with sling on
• No Treadmill
Progression Criteria
• The patient can progress to Phase III when they are at least 5 weeks after surgery
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation
Rehabilitation
GuidelinesGuidelines
for Rotatorfor
Cuff
Type
andII Isolated
Rotator Cuff
Subscapularis
Repair
Repair
PHASE III (begin after meeting Phase II criteria, usually 5-6 weeks after surgery)
9
Appointments
• Rehabilitation appointments are 2 times per week
Rehabilitation Goals
• Full shoulder passive and active range of motion in all planes
• Normal (rated 5/5) strength for shoulder internal rotators and external rotators at 30° of
shoulder abduction
• Correct postural dysfunction
Precautions
• No active abduction for the first 8 weeks after surgery
• Dr. Baer and Dr. Orwin’s patients should avoid external resistance (bands or weights) for
shoulder abduction or supraspinatus strengthening for the first 10 weeks; Dr. Scerpella’s
and Dr. Dunn’s patients should avoid external resistance for 12 weeks
• Begin strengthening the supraspinatus very gradually by ensuring that the exercises are
pain free and do not include long lever arms that will significantly change the torque
throughout the motion
Suggested Therapeutic
Exercise
• Shoulder internal rotation and external rotation isometrics, gradually progressing to
isotonics with exercise bands or weights that begin at 30° of shoulder abduction as
strength improves
• Open kinetic chain shoulder rhythmic stabilizations in supine at 90° of shoulder elevation
(eg. stars or alphabet exercises)
• Gentle closed kinetic chain shoulder and scapular stabilization drills
• Short arc proprioceptive neuromuscular facilitation patterns
• Side lying shoulder flexion
• Scapular strengthening
• Shoulder active/active assistive/passive range of motion exercises as needed
• Begin core strengthening
• Begin trunk and hip mobility exercises
Cardiovascular Fitness
• Walking and stationary bike
• No treadmill, swimming or running
Progression Criteria
• The patient can progress to phase IV when they have achieved full shoulder active range
of motion (equal to the uninvolved side) and normal (rated 5/5) strength for the shoulder
internal rotators and external rotators at 30° of shoulder abduction
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation
Rehabilitation
GuidelinesGuidelines
for Rotatorfor
Cuff
Type
andII Isolated
Rotator Cuff
Subscapularis
Repair
Repair
PHASE IV (begin after meeting Phase III criteria, usually 12 to 14 weeks after surgery)
Appointments
• Rehabilitation appointments are once every 1 to 2 weeks
Rehabilitation Goals
• Normal (rated 5/5) rotator cuff strength and endurance at 90° of shoulder abduction and
scaption
• Advance proprioceptive and dynamic neuromuscular control retraining
• Correct postural dysfunctions with work and sport specific tasks
• Develop strength and control for movements required for work or sport
Precautions
• Post-rehabilitation soreness should alleviate within 12 hours of the activities
Suggested Therapeutic
Exercise
• Multi-plane shoulder active range of motion with gradual increase in the velocity of
movement being sure to assess scapular rhythm
• Shoulder mobilizations as needed
• Rotator cuff strengthening in 90° of shoulder abduction, and overhead (beyond 90° of
shoulder abduction)
• Scapular strengthening and dynamic neuromuscular control in open kinetic chain and
closed kinetic chain positions
• Core and lower body strengthening
Cardiovascular Fitness
• Walking, stationary bike, and stairmaster
• No treadmill or swimming
• The patient may begin running if they have normal (rated 5/5) strength for the shoulder
internal rotators and external rotators at 30° of shoulder abduction and normal shoulder
active range of motion
Progression Criteria
• Full shoulder active range of motion in all planes and multi-plane movements
• Normal (rated 5/5) strength at 90° of shoulder abduction
• Negative impingement signs
10
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation Guidelines for Type II Rotator Cuff Repair
PHASE V (begin after meeting Phase IV criteria, usually 20 to 22 weeks after surgery)
Appointments
• Rehabilitation appointments are 1 time every 2 to 3 weeks
Rehabilitation Goals
• Normal (rated 5/5) rotator cuff strength at 90° abduction
• Normal (rated 5/5) supraspinatus strength
• Advance proprioceptive and dynamic neuromuscular control retraining
• Correct postural dysfunctions with work and sport specific tasks
• Develop strength and control for movements required for work or sport
• Develop work capacity cardiovascular endurance for work and/or sport
Precautions
• Post-rehabilitation soreness should alleviate within 12 hours of the activities
Suggested Therapeutic
Exercise
• Multi-plane shoulder active range of motion with a gradual increase in the velocity of
movement being sure to assess scapular rhythm
• Shoulder mobilizations as needed
• Rotator cuff strengthening in 90° of shoulder abduction in provocative and/or
work/sport specific positions, including eccentric strengthening, endurance and velocity
specific exercises
• Scapular strengthening and dynamic neuromuscular control in overhead positions and
work/sport specific positions
• Work and sport specific strengthening
• Core and lower body strengthening
• Begin education in sport specific biomechanics with an initial program for throwing,
swimming or overhead racquet sports as needed
• Transition to a specific throwing program or swimming program once the patient can
demonstrate good control with the desired mechanics
Cardiovascular Fitness
• Use exercise to replicate energy systems needed for work or sport
Progression Criteria
• The patient may return to sport after receiving clearance from the orthopedic surgeon
and the sports rehabilitation provider. Return to sport decisions are based on meeting the
goals of this phase
11
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation Guidelines for Isolated Subscapularis Repair
Rehabilitation Guidelines for Isolated Subscapularis Repair
PHASE I (Surgery to 2 weeks after surgery)
Appointments
• Rehabilitation appointments begin 7-10 days after surgery
Rehabilitation Goals
• Reduce pain and swelling in the post-surgical shoulder
• Maintain active range of motion (AROM) of elbow, wrist and neck
• Protect healing of repaired tissues
Precautions
• Use sling continuously except while doing therapy
• Relative rest to reduce inflammation
Suggested Therapeutic
Exercise
• Elbow, wrist and neck AROM
• Ball squeezes
• Completely passive range of motion (PROM) for flexion and abduction (0° - 50°)
Cardiovascular Fitness
• Walking, stationary bike with sling on. No Treadmill, Stairmaster or swimming
• Avoid running and jumping due to the forces that can occur at landing
Progression Criteria
• 14 days after surgery
PHASE II (begin after meeting Phase I criteria, usually 2 weeks after surgery)
Appointments
• Rehabilitation appointments are 1 to 2 times per week
Rehabilitation Goals
• Controlled restoration of PROM and/or AAROM
• Correct postural dysfunctions
Precautions
• Continue use of sling for sleep and activities during the first 6 weeks, weaning out
of the sling slowly based on the safety of the environment after 6 weeks
• No external rotation motion beyond neutral for the first 6 weeks (protect repair)
• No resisted internal rotation for the first 6 weeks (protect repair)
Suggested Therapeutic
Exercise
• PROM and/or AAROM for the shoulder as tolerated for flexion and abduction
• Gentle shoulder mobilizations as needed
• Isometric rotator cuff strengthening in non-provocative positions. No internal
rotator or subscapularis strengthening
• Scapular strengthening with arm in neutral
• Cervical spine and scapular AROM
• Postural exercises
• Core strengthening
12
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation Guidelines for Isolated Subscapularis Repair
Cardiovascular Fitness
• Walking and stationary bike. No Treadmill, Stairmaster or swimming
• Avoid running and jumping until athlete has full rotator cuff strength in a neutral
position due to forces that can occur at landing
Progression Criteria
• 6 weeks after surgery
PHASE III (begin after meeting Phase II criteria, usually 6 weeks after surgery)
Appointments
• Rehabilitation appointments are1 time every 1 to 2 weeks
Rehabilitation Goals
• Full AROM in all planes
• Normal (rated 5/5) strength for internal rotation (IR)/external rotation (ER) at 0°
abduction
• Correct postural dysfunction
Precautions
• Begin external rotation range of motion past neutral and resisted internal rotation
gradually to assess response and allow for progress adaptation
Suggested Therapeutic
Exercise
• IR/ER isotonics with theraband or weights that begin at 0° abduction and gradually
increases abduction as strength improves
• Open kinetic chain (OKC) shoulder rhythmic stabilizations in supine at 90° elevation
(stars or alphabet)
• Gentle closed kinetic chain (CKC) shoulder and scapular stabilization drills
• Proprioceptive neuromuscular facilitation(PNF) patterns
• Side lying shoulder flexion
• Scapular strengthening
• AROM, AAROM and/or PROM as needed
• Core strengthening
• Begin trunk and hip mobility exercises
Cardiovascular Fitness
• Walking and stationary bike. No Treadmill, Stairmaster or swimming
• Avoid running and jumping until athlete has full rotator cuff strength in a neutral
position due to forces that can occur at landing
13
6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation Guidelines for Isolated Subscapularis Repair
Progression Criteria
• Full AROM (equal to uninvolved) and normal (rated 5/5) strength for IR/ER at 30°
abduction
PHASE IV (begin after meeting Phase III criteria, usually 12 to 14 weeks after surgery)
Appointments
• Rehabilitation appointments are 1 time every 2 to 3 weeks
Rehabilitation Goals
• Normal (rated 5/5) rotator cuff strength and endurance at 90° abduction and
scaption
• Advance proprioceptive and dynamic neuromuscular control retraining
• Correct postural dysfunctions with work and sport specific tasks
• Develop strength and control for movements required for work or sport
Precautions
• Post-rehab soreness should alleviate within 12 hours of the activities
Suggested Therapeutic
Exercise
• Multi-plane AROM with gradual increase in velocity of movement - assessing
scapular rhythm
• Shoulder mobilizations as needed
• Rotator cuff strengthening in at 90° abduction, and overhead
• Scapular strengthening and dynamic neuromuscular control in OKC and CKC
positions
• Core and lower body strengthening
• At about 16-18 weeks, begin education in sport specific biomechanics with initial
program for throwing – low velocity, focusing on movement control (air throws and
light toss)
Cardiovascular Fitness
• Walking, stationary bike, Stairmaster. No Treadmill or swimming
• May begin light jogging and running if patient has full rotator cuff strength in
neutral and normal AROM
Progression Criteria
• Full AROM in all planes and multi-plane movements
• Normal (rated 5/5) strength at 90° abduction
• Negative impingement signs
PHASE V (begin after meeting phase IV criteria, usually 16 to18 weeks after surgery)
Appointments
• Rehabilitation appointments are 1 time per week every 2 to 3 weeks
Rehabilitation Goals
• Normal (rated 5/5) rotator cuff strength at 90° abduction and supraspinatus
• Advance proprioceptive and dynamic neuromuscular control retraining
• Correct postural dysfunctions with work and sport specific tasks
• Develop strength and control for movements required for work or sport
• Develop work capacity cardiovascular endurance for work and/or sport
Precautions
• Post-rehab soreness should alleviate within 12 hours of the activities
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6 2 1 S c i e n c e D r i v e • M a d i s o n , W I 5 3 7 1 1 • u ws p o r t sm e d i c i n e . o r g
Rehabilitation
Rehabilitation
Guidelines
Guidelines
for Rotator
for Cuff
Isolated
and Isolated
Subscapularis
Subscapularis
Repair Repair
Suggested Therapeutic
Exercise
• Multi-plane AROM with gradual increase in velocity of movement - assessing
scapular rhythm
• Shoulder mobilizations as needed
• Rotator cuff strengthening in at 90° abduction, provocative positions and work/
sport specific positions - including eccentric strengthening, endurance and velocity
specific exercises
• Scapular strengthening and dynamic neuromuscular control in overhead positions
and work/sport specific positions
• Work and Sport specific strengthening
• Core and lower body strengthening
• Throwing program, swimming program or overhead racquet program as needed
Cardiovascular Fitness
• Design to use work or sport specific energy systems
Progression Criteria
• The patient may return to sport after receiving clearance from the orthopedic
surgeon and the sports rehabilitation provider. This will be based on meeting the
goals of this phase
These rehabilitation guidelines were developed collaboratively by Marc Sherry, PT, DPT, LAT, CSCS
(msherry@uwhealth.org) and the UW Health Sports Medicine physician group.
Updated 12/2013
References
1.Wilk KE, Reinold MM, Dugas JR, Arrigo
CA, Moser MW, Andrews JR. Current
concepts in the recognition and treatment
of superior labral (SLAP) lesions. J Orthop
Sports Phys Ther. May 2005;35(5):273291.
2.Burkhart SS, Morgan CD, Kibler WB.
Shoulder injuries in overhead athletes.
The “dead arm” revisited. Clin Sports
Med. Jan 2000;19(1):125-158.
3.Wolf BR, Dunn WR, Wright RW. Indications
for repair of full-thickness rotator
cuff tears. Am J Sports Med. Jun
2007;35(6):1007-1016.
4.Kuhn JE, Dunn WR, Ma B, et al.
Interobserver agreement in the
classification of rotator cuff tears. Am J
Sports Med. Mar 2007;35(3):437-441.
7.Boes MT, McCann PD, Dines DM.
Diagnosis and management of massive
rotator cuff tears: the surgeon’s dilemma.
Instr Course Lect. 2006;55:45-57.
5.Nho SJ, Shindle MK, Sherman SL,
Freedman KB, Lyman S, MacGillivray JD.
Systematic review of arthroscopic rotator
cuff repair and mini-open rotator cuff
repair. J Bone Joint Surg Am. Oct 2007;89
Suppl 3:127-136.
6.Abrams JS. Arthroscopic approach to
massive rotator cuff tears. Instr Course
Lect. 2006;55:59-66.
Copyright 2013 UW Health Sports Medicine Center
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SM-38183-13
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