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Knee & Shoulder Doctor

Arthroscopic Rotator Cuff Repair Protocol

This protocol has been modified and is being used with permission from the BWH Sports and Shoulder Service.

Rotator cuff repairs are performed to alleviate pain and improve range of motion and strength. With modern technology and advanced techniques, more rotator cuff tears are repaired arthroscopically.

The purpose of this protocol is to provide a GUIDELINE for the postoperative management of patients that have undergone an arthroscopic rotator cuff repair/mini open rotator cuff repair. Please note that modifications to this protocol may be necessary if other procedures were performed at the time of rotator cuff repair. If a therapist or patient requires the assistance in progression of rehabilitation, please consult the referring surgeon.

Progression to the next phase is based on clinical exam and/or time frames as appropriate. The tear size and morphology, bone/tissue quality, strength of the repair, and other factors may shorten or delay each phase. Please consult with the referring surgeon to help determine when progression to the next phase may proceed.

Precautions: For Phase I and II (Weeks 1-12):

  • Sling at all times for weeks 1-6
  • No lifting, pulling, pushing
  • No supporting of body weight by hands and arms
  • No excessive behind the back movements
  • No sudden jerking motions


Phase I (Weeks 1-6)

PROM Phase


  • Decrease pain and inflammation
  • Maintain integrity of repair
  • Prevent elbow, wrist, hand stiffness
  • Improve PROM

Week 1

  • Sling all times
  • Sleep in sling
  • Patient education: posture, joint protection, positioning, hygiene, etc.
  • Cryotherapy for pain and inflammation
  • Wound care
  • Start elbow, wrist, hand AROM (unless biceps tenodesis performed at time of RTCR)

Weeks 2-6

  • Sling all times
  • Start PROM program and pendulum exercises approximately 2-3 weeks after surgery
  • Forward flexion
  • Abduction with scapular stabilization
  • ER in scapular plane
  • IR in scapular plane
  • Start scapular program at weeks 3-4
  • Continue elbow, wrist, hand AROM
  • Cryotherapy as needed for pain control and inflammation


Phase II (Weeks 7-12)

AROM Phase


  • Allow healing of soft tissue
  • Do not overstress healing tissue
  • Gradually restore full passive ROM (weeks 4-6) and then active ROM (weeks 6-12)
  • Improve shoulder motion biomechanics
  • Optimize neuromuscular control

Weeks 7-12

  • Discontinue sling unless instructed otherwise by surgeon
  • Start AROM program
  • Shoulder flexion in scapular plane
  • Shoulder abduction with scapular stabilization
  • Shoulder IR in scapular plane
  • Start RTC isometrics at week 7
  • Continue scapular program
  • Continue cryotherapy as needed
  • May use heat prior to ROM exercises
  • Ice after exercise if needed


Phase III (Week 13-18)

Strengthening Phase


  • Obtain Full AROM (week 10-12)
  • Gradually restore shoulder strength and endurance
  • Gradual return to functional activities

Weeks 13-18

  • Continue stretching and active ROM exercises (as needed)
  • Dynamic stabilization exercises
  • Start strengthening program
  • Forward flexion/External rotation (ER)/Internal rotation (IR) with therabands or tubing
  • ER Sidelying exercises
  • Lateral raises only if patient can perform without hiking shoulder
  • Elbow Flexion and extension


Phase IV (Weeks 19-24)

Advanced Strengthening Phase


  • Maintain full non-painful active ROM
  • Advance conditioning exercises
  • Gradual return to full functional activities

Weeks 19-24

  • Continue stretching, AROM, and initial strengthening exercises
  • Advance proprioceptive, neuromuscular activities
  • Gradual return to strenuous work activities around weeks 22-24
  • Gradual return to recreational and sport activities around weeks 22-24

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