SPORTS MEDICINE / SHOULDER SERVICE
GEORGETOWN UNIVERSITY MEDICAL CENTER – MEDSTAR HEALTH
MASSIVE OPERATIVE ROTATOR CUFF REPAIR PROTOCOL
WITH OR WITHOUT CLAVICLE RESECTION
JOHN J. KLIMKIEWICZ, M.D.
STAGE I (0 – 6 WEEKS)
A. Patient to wear sling or abduction pillow continuously for 4 weeks. The sling may be off for exercises, showering, and dressing. OK to do tabletop activities within pain tolerance (eat, brush teeth, write, and occasional keyboard).
If in abduction brace or pillow, only PROM / AAROM above the level of the pillow or brace. The brace is used only in patients with a problem with the deltoid, therefore, protect the anterior deltoid.
B. PROM / AAROM only to limits determined in operating room. If no limits listed on prescription, assume patient able to do full ROM.
1.) Pendulum (Codman) exercises
2.) Wand exercises for PROM / AAROM exercises – supine only
3.) Strongly suggest home pulley use.
4.) Ice following treatment and home exercises.
5.) Scapular stabilization exercises.
6.) Internal rotation to back pocket only.
***GOAL: Full PROM to pre-set limits or if no limits, to symmetric ROM.
***PRECAUTIONS: protect Anterior deltoid and rotator cuff.
***VISITS: 1 time per week (6 visits over 6 weeks)
STAGE II (6 – 10 WEEKS)
A. AAROM advance from supine to standing.
B. AROM, no weight, painfree arc only.
***GOAL: AROM to 75% of predetermined limits.
***PRECAUTIONS: Do not increase inflammation.
***VISITS: 1 time per week (max) or 1 time every other week.
C. Scapular stabilization exercises
STAGE III (10 weeks – 5 months)
A. AROM for all exercises
1.) Use 2 oz to 1 lb. Weights
2.) Patient should experience only minimal pain with exercises or occurring later in day.
B. Scapular Stabilization exercises
***GOAL: Full AROM by week 12
***PRECAUTION: Do not increase inflammation or overwork cuff.
4 oz. Weight limit until week 8, then progress as tolerated
***VISITS: 6 maximum over 6 weeks. Emphasize home program.
STAGE IV (5 – 6 months)
A. Progress on rotator cuff exercises with no weight limit. Emphasis on home program.
B. Scapular stabilization exercises.
***GOAL: Limited return to work and sports 4-6 months post-op. Check with
Full AROM to pre-set limits
Home Program: 7 days/week for stretching/ice
4 days/week for strengthening
***VISITS: 1 time every 2 weeks (max) only if patient is having significant
This protocol provides you with general guidelines for the rehabilitation following massive rotator cuff repair. Specific changes in program will be made by the physician as appropriate for an individual patient. If there are any questions please contact my office at (202) 444-8613.