Rehabilitation Protocol

Arthroscopic Rotator Cuff Repair

Protocol Overview

This protocol is designed to protect the healing rotator cuff repair while progressively restoring motion and function. The rotator cuff tendon takes approximately 3 months to heal to bone. Early protection is critical—do not rush progression. Protocol may vary based on tear size and tissue quality.

Important: This protocol is provided as a guideline. Always follow the specific recommendations from Dr. Joshi and your physical therapist, as modifications may be necessary based on your individual surgery and healing progress.

Phase 1

Maximal Protection

Weeks 0-6

Goals

Protect the repair
Decrease pain and inflammation
Prevent shoulder stiffness
Maintain elbow, wrist, and hand function

Exercises

Pendulum exercises (small circles): 3x daily
Passive forward flexion to 120° (therapist assisted)
Passive external rotation to 30° in scapular plane
Passive internal rotation to chest
Elbow, wrist, and hand active range of motion
Grip strengthening
Scapular clock exercises (gentle)

Precautions

Sling at all times (including sleep)
No active shoulder motion
No lifting with surgical arm
No supporting body weight with arm
No driving
Sleep semi-reclined

Criteria for Next Phase

Pain well controlled
Passive forward flexion 120°+
Passive ER 30°+

Phase 2

Protected Motion

Weeks 6-12

Goals

Gradually discontinue sling
Progress to active-assisted motion
Improve flexibility
Begin periscapular strengthening

Exercises

Wean from sling per protocol
Active-assisted flexion (pulley, wand, table slides)
Active-assisted ER/IR with wand
Passive stretching all directions
Supine flexion to table
Scapular retraction/protraction
Isometric deltoid (submaximal)
Light resistance scapular exercises

Precautions

No active elevation against gravity until cleared
No resistance to rotator cuff
Progress gradually—respect tissue healing
Avoid pain with exercises

Criteria for Next Phase

Active-assisted flexion 140°+
ER 45°+
Able to discontinue sling
Good scapular mechanics

Phase 3

Early Strengthening

Weeks 12-16

Goals

Progress to active range of motion
Begin rotator cuff strengthening
Improve neuromuscular control
Progress functional activities

Exercises

Active range of motion all planes
Isometric rotator cuff (submaximal)
Side-lying external rotation (no weight initially)
Light resistance band ER/IR
Prone rowing
Standing flexion with light weight
Wall push-ups
Rhythmic stabilization exercises

Precautions

Light resistance only
No pain with strengthening
Avoid fatigue
No sudden/jerking motions

Criteria for Next Phase

Full active ROM
Good strength with light resistance
No pain with activities

Phase 4

Advanced Strengthening

Weeks 16-24

Goals

Restore full strength
Return to work and recreational activities
Sport-specific training if applicable

Exercises

Progressive rotator cuff strengthening
Resistance band program (all directions)
Dumbbell exercises with progressive weight
Push-ups (modified to full)
Plyometric exercises (if appropriate)
Sport-specific drills
Work simulation activities

Precautions

Gradual progression of resistance
Avoid overtraining
Monitor for any pain or weakness

Criteria for Next Phase

Strength 85%+ of opposite side
Pain-free with activities
Meets demands of work/sport

Return to Activity Guidelines

Driving: 6-8 weeks (when safe and off narcotics)
Desk work: 1-2 weeks (with sling)
Light duty work: 8-12 weeks
Full duty (non-overhead): 4-6 months
Overhead work: 6+ months
Golf: 4-6 months
Swimming: 4-6 months
Tennis: 6-9 months
Throwing sports: 9-12 months

All return to activity timelines are estimates and require clearance from Dr. Joshi based on your individual progress.

Questions About Your Recovery?

Contact our office or discuss with your physical therapist if you have questions about your rehabilitation.

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