Rehabilitation program

after rotator cuff surgery

Progressive
NOTES In the clinic
Part 1: Tendon protection Wk 1 2 3 4 5 6 7 8 9 10 12
A Active elbow extension (supine/ standing) • • • • •
Sling week 1-2 B Vein pump (spread/collect fingers) • • • • •
postop: Exercises
Shoulder C Rotate forearm (supination/ pronation) • • • • •
in sling
immobilized in D Lift sternum (retraction of shoulders) • • • • •
standard fixed E Head lateral flexion • • • • •
sling F Cervical flexion • • • • •
Sling week 3-5 Part 2:
postop:
Shoulder Passive range of motion (by PT) Wk 1 2 3 4 5 6 7 8 9 10 12
immobilized in 1 Flexion • • • • •
standard sling 2 Abduction • • • • •
3 Supine external rotation w. 20-60 deg. abd. • • • • • PROM
4 When needed manual guiding of scapula • • • • •
5 When needed manual therapy • • • • •

Assisted active range of motion Wk 1 2 3 4 5 6 7 8 9 10 12

Repetitions:
6 Reach the foot (flexion) • • • •
7 Wash the table (flexion on table) AAROM • • • • •
3 sets of 10 8 Supine bench press w/ broomstick • • • • • •
repetitions 9 Flexion/ scaption w/ jump rope • • • • • •
10 Abduction w/ broomstick • • • • • •
11 Supine external rotation w/ broomstick • • • • • •
Isometric hold Wk 1 2 3 4 5 6 7 8 9 10 12
G Squeeze a ball • • • • • • •
H Adduction • • • • • • •
Movement I Internal rotation (not subscapularis lesion) • • • • • •
restrictions for J External rotation (not infraspinatus lesion) • • • • • •
AAROM and K Abduction • • • • • •
AROM: STRENGTH
L Low row (against table) • • • • • •
Flexion: 0o-90o
(week 1-5) M Flexion against wall • • • • • • •
N Extension against wall (flexed elbow) • • • • • • •
Abduction: 0o-90o
(week 1-5) Active exercise closed and open chain Wk 1 2 3 4 5 6 7 8 9 10 12
12 Downward pressure in abduction • • • • • • • • •
External rot.: 0o
(week 1-2)
13 Low row w/ Thera-Band (extension) AROM • • • • • • • • •
14 Incline plinth sliding (flexion) • • • • • • • • •
Internal rotation: 15 Sitting bilateral downward press • • • • • • • • •
no restrictions
16 High row with pulley • • • • • • • •
Repaired 17 Fitter • • • • • • • •
Level 1
tendon(s) are 18 Prone low row • • • • • • • •
protected 19 Supine scaption on sloping board • • • • • • • •
20 Supine internal rotation w/ pulley • • • • • • • •
Specify 21 Supine external rotation w/ pulley • • • • • • • •
percieved pain
22 Standing internal rotation w/ pulley • • • • • • •
on a scale from
0-10: 23 Lawn mover • • • • • • •
24 Standing external rotation w/ pulley • • • • • • •
0 equals no pain Level 2
25 Wall slide • • • • • •
10 equals the
26 Backstroke • • • • • •
worst imaginable
27 Standing arm elevation in scapular plane • • • • • •
Pain below 5 is 28 Standing shoulder flexion • • • • • •
permitted during 29 Sidelying external rotation • • • • • •
exercise therapy.
30 Sidelying shoulder flexion • • • • • •
Pain should drop to 31 Prone drop/ grab ball Level 3 • •
below 2 after 32 Prone external rotation w. 90 deg. elevation • •
exercise therapy. 33 Standing protraction w/ pulley (throwing) • •
34 Standing retraction w/ pulley (throwing) • •
By Birgitte Hougs Kjær, Copenhagen University Hospital Bispebjerg Frederiksberg 2017
 Rehabilitation program
after rotator cuff surgery
Usual care

NOTES In the clinic

Part 1: Tendon protection Wk 1 2 3 4 5 6 7 8 9 10 12
A Active elbow extension (supine/ standing) • • • • •
Sling week 1-2 B Vein pump (spread/collect fingers) • • • • •
postop: Exercises
C Rotate forearm (supination/ pronation) • • • • •
Shoulder in sling
immobilized in D Lift sternum (retraction of shoulders) • • • • •
standard fixed E Head lateral flexion • • • • •
sling F Cervical flexion • • • • •
Sling week 3-5
postop: Part 2:
Shoulder
immobilized in Passive range of motion (by PT) Wk 1 2 3 4 5 6 7 8 9 10 12
standard sling 1 Flexion • • • • •
2 Abduction • • • • •
3 Supine external rotation w. 20-60 deg. abd. • • • • • PROM
4 When needed manual guiding of scapula • • • • •
5 When needed manual therapy • • • • •

Assisted active range of motion Wk 1 2 3 4 5 6 7 8 9 10 12

6 Reach the foot (flexion) • • • • • •
Repetitions: 7 Wash the table (flexion on table) • • • • •
8 Supine bench press w/ broomstick AAROM • • • • • •
3 sets of 10 9 Flexion/ scaption w/ jump rope • • • • • •
repetitions
10 Abduction w/ broomstick • • • • • •
11 Supine external rotation w/ broomstick • • • • • •

Active exercise closed and open chain Wk 1 2 3 4 5 6 7 8 9 10 12

12 Downward pressure in abduction • • • • • •
13 Low row w/ Thera-Band (extension) • • • • • •
AROM
14 Incline plinth sliding (flexion) • • • • • •
15 Sitting bilateral downward press • • • • • •
Movement 16 High row with pulley • • • • •
restrictions: 17 Fitter Level 1 • • • • •
18 Prone low row • • • • •
No active
movement within
19 Supine scaption on sloping board • • • • •
the first 5 weeks 20 Supine internal rotation w/ pulley • • • • •
postop. 21 Supine external rotation w/ pulley • • • • •

22 Standing internal rotation w/ pulley • • • • •

Specify percieved 23 Lawn mover • • • • •
pain on a scale
24 Standing external rotation w/ pulley • • • • •
from 0-10:
25 Wall slide • • • • •
0 equals no pain 10 26 Backstroke Level 2 • • • • •
equals the worst
imaginable 27 Standing arm elevation in scapular plane • • • • •
Pain below 5 is 28 Standing shoulder flexion • • • • •
permitted during
exercise therapy. 29 Sidelying external rotation • • • • •
Pain should drop to 30 Sidelying shoulder flexion • • • • •
below 2 after 31 Prone drop/ grab ball • •
exercise therapy. Level 3
32 Prone external rotation w. 90 deg. elevation • •
33 Standing protraction w/ pulley (throwing) • •
34 Standing retraction w/ pulley (throwing) • •

By Birgitte Hougs Kjær, Copenhagen University Hospital Bispebjerg Frederiksberg 2017

 Rehabilitation program
after rotator cuff surgery
Progressive

At home
NOTES

Part 1: Tendon protection Wk 1 2 3 4 5 6 7 8 9 10 12

Sling week 1-2 A Active elbow extension (supine/ standing) • • • • •
postop: B Vein pump (spread/collect fingers) • • • • •
Shoulder Exercises
immobilized in C Rotate forearm (supination/ pronation) • • • • •
in sling
standard fixed D Lift sternum (retraction of shoulders) • • • • •
sling E Head lateral flexion • • • • •
F Cervical flexion • • • • •
Sling week 3-5
postop:
Shoulder
immobilized in
standard sling

Repetitions:
3 sets of 10 Part 2:
repetitions Assisted active range of motion Wk 1 2 3 4 5 6 7 8 9 10 12
6 Reach the foot (flexion) • • • •
Frequency:
Range of motion
7 Wash the table (flexion on table) ASSISTED • • • • •
exercises is 8 Supine bench press w/ broomstick ACTIVE • • • • • •
performed daily. 10 Abduction w/ broomstick • • • • • •
11 Supine external rotation w/ broomstick • • • • • •
Strength exercises
is performed on Performed without sling
the days without
PT training.

From week 6
both closed and
open chain Isometric hold Wk 1 2 3 4 5 6 7 8 9 10 12
exercises are M Flexion against wall • • • • •
performed. N Extension against wall (flexed elbow) • • • • •
I Internal rotation (not subscapularis lesion) • • • • •
Specify J External rotation (not infraspinatus lesion) • • • • •
percieved pain K Abduction STRENGTH • • • •
on a scale from
Performed without sling
0-10:

0 equals no pain
10 equals the
worst imaginable

Pain below 5 is Active range of motion Wk 1 2 3 4 5 6 7 8 9 10 12

permitted during 13 Low row w/ Thera-Band (extension) • • • • • •
exercise therapy.
18 Prone low row • • • • • •
ACTIVE
Pain should drop to 35 Supine external rotation (hand to neck) • • • • • •
below 2 after 36 Supine internal rotation (hand to lower back) • • • • • •
exercise therapy.

By Birgitte Hougs Kjær, Copenhagen University Hospital Bispebjerg Frederiksberg 2017

 Rehabilitation program
after rotator cuff surgery
Usual care

At home
NOTES

Part 1: Tendon protection Wk 1 2 3 4 5 6 7 8 9 10 12

Sling week 1-2 A Active elbow extension (supine/ standing) • • • • •
postop: B Vein pump (spread/collect fingers) • • • • •
Shoulder C Rotate forearm (supination/ pronation) • • • • • Exercises
immobilized in in sling
D Lift sternum (retraction of shoulders) • • • • •
standard fixed
sling E Head lateral flexion • • • • •
F Cervical flexion • • • • •
Sling week 3-5
postop:
Shoulder
immobilized in
standard sling

Repetitions: Part 2:
3 sets of 10 Assisted active range of motion Wk 1 2 3 4 5 6 7 8 9 10 12
repetitions
6 Reach the foot (flexion) • • • • • •
Frequency: 7 Wash the table (flexion on table) ASSISTED • • • • •
Range of motion 8 Supine bench press w/ broomstick ACTIVE • • • • • •
exercises is 10 Abduction w/ broomstick • • • • • •
performed daily.
11 Supine external rotation w/ broomstick • • • • • •
Strength exercises
is performed on the
days without PT
training.

From week 6
both closed and Active range of motion Wk 1 2 3 4 5 6 7 8 9 10 12
open chain 13 Low row w/ Thera-Band (extension) • • • • • •
exercises are 18 Prone low row • • • • • •
performed. ACTIVE
35 Supine external rotation (hand to neck) • • • • • •
36 Supine internal rotation (hand to lower back) • • • • • •
Specify
percieved pain
on a scale from
0-10:

0 equals no pain
10 equals the
worst imaginable

Pain below 5 is
permitted during
exercise therapy.

Pain should drop to

below 2 after
exercise therapy.

By Birgitte Hougs Kjær, Copenhagen University Hospital Bispebjerg Frederiksberg 2017