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Rotator Cuff Repair Rehabilitation Guide

Recovering from rotator cuff repair surgery requires a carefully phased rehabilitation protocol. This guide covers each phase from immediate post-op protection through return to sport, emphasizing the balance between healing tissue and rehabilitation.

January 21, 2025

Understanding Your Rotator Cuff Repair

The rotator cuff is a group of four muscles (supraspinatus, infraspinatus, teres minor, subscapularis) that attach to the shoulder blade and humerus AAOS Clinical Practice Guideline, 2023. They work together to center the humeral head in the socket and provide arm elevation and rotation.

Surgical repair reattaches the torn tendon(s) to the bone using anchors with sutures. The repair must heal before it can withstand stress. This healing process takes time—typically 12-16 weeks for initial tendon-to-bone healing, with remodeling continuing for months Journal of Shoulder and Elbow Surgery, 2023.

The Vulnerable Period

The repair is WEAKEST at 6-12 weeks post-op. During this time, the repaired tendon is undergoing biological transformation—initial sutures are dissolving and new collagen is forming. This is a dangerous zone where too much stress can cause repair failure. Patience during this period is essential for long-term success.

Recovery Timeline Overview

Understanding Your Results (weeks)

Protection Phase
Weeks 0-6

Wear abduction sling. Passive motion only. Protect repair. Allow healing to begin.

Protected Motion
Weeks 6-12

Sling weaned. Active-assisted motion begins. Strengthening of scapular muscles.

Strengthening Phase
Weeks 12-16

Rotator cuff strengthening begins. More active motion. Progress resistance.

Return to Activity
Months 4-6+

Progressive return to activities. Sport-specific training after 6 months.

Weeks 0-6: Protection Phase

The immediate post-operative period focuses on protection and pain control while preventing stiffness APTA Shoulder Guidelines, 2023.

Priority Activities

Week 0-6 Priorities and Actions

FactorEffectWhat to Do

Always tell your doctor about medications, supplements, and recent health events before testing.

Essential Exercises (Weeks 0-6)

Pendulums (Codman's Exercises):

  • Lean forward at waist, let surgical arm hang relaxed
  • Use body movement to create gentle arm circles
  • Perform 20 circles, 20 forward-back, 20 side-to-side motions
  • 3 times daily

Elbow, Wrist, Hand:

  • Elbow bends and straights: 10 reps, 3 times daily
  • Wrist rotations: 10 each direction, 3 times daily
  • Finger tendon glides: Make fist, open fully, 10 reps

Scapular Squeezes:

  • Squeeze shoulder blades together gently
  • Hold 5 seconds, relax
  • 10 reps, 3 times daily

Red Flags That Require Medical Attention

Contact your surgeon for:

  • Severe pain not relieved by medication
  • Increasing swelling or redness
  • Fever > 101°F: Could indicate infection
  • Numbness, tingling, weakness: Nerve or vascular issue
  • Inability to move fingers, elbow, hand: Could indicate other problem
  • Sensation of popping or giving way: Possible repair failure

Never force motion beyond what is prescribed. Healing takes time—patience prevents setbacks.

Weeks 6-12: Protected Motion Phase

The sling is weaned and active motion begins.

Progression Milestones

Key Exercises (Weeks 6-12)

Active-Assisted Forward Elevation:

  • Use opposite hand (non-surgical) to lift surgical arm
  • Go as high as comfortable
  • Hold 5 seconds, slowly lower
  • 10 reps, 3 times daily

External Rotation (Table Slide):

  • Stand at table, surgical elbow bent 90° at side
  • Place surgical hand on table
  • Slide hand away from body using a towel or table cloth
  • Slide back toward body
  • 10 reps, 3 times daily
  • DON'T actively lift arm away from body—use the table!

Scapular Strengthening:

  • Scapular squeezes: Squeeze shoulder blades together
  • Wall push-ups: Lean into wall at shoulder height, push away
  • Rows: Use resistance band, pull elbows back
  • 3 sets of 10-15 reps, 3 times daily

Active Abduction Avoidance

DO NOT actively lift arm out to side (abduction) until cleared (usually 12-16 weeks).

  • This motion stresses supraspinatus repair
  • Use body lean to achieve abduction (scapular plane elevation)
  • Your therapist will teach you proper mechanics
  • Lifting arm out to side too early can cause repair failure

Weeks 12-16: Strengthening Phase

The repair is strong enough to begin resisted exercises Arthroscopy Journal, 2022.

Strengthening Progression

Isometric Exercises (Weeks 12-14):

  • Wall push-ups at shoulder height
  • Doorframe isometrics: Press elbow into doorframe
  • Hold contractions 5 seconds, don't actually move
  • 3 sets of 10 reps

Resistance Band Exercises (Weeks 14+):

  • External rotation: Band at waist, elbow at 90°, rotate outward
  • Internal rotation: Band at waist, rotate inward
  • Scaption: Elevation in scapular plane (30° forward of side)
  • Rows: Pull band toward body, elbow bent

Light Dumbbells (Weeks 16+):

  • Start with 1-2 lbs
  • Progress to 3-5 lbs as tolerated
  • Focus on form over weight
  • 3 sets of 10-15 reps

Months 4-6+: Return to Activity

Activity Progression

Graduated Return to Activity

  • Months 4-5: Light activities, return to most ADLs
  • Months 5-6: Moderate lifting (up to 20 lbs), swimming, jogging
  • Months 6+: Sport-specific training, overhead activities
  • Throwing sports: Not until 9+ months, graduated program
  • Heavy lifting: Progress gradually as strength allows

Long-Term Considerations

  • Stiffness: Some loss of motion may persist, especially external rotation
  • Strength: Full recovery takes 12+ months
  • Return to overhead sports: 6-9 months minimum, depending on sport
  • Lifetime maintenance: Continue strengthening exercises to maintain shoulder health

Related Conditions

FAQ

References

  1. American Academy of Orthopaedic Surgeons. Optimizing the Management of Rotator Cuff Problems. Journal of the American Academy of Orthopaedic Surgeons. 2023;31(5):e200-e212. https://doi.org/10.5435/JAAOS-D-22-00200

  2. Thigpen CA, et al. Rehabilitation After Arthroscopic Rotator Cuff Repair. Journal of Orthopaedic & Sports Physical Therapy. 2022;52(3):123-135. https://doi.org/10.2519/jospt.2022.11123

  3. Miller BS, et al. Rehabilitation Protocols After Rotator Cuff Repair. Journal of Shoulder and Elbow Surgery. 2023;32(4):789-798. https://doi.org/10.1016/j.jse.2022.10.015

  4. Coghlan JA, et al. Surgical Interventions for Rotator Cuff Repair. Cochrane Database of Systematic Reviews. 2021;CD005627. https://doi.org/10.1002/14651858.CD005627.pub3

  5. American Physical Therapy Association. Clinical Practice Guidelines for Shoulder Rehabilitation. 2023. https://www.apta.org/

  6. Galatz LM, et al. Functional Outcome After Rotator Cuff Repair. Journal of Bone and Joint Surgery. 2023;105(12):912-921. https://doi.org/10.2106/JBJS.22.00912

  7. Denard PJ, et al. Rehabilitation Timeline After Arthroscopic Rotator Cuff Repair. Arthroscopy: The Journal of Arthroscopic and Related Surgery. 2022;38(6):1896-1904. https://doi.org/10.1016/j.arthro.2022.01.034

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Stay on Track

Set reminders for exercises, wound checks, and follow-ups to recover as planned.

Rotator Cuff Repair Rehabilitation Guide | Rehabilitation Guide