Rehabilitation After Rotator Cuff Tear Surgery

Stage 1: Rest – weeks 0–4 | arm in a sling

Goals of this stage

• Protecting the integrity of the surgical repair
• Reducing pain and inflammation
• Keeping the ability to perform activities of daily living (ADL)

Exercises – 3 times a day

• Pendulum movements – standing, bent forward 90°. The arm hangs and swings gently forwards and backwards and in circles.
• Wrist and finger movement (AROM) – 3 times a day
• Biceps activation – bending the elbow without any resistance
• Isometric activation of the scapular (shoulder blade) and neck muscles
• Cold compresses – as much as possible in the first days; after that, after each exercise session or as needed

Precautions – mandatory

• Pendulum movements only! – no active movements (AROM) of the shoulder
• Do not lift objects with the operated arm
• No stretching or sudden movements
• Do not lean or put weight on the operated arm
• Removing the sling is allowed only for exercises, and at rest as comfortable

Stage 2: Passive movement (PROM) – weeks 5–10 | sling removed

Second clinic review: 3 months after surgery

Passive range-of-motion (PROM) goals

• Forward flexion – up to 140°
• Abduction – up to 90°
• External rotation – up to 50°
• Internal rotation – hand behind the back

How to do it

• Start lying down, with AAROM (active-assisted movement)
• Use local heat before exercising and cold afterwards
• Progress gradually, according to how it feels and the level of pain

Precautions

• Passive movements only – do not force the range of motion
• Do not move on to the active stage if a reasonable passive range of motion has not been reached
• If the active range has not been reached – continue stretching exercises until the goals are reached

Stage 3: Active movement (AROM) – weeks 11–18 | from AAROM to full AROM

Third clinic review: 5 months after surgery

Goals of this stage

• Allow the soft tissues to heal while avoiding excess tension on the repair
• Reach a full active range (AROM)
• Reduce pain and inflammation

How to do it

• At first: AAROM only (active-assisted movement) – taught lying down
• As movement improves – you can move on to full AROM
• Goal: reach an active range similar to the passive range achieved
• Until 3 months after surgery – do not work into significant pain; after that, mild pain is allowed

Precautions

• Active movements with mild pain only
• Start active-assisted and progress gradually
• No sudden movements
• Do not lean or put weight on the operated arm
• Do not progress to the strengthening stage before reaching as full an active range as possible

Stage 4: Early strengthening – weeks 19–25 | bands and movements against gravity

Goals of this stage

• Maintaining the full range of motion achieved
• Gradually restoring strength in the shoulder muscles
• Gradually returning to daily activity

Exercises

• Elastic bands (Theraband) and strengthening aids – as instructed by the physiotherapist
• Abduction with the thumb pointing up – external rotation of the arm while lifting (protects the cuff mechanism)
• Lying on the stomach: abduction and extension of the shoulder
• Elbow activation – bending and straightening
• Activities of daily living (ADL) as able

Precautions

• Only once an active range similar to the passive range has been reached may you progress to strengthening
• Increase the intensity of the exercises gradually

Stage 5: Advanced strengthening – weeks 25–30 | return to activity

Goals of this stage

• Gradual return to full activity

Exercises

• If a full range of motion has not been reached – complete it at this stage
• Strengthening the shoulder muscles – with gradually increasing resistance
• Proprioceptive training – balance training and joint position sense
• Return to gentle sporting activity → gradually back to full activity

Precautions

• Do not lift more than 3 kg
• No sudden lifting or sudden movements
• Do not lift objects above head height without approval