What is the typical rehabilitation plan timeline after rotator cuff repair?

Rehabilitation Timeline After Rotator Cuff Repair

Follow a 24-week, milestone-driven rehabilitation protocol divided into 4 progressive phases: immobilization (0-6 weeks), passive range of motion (0-6 weeks), active motion (6-12 weeks), and strengthening/functional exercises (12-24 weeks). 1

Phase 1: Immobilization and Protection (Weeks 0-6)

Immobilization Duration:

• Use a standard sling for 4-6 weeks postoperatively 2
• The American Academy of Orthopaedic Surgeons cannot recommend for or against abduction pillows versus standard slings due to insufficient evidence 3
• Immobilization primarily serves for pain control and preventing further injury during acute healing 3

Pain Management During This Phase:

• Start scheduled acetaminophen 1000mg every 6 hours combined with an NSAID or COX-2 inhibitor 4
• Reserve opioids strictly for rescue analgesia when other methods fail 4
• Apply ice for 15-20 minutes every 2-3 hours 4

Early Motion Considerations:

• Begin passive range of motion exercises during the immobilization period 2
• For patients at high risk of stiffness, start closed-chain overhead stretches (table slides) early 5
• For standard repairs, delay overhead stretches until 6 weeks to protect repair integrity 5

Phase 2: Active Range of Motion (Weeks 6-12)

Motion Progression:

• Initiate active range of motion exercises at 4-6 weeks postoperatively 2
• The timing of when to start motion (early versus delayed) remains controversial, though no significant differences in functional outcomes or re-tear rates have been identified between approaches 6, 7
• Progress based on individual healing milestones rather than strict time-based protocols 1

Activity Milestones:

• Return to driving typically occurs between 7-12 weeks 2

Phase 3: Strengthening (Weeks 12-24)

Resistance Exercise Initiation:

• Begin resisted exercises between 7-12 weeks postoperatively 2
• The optimal timing for starting resistive exercises remains controversial and lacks high-quality evidence 6
• Progress strengthening exercises gradually based on pain tolerance and repair integrity 1

Phase 4: Functional and Sport-Specific Training (Weeks 12-24)

Advanced Rehabilitation:

• Incorporate functional and sport-specific exercises during this final phase 1
• Complete the full rehabilitation process by 24 weeks 1
• Continue advancing based on individual progress with ongoing communication between therapist and surgeon 1

Critical Customization Factors

Tear Size Considerations:

• Medium-sized tears (2 cm) and large tears (4 cm) typically follow similar timelines, though larger tears may require more conservative progression 2
• Massive rotator cuff tears may benefit from anterior deltoid-focused programs supplemented by functional rehabilitation 8

Patient-Specific Risk Factors:

• Older age is associated with higher failure rates and poorer outcomes 9
• Comorbidities (diabetes, smoking) may negatively affect healing and require more conservative progression 9
• Patients at risk for stiffness need earlier overhead stretching 5

Common Pitfalls to Avoid

Balance Between Protection and Stiffness:

• The rehabilitation process must balance tendon healing against the risk of postoperative stiffness 1
• Early aggressive rehabilitation may compromise repair integrity, while overly conservative approaches risk stiffness 7
• A gentle protocol with limits in range of motion and exercise times is safer for tendon healing without substantial risks 7

Communication Requirements:

• Close communication between surgeon, patient, and physical therapy team is essential throughout the entire 24-week recovery process 7
• Programs should be milestone-driven and individualized based on tear characteristics and patient progress 1, 5