 
 
Rehabilitation Protocol for Rotator Cuff Repair-Small to Medium 
Sized Tears 
 
This protocol is intended to guide clinicians through the post-operative course for rotator cuff repair-small to medium 
tears. This protocol is time based (dependent on tissue healing) as well as criterion based. Specific intervention should 
be based on the needs of the individual and should consider exam findings and clinical decision making. The timeframes 
for expected outcomes contained within this guideline may vary based on surgeon’s preference, additional procedures 
performed, and/or complications. If a clinician requires assistance in the progression of a post-operative patient, they 
should consult with the referring surgeon. 
The interventions included within this protocol are not intended to be an inclusive list of exercises. Therapeutic 
interventions should be included and modified based on the progress of the patient and under the discretion of the 
clinician.  
Considerations for the Post-operative Rotator Cuff Repair Rehabilitation Program 
Many different factors influence the post-operative rotator cuff repair rehabilitation outcome, including rotator cuff tear 
size, type of repair, tissue quality, number of tendons involved, and individual patient factors like age and co-morbidities 
including increased BMI and diabetes. Consider taking a more conservative approach for more complex tears, including 
large/massive tears (>3 cm) and >1 tendon involvement.  
 
Post-operative Complications 
If you develop a fever, unresolving numbness/tingling, excessive drainage from the incision, uncontrolled pain or any 
other symptoms you have concerns about you should contact the referring physician.  
 
PHASE I: IMMEDIATE POST-OP (0-3 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Protect surgical repair 
• Reduce swelling, minimize pain 
• Maintain UE ROM in elbow, hand and wrist 
• Gradually increase shoulder PROM 
• Minimize muscle inhibition 
• Patient education 
Sling 
• Neutral rotation 
• Use of abduction pillow in 30-45 degrees abduction 
• Use at night while sleeping 
Precautions 
• No shoulder AROM/AAROM 
• No lifting of objects 
• No supporting of body weight with hands 
• Avoid scapular retraction with a teres minor repair 
Interventions 
Swelling Management 
• Ice, compression 
 
Range of motion/Mobility 
• PROM: ER<20 scapular plane, Forward elevation <90, seated GH flexion table slide, horizontal table 
slide 
• AROM: elbow, hand, wrist (PROM elbow flexion with concomitant biceps tenodesis/tenotomy) 
• AAROM: none 
 
Strengthening (Week 2) 
 
 
• Periscapular: scap retraction*, prone scapular retraction*, standing scapular setting, supported 
scapular setting, inferior glide, low row 
- *avoid with subscapularis repair and teres minor repair 
• Ball squeeze 
Criteria to 
Progress 
• 90 degrees shoulder PROM forward elevation 
• 20 degrees of shoulder PROM ER in the scapular plane 
• 0 degrees of shoulder PROM IR in the scapular plane 
• Palpable muscle contraction felt in scapular and shoulder musculature 
• No complications with Phase I 
 
 
PHASE II: INTERMEDIATE POST-OP (4-6 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Continue to protect surgical repair 
• Reduce swelling, minimize pain 
• Maintain shoulder PROM 
• Minimize substitution patterns with AAROM 
• Patient education 
Sling 
• Neutral rotation 
• Use of abduction pillow in 30-45 degrees abduction 
• Use at night while sleeping 
Precautions 
• No lifting of objects 
• No supporting of body weight with hands 
Interventions 
*Continue with 
Phase I 
interventions 
 
Range of motion/Mobility 
• PROM: ER<20 scapular plane, Forward elevation <90 
• AAROM: Active assistive shoulder flexion, shoulder flexion with cane, cane external rotation stretch, 
washcloth press, sidelying elevation to 90 degrees 
 
Strengthening 
• Periscapular: Row on physioball, shoulder extension on physioball 
Criteria to 
Progress 
• 90 degrees shoulder PROM forward elevation 
• 20 degrees shoulder PROM ER in scapular plane 
• 0 degrees of shoulder PROM IR in the scapular plane 
• Minimal substitution patterns with AAROM 
• Pain < 4/10 
• No complications with Phase II 
 
PHASE III: INTERMEDIATE POST-OP CONTINUED (7-8 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Do not overstress healing tissue 
• Reduce swelling, minimize pain 
• Gradually increase shoulder PROM/AAROM 
• Initiate shoulder AROM 
• Improve scapular muscle activation 
• Patient education 
Sling 
• Discontinue  
Precautions 
• No lifting of heavy objects (>10 lbs) 
Interventions 
*Continue with 
Phase I-II 
interventions 
Range of motion/Mobility 
• PROM: ER<30 scapular plane, Forward elevation <120 
• AAROM: seated shoulder elevation with cane, seated incline table slides, ball roll on wall 
• AROM: elevation < 120, supine flexion, salutes, supine punch, wall climbs 
 
Strengthening 
• Periscapular**: Resistance band shoulder extension, resistance band seated rows, rowing, lawn 
mowers, robbery, serratus punches 
• **Initiate scapular retraction/depression/protraction with subscapularis and teres minor repair 
• Elbow: Biceps curl, resistance band bicep curls and triceps 
 
 
Criteria to 
Progress 
• 120 degrees shoulder PROM forward elevation 
• 30 degrees shoulder PROM ER and IR in scapular plane 
• Minimal substitution patterns with AROM 
• Pain < 4/10 
 
PHASE IV: TRANSITIONAL POST-OP (9-10 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Do not overstress healing tissue 
• Gradually increase shoulder PROM/AAROM/AROM 
• Improve dynamic shoulder stability 
• Progress periscapular strength 
• Gradually return to full functional activities 
Precautions 
• No lifting of heavy objects (> 10 lbs) 
Interventions 
*Continue with 
Phase II-III 
interventions 
Range of motion/mobility 
• PROM: ER<45 scapular plane, Forward elevation <155, ER @ 90 ABD < 60 
• AROM: supine forward elevation with elastic resistance to 90 deg, scaption and shoulder flexion to 
90  degrees elevation 
 
Strengthening 
• Periscapular: Push-up plus on knees, prone shoulder extension Is, resistance band forward punch, 
forward punch, tripod, pointer 
Criteria to 
Progress 
• 155 degrees shoulder PROM forward elevation 
• 45 degrees shoulder PROM ER and IR in scapular plane 
• 60 degrees shoulder PROM ER @ 90 ABD 
• 120 degrees shoulder AROM elevation 
• Minimal to no substitution patterns with shoulder AROM 
• Performs all exercises demonstrating symmetric scapular mechanics 
• Pain < 2/10 
 
PHASE V: TRANSITIONAL POST-OP CONTINUED  (11-12 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Restore full PROM and AROM 
• Enhance functional use of upper extremity 
Interventions 
*Continue with 
Phase II-IV 
interventions 
Range of motion/mobility 
• PROM: Full 
• AROM: Full 
 
Stretching 
• External rotation (90 degrees abduction), Hands behind head, IR behind back with towel, sidelying 
horizontal ADD, sleeper stretch, triceps and lats, doorjam series 
Criteria to 
Progress 
• Full pain-free PROM and AROM 
• Minimal to no substitution patterns with shoulder AROM 
• Performs all exercises demonstrating symmetric scapular mechanics 
• Pain < 2/10 
 
PHASE VI: STRENGTHENING POST-OP (13-16 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Maintain pain-free ROM 
• Initiate RTC strengthening (with clearance from MD) 
• Initiate motor control exercise 
• Enhance functional use of upper extremity 
 
 
Interventions 
*Continue with 
Phase II-V 
interventions 
Strengthening 
• Rotator cuff: internal external rotation isometrics, side-lying external rotation,  
Standing external rotation w/ resistance band, standing internal rotation w/ resistance band, 
internal  rotation, external rotation, sidelying ABD
standing ABD 
• Periscapular: T and Y, “T” exercise, push-up plus knees extended, wall push up, “W” exercise, 
resistance band Ws, dynamic hug, resistance band dynamic hug 
• Biceps curl (begin with concomitant biceps tenodesis/tenotomy) 
 
Motor Control 
• Internal and external rotation in scaption and Flex 90-125 (rhythmic stabilization)  
• IR/ER and Flex 90-125 (rhythmic stabilization)  
• Quadruped alternating isometrics and ball stabilization on wall  
• PNF – D1 diagonal lifts, PNF – D2 diagonal lifts  
• Field goals  
Criteria to 
Progress 
• Clearance from MD and ALL milestone criteria below have been met 
• Full pain-free PROM and AROM 
• ER/IR strength minimum 85% of the uninvolved arm 
• ER/IR ratio 60% or higher 
• Negative impingement and instability signs 
• Performs all exercises demonstrating symmetric scapular mechanics 
• QuickDASH/PENN 
 
PHASE VII: EARLY RETURN-TO-SPORT (4-6 MONTHS AFTER SURGERY) 
Rehabilitation 
Goals 
• Maintain pain-free ROM 
• Continue strengthening and motor control exercises 
• Enhance functional use of upper extremity 
• Gradual return to strenuous work/sport activity 
Interventions 
*Continue with 
Phase II-VI 
interventions 
Strengthening 
• Rotator cuff: External rotation at 90 degrees, internal rotation at 90 degrees, resistance band 
standing external rotation at 90 degrees, resistance band standing internal rotation at 90 degrees 
 
Motor control 
• Resistance band PNF pattern, PNF – D1 diagonal lifts w/ resistance, diagonal-up, diagonal-down  
Wall slides w/ resistance band  
• See specific return-to-sport/throwing program (coordinate with physician) 
Criteria to 
Progress 
• Last stage-no additional criteria 
Return-to-Sport 
• For the recreational or competitive athlete, return-to-sport decision making should be individualized 
and based upon factors including level of demand on the upper extremity, contact vs non-contact 
sport, frequency of participation, etc. We encourage close discussion with the referring surgeon prior 
to advancing to a return-to-sport rehabilitation program. 
Revised 6/2020 
 
Contact 
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
References: 
 
1. 
American Academy of Orthopaedic Surgeons. Management of Rotator Cuff Injuries Clinical Practice Guideline. 
https://www.aaos.org/rotatorcuffinjuriescpg Published March 11, 2019 
2. 
Chang KV, Hung CY, Han DS, et al: Early versus delayed passive range of motion exercise for arthroscopic rotator cuff repair: A meta-analysis of 
randomized controlled trials. Am J Sports Med 2014. [Epub ahead of publication]  
3. 
Cuff, D.J., Pupello, D.R. Prospective randomized study of arthroscopic rotator cuff repair using an early versus delayed postoperative physical 
therapy protocol. Journal of Shoulder and Elbow Surgery. 2012. p. 1-6. 
 
4. 
Edwards PK, Ebert JR, et al. A systematic review of electromyography studies in normal shoulders to inform postoperative rehabilitation following 
rotator cuff repair. JOSPT. 2017. 47 (12): 931-944. 
 
5. 
Ghodadra NS, Provencher MT, et al. Open, Mini-open, and All-Arthroscopic Rotator Cuff Repair Surgery: Indications and Implications for 
Rehabilitation. JOSPT 2009; 39 (2): 81-89. 
6. 
Kibler, W.B., Sciascia, A. D., Uhl, T. L., et al. Electromyographic analysis of specific exercises for scapular control in early phases of shoulder 
rehabilitation. The American Journal of Sports Medicine. 2008. 36(9): p. 1789-1798. 
 
7. 
Lee, B.G., Cho, N.S., Rhee, Y.G. Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: 
aggressive versus limited early passive exercises. The Journal of Arthroscopic and Related Surgery. 2012. 28(1): p. 34-42. 
 
8. 
Long Chen, Kun Peng, Dagang Zhang, Jing Peng, Fei Xing, Zhou Xiang. Rehabilitation protocol after arthroscopic rotator cuff repair: early versus 
delayed motion. Int J Clin Exp Med 2015;8(6):8329-8338  
9. 
Thigpen CA, Shaffer MA, et al. The American Society of Shoulder and Elbow Therapists’ consensus statement on rehabilitation following 
arthroscopic rotator cuff repair. J Shoulder Elbow Surg. 2016. 25, p 521-535. 
10. Van der Meijden, O.A., Westgard, P., Chandler, Z., et al. Rehabilitation after arthroscopic rotator cuff repair: current concepts review and evidence-
based guidelines. International Journal of Sports Physical Therapy. 2012. 7(2): p. 197-218. 
 
