SMALL: partial tear 1-2 anchors used (<1 cm)
MEDIUM: Complete tear of SS tendon/or 2 tendons torn (2-3 cm)
At this stage the most important goals are that of patient education and gentle
ROM with respect to the healing properties of the tissue. Focus on positioning
and postures that place the least amount of stress on the tissue.
Sling: To be worn for 4-6 weeks with removal allowed for person hygiene
and typing at a computer. It may be beneficial to use a pillow for support while
sleeping once the sling is removed. When your sling is off your elbow should remain by your side.
Ice: 2-3 times daily for 15 minutes to decrease the inflammation and
help to control pain.
PHYSICAL THERAPY: Start physical therapy 1x week for 6 weeks at 10 days
post-op. At six weeks post- op physical therapy may increase to 2x week for 10-14
REMEMBER that these guidelines may be modified depending on the size
and location of tear along with the integrity of the tissue.
1. Small Pendulums/Tummy Rubs
2. Elbow and wrist AROM
3. Posture awareness
Week Two-Four Weeks
1. Supine PROM flexion and ER in the scapular plane
2. Standing Saws
3. Scapular exercises: Retraction, PNF patterns
4. Active ER at side to 45 degrees
1. Add AAROM (wand) in supine for small tears. Progress to standing. No IR
2. 4 point weight bearing for scapular neuromuscular facilitation
3. Bent over rows
4. Joint mobilizations to OR and AC joints
5. Initiate submaximal isometrics and RS/AI at side.
6. 4 point ball streteches
7. Active ER with arm at side as tolerated
Patient should have achieved 75-100% of PROM in Flex, Abd, and ER at the end
of this phase.
The focus at this stage is to increase ROM, promote normal scapulohumeral mechanics,
and facilitate strengthening of the Rotator Cuff Musculature
1. Progress to full PROM except IR. PROM of ER in 90/90. If is a small tear
HADD and post capsule stretch.
2. Progress to side-lying ER
3. Initiate scaption. Use pillows on table if needed to facilitate proper scapular
4. Overhead pulleys for Flex, add Abd at 8 weeks
5. Progress weight bearing RS/AI to 3 point/2point positions
6. Progress bent over rows and add horizontal abduction
7. Facilitation of Scapular control during exercises
8. Gentle MRE if tolerable
9. Rowing on pulley system with low weights
10. Advance RS/AI positions
11. UBE retro for scapula and warm up of shoulder
12. Slideboard for stretches
Patient should be able to perform scaption without shoulder shrug to 45 degrees
at the end of this phase.
The focus at this stage is to achieve end range of passive motion, and further
progress rotator cuff and scapular muscle strength
1. Initiate IR stretch behind back and on pulleys
2. Add HADD /post capsule stretch for Medium tears
3. End range PROM stretches (wall stretches, prayer, ball stretches)
4. Wall push ups/push ups plus
5. Lower trapezius work in modified positions toward the end of the 12 weeks
6. Progress ER to prone with 90 degrees of Abd and standing with 45 degrees abd
7. Bodyblade below 45 degrees: start at side in flexion and progress to scapular
plane then full flexion and abduction
8. Add flexion isotonics and progress above 90 when tolerable
9. Advance push ups to table level then continue toward the floor as tolerated
10. Beginning chest pass with light medicine balls at end of phase
11. Continue to progress CKC exercises with various devices in weight bearing:
Wobble boards, discs, air ex pads etc
11. Modified seated press ups progressing to full position
12. PNF patterns with weights, pulleys, MREs etc.
The patient should have full PROM, AROM at least 75%, and be able to perform
scaption past 90 degrees at the end of this phase.
The focus at this stage is to prepare for return to occupation, sport or desired
1. Work or sport specific exercises
2. Advanpe plyometrics with Medicine Balls and assisted equipment
3. Work hardening
4. Gradual return to sport or desired activity
Even though the individual may be feeling good and want to return to his/her
activity, remember that the tissue continues to mature and it may take a whole
year for that process to occur. The majority will return to their activity at
6-9 months depending upon the size of the repair and response to treatment.