LARGE: one and one-half tendons torn (SS and IS)
MASSIVE: All three tendons torn
Note: Subscapularis may be involved with Massive tear. If it is, limit ER


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 at all times for 6 weeks with removal allowed for personal hygiene and computer work. Sling use will be discontinued at the discretion of the physician only. 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 the pain.

Physical Therapy: Start therapy 10 days post-op and schedule Ix week for the next 4 weeks. At 6 weeks post-op, schedule 2x week for 10 more weeks. Your therapist may decide to alter the weekly visits in the program depending upon your progress at that
phase of the rehab.

Remember that all of these guidelines maybe modified depending upon the size and location of the tears along with the integrity of the tissue. Avoid irritating the repair with aggressive stretching at this phase.

Week One

1. Small Pendulums/Tummy Rubs
2. Elbow and Wrist AROM
3. Ball squeezes in the hand
4. Posture Awareness

Week Two-Four

1. Supine PROM and ER in the scapular plane
2. Standing small saws
3. Scapular retraction
4. Active Assistive ER at side with wand
5. Gentle Grade I/II mobilizations to GH joint
6. Scapular mobilizations in S/L

Week four-Six

1. Bent over rows to neutral
2. 4 point weightbearitig for proprioception
The goal at the end of this phase is to have 50% of full PROM in Flex, ABD and ER 50%.


The focus at this stage is to increase PROM, initiate AAROM, facilitate normal scapulohumeral mechanics and begin RC strengthening.

Week Six-Eight

1. Begin Wand exercises for Flex/Abd/ER in supine.
2. Progress to end range PROM FlexAbd/ER as tolerated.
3. Progress WB exercises to 3 and 2 point positions
4. Progress bent over rows
5. Add submaximal isometrics for Flex/Abd, Ext
6. Continue with GH mores and add AC joint distraction
7. Submaximal RS/AI
8. Ball stretches for Flex/Abd

The goal at the end of this phase-is to have 7.5% of.full PROM


The focus at this stage is to achieve full PROM and 50% of AROM and further progress rotator cuff and parascapular strengthening.

Week Eight-Twelve

1. Add pulleys for flexion, progress to Abductipn then IR last
2. Add posterior capsule stretching and HADD
3. Scaption and S/L ER.
4. RS/AI for shoulder in progressed positions and speeds
5. UBE retro
6. Add HABD isotonics
7. Slideboard, prayer and other weightbearing stretches for end ROM
8. Body blade below 45 degrees in flexio, scaption, and abduction if tolerated
9 . Wall push ups and push up plus

Week Twelve -Sixteen

1. Progress ER Strengthening in prone and standing at 45 degrees
2. Progress push up positions
3. Modified press-ups
4. Scaption/Flexion/HABD isotomcs
5. Body blade progressions
6. CKC exercises on wobble board, air disc, etc.
7. Advance RS/AI positions
8. If patient can tolerate position, add lower trapezius work

The goal of this phase is full PROM and 85-100% of available AROM depending upon tear.


The focus at this stage is to prepare the patient for return to work, sport or desired activities. With a large/massive tear this stage usually begins around six months post-op.

1. Work or sport specific exercises
2. Advance plyometrics with Medicine Balls and assisted equipment
3. Work Hardening
4. Gradual return to sport or desired activity

Even though the patient may feel good and want to return to hislher activity, remember that the tissue continues to mature and it may take an entire year for that process to occur. The majority ofretum to activity at 6-9 months depending upon the size of the repair and their response to treatment.