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Rehabilitation Guidelines for Small Rotator Cuff Tears

Post-Operative Rehabilitation Guidelines for Small Rotator Cuff Tears

1-4 Weeks:

  • Sling Immobilization
  • Active ROM Elbow, Wrist and Hand
  • True Passive (ONLY) ROM Shoulder. NO ACTIVE MOTION.
  • Pendulums,
  • Supine Elevation in Scapular plane = 140 degrees
  • External Rotation to tolerance with arm at side. (emphasize ER, minimum goal 40°)
  • Scapular Stabilization exercises (sidelying)
  • Deltoid isometrics in neutral (submaximal) as ROM improves
  • No Pulley/Canes until 5 weeks post-op (these are active motions)

4-8 Weeks:

  • Discontinue abduction pillow at 4 weeks post-op
  • Discontinue sling use at 5 weeks post-op
  • Begin Active Assist ROM and advance to Active as Tolerated
  • Elevation in scapular plane and external rotation as tolerated
  • No Internal rotation or behind back until 6wks.
  • Begin Cuff Isometrics at 5 wks with arm at the side

8-12 Weeks:

  • Active Assist to Active ROM Shoulder As Tolerated
  • Elevation in scapular plane and external rotation to tolerance
  • Begin internal rotation as tolerated
  • Light stretching at end ranges
  • Cuff Isometrics with the arm at the side
  • Upper Body Ergometer

3-12 Months

  • Advance to full ROM as tolerated with passive stretching at end ranges
  • Advance strengthening as tolerated: isometrics à bands à light weights (1-5 lbs); 8-12 reps/2-3 sets per rotator cuff, deltoid, and scapular stabilizers
  • Only do strengthening 3x/week to avoid rotator cuff tendonitis
  • Begin eccentrically resisted motions, pylometrics (ex. Weighted ball toss), proprioception (es. body blade)
  • Begin sports related rehab at 4 ½ months, including advanced conditioning
  • Return to throwing at 6 months
  • Throw from pitcher’s mound at 9 months
  • Collision sports at 9 months
  • MMI is usually at 12 months post-op


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