Diagnosis and Management of Partial Thickness Rotator Cuff Tears

A Comprehensive Review

Kevin D. Plancher, MD, MPH; Jaya Shanmugam, MD; Karen Briggs, MPH; Stephanie C. Petterson, MPT, PhD

Disclosures

J Am Acad Orthop Surg. 2021;29(24):1031-1043. 

In This Article

Postoperative Rehabilitation

After surgical repair, the initial phase of physical therapy should focus on protecting the repair site and pain control. Shoulder immobilization with a brace and abduction pillow for approximately 3 to 4 weeks minimizes muscle activation and strain on the repaired RC. Although some have suggested early immobilization is not necessary, others report increased retear rates with early motion.[44] Supine forward flexion to 90° and external rotation to 10° to 20° can be initiated on postoperative day one. Forward elevation greater than 30° and external rotation in the scapular plane minimize strain on the repaired tissue. Internal rotation stretching behind the back should be avoided for a limited time.

The goals of the intermediate phase of healing are to restore shoulder ROM and functional strength. Progression from active-assisted to active ROM supine forward flexion and external rotation exercises can be commenced at 4 to 6 weeks with discontinuation of the abduction pillow splint. The patient should achieve pain-free passive supine elevation to 120° by 6 weeks. Strengthening and resistance exercises can be instituted at 8 to 12 weeks. Sport-specific exercises for overheard throwers may begin at 5 to 6 months with progression through a throwing program to promote return to sports and proper mechanics. Return to sports and manual labor with the exception of professional athletes is usually permitted after 6 months.

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