Arthroscopic Rotator Cuff Tendon Repair Surgery: Postoperative Care and Rehabilitation

Goal and why it matters: Lying on the sound side puts the operated arm in the plane where gravity presses least on the repair. That is what makes it possible to gain range with very little effort and a great deal of control.

Stage and starting criteria: This guide places it after day 90. The reference protocol permits it from week four to six on the small-to-medium pathway, so if your written programme released it earlier, that programme takes precedence. The entry condition is the same either way: clearance for assisted motion and a pain-free supported table slide. The cap in the reference protocol is 90 degrees, no further.

Equipment and environmental safety: A flat bed and a pillow for the head, with enough room behind you that the arm meets nothing on its path. No weight in the hand.

Starting position: Lie on your left side — the sound side — with the knees slightly bent for stability. The right arm rests along your own side with the elbow nearly straight.

1. Set the pillow so the neck stays in line.
2. Lift the right arm off your side with the least possible effort and bring it towards the ceiling.
3. Stop at 90 degrees, the point where the arm is perpendicular to the trunk.
4. Pause briefly.
5. Return the arm to your side slowly and under control; do not let it drop.

Range, side, and restrictions: 90 degrees is a ceiling, not a target to be forced. If pain or compensation appears before 90 degrees, that is your ceiling, and the trunk stays still throughout.

Breathing, speed, and rhythm: Breathe out as the arm rises and control the lowering over two to three seconds.

Documented dose: The reference protocol names this movement with its 90-degree cap but gives no repetition count; the number comes from your physiotherapy programme.

Rest: Let the arm rest along your side between repetitions so its weight settles fully onto the trunk.

Signs of correct technique and expected response: The trunk stays still, the arm travels up and down in a straight path, and the shoulder does not ride towards the ear; the effort felt is mild and settles with rest.

Stop immediately if: Sharp pain, the arm suddenly dropping, pins and needles, or an increase in night pain.

Common mistakes: Rolling the trunk backwards to gain more range, going past 90 degrees, and letting the arm fall on the way down.

Easier version/regression: Halve the range or go back to the supported table slide.

Progression criteria and next stage: Reaching 90 degrees smoothly with full control of the lowering; the next stage is active elevation lying on your back, after clearance for the active phase.

Expected and adverse responses: Mild work at the side of the shoulder is expected; sharp pain, a sudden drop of the arm, or worse night pain means the range or the count was too high.

Avoid: active elevation before permission, carrying loads, weight-bearing through the hand, reaching behind the back, end-range stretching, or discontinuing the sling solely because pain has improved.

Criteria for entering month 3: Passive or assisted range is smooth within the prescribed limit, the shoulder does not hike, and symptoms are not worse the next morning.

Goal and why it matters: Lying on your back reduces the effect of gravity so the rotator cuff and deltoid can relearn active motion with less compensation.

Stage and starting criteria: This guide places it after day 90. The entry condition is still explicit clearance for active motion, a smooth assisted range, and no significant pain at rest. On the small-to-medium pathway your programme may release active motion from week seven to eight, and later after a massive repair; either way your written programme outranks this guide.

Equipment and environmental safety: Use a flat bed with enough room for both arms; do not use a weight, dowel, or unstable surface.

Starting position: Lie on your back, with the left hand on the abdomen and the right arm beside the trunk, without a dowel or weight.

1. Gently stabilize the right shoulder blade against the bed.
2. Lift the right arm toward the ceiling under its own power.
3. Stop before the shoulder hikes or pain begins.
4. Pause briefly.
5. Lower the arm slowly without letting it drop.

Range, side, and restrictions: The arm rises only to the point before pain or shrugging and the low back stays on the bed; your physiotherapist sets the range, and the quality of the lowering outranks a larger range.

Breathing, speed, and rhythm: Exhale as the arm rises, lower it more slowly, and let it relax beside the trunk between repetitions.

Documented dose: Your physiotherapist sets the range and repetitions. At first, the quality of lowering the arm matters more than a large range.

Rest: Let the arm rest beside the trunk between repetitions until the muscle fatigue clears; the exact interval comes from your physiotherapy programme.

Signs of correct technique and expected response: The left hand does not assist, and the lower back does not arch. Stop for increasing tremor, a sudden loss of control, or worsening night pain.

Stop immediately if: the arm suddenly drops, sharp pain develops, or a neurological symptom appears.

Common mistakes: Assistance from the left hand, lower-back arching, or using momentum.

Easier version/regression: Shorten the range or use the dowel for help again. Do not progress to an inclined or standing position until control is complete.

Progression criteria and next stage: Controlled lifting and lowering without compensation. Increasing trunk incline or standing exercise only after approval.

Expected and adverse responses: Mild fatigue without sharp pain that settles with rest.

Goal and why it matters: Lifting the arm slightly forward of the side practices a functional shoulder path and improves shoulder-blade control for everyday tasks.

Stage and starting criteria: This guide places it after day 90. The entry condition is still a smooth supine elevation, clearance for standing active motion, and the ability to hold the shoulder up without compensating. After a large or massive repair it usually begins around week fourteen or later, and the calendar alone is not permission to start.

Equipment and environmental safety: Use a mirror and a dry, uncluttered standing surface. Hold no weight, and stand beside a wall if your balance is limited.

Starting position: Stand in front of a mirror with the left arm by the side, the right thumb pointing upward, and no weight in either hand.

1. Set the shoulder blade gently.
2. Lift the right arm slightly forward of the side.
3. Stop before the shoulder hikes or you reach the range limit.
4. Pause briefly.
5. Lower the arm slowly.

Range, side, and restrictions: Start below shoulder height and stay within your program's limit.

Breathing, speed, and rhythm: Exhale as the arm rises, lower it more slowly, and let it relax beside the body between repetitions.

Documented dose: Your physiotherapist sets the repetitions, and no weight is added yet.

Rest: Let the arm rest at your side between repetitions and keep the shoulder away from the ear; the rest interval comes from your rehabilitation programme.

Signs of correct technique and expected response: The trunk remains still and the shoulder stays away from the ear. Stop for lower-back arching, shoulder hiking, sharp pain, or arm drop.

Stop immediately if: sharp pain, arm drop, or tingling occurs.

Common mistakes: Shoulder shrugging, lower-back arching, or turning the thumb down.

Easier version/regression: Return to the supine position or shorten the range.

Progression criteria and next stage: A smooth path below the permitted height with no next-day reaction. A larger range or resistance only after entering the strengthening phase. Progress means a smoother path, not simply lifting the hand higher.

Expected and adverse responses: Mild fatigue at the side of the shoulder without increased night pain.

Goal and why it matters: This drill retrains coordinated active motion of the arm and shoulder blade and makes the path of the hand smoother. It is not a resisted “lateral raise” or a strength exercise. The hand remains empty throughout, and movement quality matters more than forcing a target angle.

Stage and starting criteria: Begin only after you have been cleared for standing active motion, with minimal pain, appropriate shoulder-blade control, and the ability to raise the arm without hiking the shoulder. After a large or massive repair, standing active elevation may begin around week 14 or later; multi-tendon or revision repairs may follow a slower plan, and the calendar alone is not permission to start.

Equipment and environmental safety: Stand in front of a mirror on a dry surface, feet hip-width apart and trunk upright.

Starting position: Let the left arm rest at the side; the wristband marks the operated right arm. Do not hold a dumbbell, band, or any other object.

1. From neutral standing, set the shoulder blades gently without forcefully pinching them back.
2. With the thumb up or slightly forward, raise the right arm out to the side.
3. Stop at the first sign of pain or compensation and never beyond 90 degrees; the hand must not rise above shoulder height.
4. Lower the arm slowly and pause briefly in neutral.
5. Now keep the palm inward and thumb up while raising the right arm straight forward.
6. Stop at the first sign of pain or compensation and never beyond 120 degrees, then lower the arm slowly to the side.

Range, side, and restrictions: Ninety degrees to the side and 120 degrees forward are ceilings, not targets to push through.

Breathing, speed, and rhythm: Exhale as the arm rises, do not force a hold at the top, lower it under slow control, and rest the arm at the side between the two directions.

Documented dose: Take the repetition count and daily frequency from your rehabilitation plan; each repetition should remain slow and compensation-free without worsening pain or range of motion that night or the next day.

Rest: Use the rest interval specified in your rehabilitation plan.

Signs of correct technique and expected response: The trunk and neck remain relaxed, the shoulder stays away from the ear, and the hand travels in a smooth path.

Stop immediately if: Stop for sharp pain, sudden arm drop, new weakness, tingling, shoulder hiking, trunk lean, or increased night/next-day pain.

Common mistakes: Back arching, swinging the arm, turning the thumb down, or exceeding the angle ceilings are errors.

Easier version/regression: First shorten the range or return to a wall-assisted/supine exercise.

Progression criteria and next stage: Progress means reaching the permitted range more smoothly without compensation; add a weight or band only after separate clearance for strengthening.

Expected and adverse responses: Mild fatigue at the side of the shoulder and the upper arm is expected and should clear with rest. Sharp pain, new weakness, pins and needles, or worse night pain and a smaller range the next day are not expected and mean the range or the count was too high.

Goal and why it matters: Light resistance builds infraspinatus and teres minor endurance in a controlled position, helping the humeral head remain stable during activity.

Stage and starting criteria: Only after formal permission to enter the strengthening phase, with almost full pain-free active range, good shoulder-blade control, and the ability to perform unresisted external rotation without a next-day reaction.

Equipment and environmental safety: Use a very light band attached securely at elbow height.

Starting position: Place a towel between the right elbow and side, rest the left hand on the thigh, and hold the band only with the right hand.

1. Stabilize the shoulder blade gently.
2. Keep the elbow against the towel.
3. Move the right forearm outward through a short range.
4. Pause briefly without holding your breath.
5. Control the band's return slowly.

Range, side, and restrictions: The right elbow stays on the towel against your side and the forearm travels outward only through the short written range; internal rotation behind the back has no place in this exercise.

Breathing, speed, and rhythm: Exhale as you pull, control the return over two to three seconds, and relax the arm beside the trunk between sets.

Documented dose: Resistance, repetitions, and training days must be specified in the strengthening prescription. Begin with light resistance and complete form, then increase only one variable at a time.

Rest: The exact interval comes from your strengthening prescription.

Signs of correct technique and expected response: You feel gentle work at the back of the shoulder while the elbow and trunk remain still.

Stop immediately if: front-of-shoulder pain, loss of range, trunk compensation, or increased night pain occurs.

Common mistakes: A heavy band, separating the elbow, or moving quickly are errors.

Easier version/regression: Return to an isometric exercise or movement without the band.

Progression criteria and next stage: Stable form, no loss of range the next day, and no increase in night pain. With care-team permission, increase only one of resistance, range, or repetitions by a small amount.

Expected and adverse responses: Mild fatigue at the back of the shoulder that resolves with rest.

Goal and why it matters: A row strengthens the muscles between the shoulder blades. A strong blade gives the rotator cuff a base to work from; without it, raising the arm slips back into compensation and shrugging. This exercise loads the shoulder blade, not the repair itself.

Stage and starting criteria: After formal entry into the strengthening phase, with active range nearly full and pain-free. If your subscapularis or teres minor was repaired, the reference protocol starts scapular retraction exercises from this phase onward and not before.

Equipment and environmental safety: A light band and a solid anchor at chest height — not a loose handle and not a half-closed door. A chair without wheels on a non-slip floor.

Starting position: Sit upright on the chair with the feet on the floor, both elbows bent at your sides, both hands holding the band with a little tension already in it.

1. Sit tall and set the shoulder blades gently.
2. Draw the elbows back along your sides so the shoulder blades come together.
3. The elbows must not travel behind the line of the trunk.
4. Pause for a second without holding the breath.
5. Control the band's return slowly and do not let it throw the hands forward.

Range, side, and restrictions: The elbows stay in front of the line of the trunk, and the trunk stays upright and does not rock backwards. Start with the lightest band you have.

Breathing, speed, and rhythm: Breathe out as you pull and control the band's return over two to three seconds.

Documented dose: The reference protocol lists the seated band row among the periscapular exercises but gives no fixed number; the resistance, the count and the training days must be written into your strengthening-phase prescription. In any given block only one variable — resistance, count or range — rises a little, never all three together.

Rest: Rest the hands on the thighs between sets; the rest interval comes from your strengthening-phase prescription.

Signs of correct technique and expected response: You feel the work between the shoulder blades, not in the neck and not at the front of the shoulder; mild fatigue between the blades clears with rest.

Stop immediately if: Pain at the front of the shoulder, shrugging, the trunk rocking, a loss of range, or an increase in night pain.

Common mistakes: Too heavy a band, taking the elbows behind the line of the trunk, rocking the trunk to pull, and letting the band snap back.

Easier version/regression: Return to the seated low row without a band, or use a lighter band.

Progression criteria and next stage: A steady form with no loss of range the next day; the next stage is a gradual rise in resistance and then the T and Y exercises.

Expected and adverse responses: Mild fatigue between the shoulder blades is expected; pain at the front of the shoulder, loss of range or worse night pain means the resistance was too high.

Goal and why it matters: In the T the arms open out to the sides, and in the Y they open diagonally upwards; those two angles build the middle and lower parts of the scapular muscles. These are the muscles that hold the shoulder blade in place during overhead work.

Stage and starting criteria: Only in the strengthening phase and after full, pain-free active range. The UVA protocol sets a clear condition: resistance is added only when the movement is pain-free and free of compensatory patterns.

Equipment and environmental safety: A firm bed and a folded towel for the forehead. Start with no weight at all; weight is added only at the next step and only as prescribed.

Starting position: Lie face down on the bed with the forehead on the folded towel so the neck stays in line, arms hanging off the edge. If lying face down is uncomfortable for you, do the same two movements standing and hinged forward from the hips.

1. Set the shoulder blades gently.
2. T: raise both arms out to the sides, level with the shoulders, up to the level of the bed, thumbs pointing up.
3. Pause briefly and lower slowly.
4. Y: open the arms diagonally upwards, at about the angle of the letter Y, again only up to the level of the bed.
5. Lower slowly and take a few breaths' rest between the two letters.

Range, side, and restrictions: Do not go above the level of the bed; the aim is quality, not height. The neck stays relaxed and the low back does not arch.

Breathing, speed, and rhythm: Breathe out as the arms rise and lower them more slowly.

Documented dose: The start is without weight. The UVA protocol does give numbers for adding weight: begin at 0.5 kg and increase by 0.5 kg every 10 days, and only if the exercise is pain-free. Take the repetition count from your own strengthening-phase prescription.

Rest: Let the arms hang completely between the T and the Y and take a few calm breaths.

Signs of correct technique and expected response: The work is felt in the middle and lower shoulder blades, the neck is relaxed and the low back does not arch; mild scapular fatigue clears with rest.

Stop immediately if: Pain at the front or top of the shoulder, shrugging, an arched low back, trembling, or an increase in night pain.

Common mistakes: Raising the arms above the level of the bed, lifting the head and neck, arching the low back, and adding weight before the form is solid.

Easier version/regression: Take the weight off, reduce the range, or do the T only and add the Y later.

Progression criteria and next stage: Steady form at the current weight with no next-day reaction; the reference protocol's criterion for leaving the strengthening phase is external and internal rotation strength of at least 85% of the uninvolved arm. The next stage is a return-to-work or return-to-sport programme after functional testing.

Expected and adverse responses: Mild scapular fatigue is expected; pain at the top of the shoulder, trembling or worse night pain means weight or repetitions were added too soon.

• Strength progression: Exercise pain is minimal, range is not reduced the next day, and the shoulder blade moves without hiking.
• Overhead work: Return only after completing strengthening and functional testing, not by the calendar alone.
• Return to sport: Full pain-free range, normal shoulder-blade control, strength approaching the other side, and tolerance of a graded program are required. For massive repairs, one university protocol cites strength of 85% to 90% of the opposite side as a criterion.

Avoid: independently restarting weight training, pull-ups, dips, heavy pressing, throwing, swimming, or contact sport merely because three or six months have passed.