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Arthroscopic Rotator Cuff Repair

Rehabilitation clinical resource for Clinical Exercise Physiologists (CEPs)

Clinical Profile

Minimally invasive surgical repair of torn rotator cuff tendons, most frequently supraspinatus. Results in loss of mobility and strength, impacting reaching (especially overhead), lifting, and functional independence.

CEP role: Using Te Whare Tapa Whā framework1, co-develop a personalised, evidence-based exercise plan2 with the client and whānau (taha whānau) to restore function and reduce atrophy3(taha tinana), increase movement confidence (taha hinengaro), and meet the client's own goals (taha wairua).

Rehabilitation Phases3

PhaseGoalsProgression
Immobilisation
~0–2 weeks

Protect repair, reduce pain / swelling, distal joint mobility.

Time-based

(surgeon clearance)
Passive ROM
~2–6 weeks

As above + maintain / increase PROM to prevent capsular stiffness.

Pain-free PROM,
ER > 30°, FF > 120°
Active-assisted & active ROM~6–12 weeks

Increase shoulder AROM.

Restore normal scapular mechanics.

All exercises pain-free with minimal compensation.
Strength & return to activity~12–20+ weeks

Increase shoulder strength and endurance. Sport / work / ADL focus.

High movement quality under fatigue, minimal kinesiophobia.

Immobilisation and Passive ROM are usually physio-led. Criteria-based progression may lead to better outcomes than time-based progression.4

Assessment

Functional assessments selected for client's rehab phase + ADLs and goals. Examples: reaching overhead, lifting from floor, carrying.

QuickDASH:5 tracks upper-limb symptoms and ADLs; use to identify functional limitations and improvements as rehabilitation progresses.

TSK-11:6 tracks kinesiophobia; higher scores associated with poorer outcomes, consider referral or pain neuroscience education.7

Monitoring

Continue
Pain ≤ 3/10, settles within 24 hours.
Modify
Pain 4–5/10, settles within 48 hours.
Stop & refer
Pain ≥ 6/10 or significantly disrupts sleep; signs of infection (fever, redness, swelling); sudden instability or loss of function; catching, popping or locking; progressive neurological symptoms.

Acronyms: ROM Range of Motion; PROM Passive ROM; AAROM Active-Assisted ROM; AROM Active ROM; ER External Rotation; FF Forward Flexion; ADLs Activities of Daily Living; QuickDASH Disabilities of the Arm, Shoulder & Hand (shorter questionnaire); TSK Tampa Scale of Kinesiophobia.

References

  1. Durie, M. (1994). Tirohanga Māori — Māori health perspectives. In Whaiora: Māori health development (pp. 67–81). Oxford University Press.
  2. Clinical Exercise Physiology New Zealand. (n.d.). Scope of practice. Retrieved 29 May 2026, from https://www.cepnz.org.nz/professional-standards/scope-of-practice
  3. Sciarretta, F. V., Moya, D., & List, K. (2023). Current trends in rehabilitation of rotator cuff injuries. SICOT-J, 9(3). https://doi.org/10.1051/sicotj/2023011
  4. Chen, Y., Meng, H., Li, Y., Zong, H., Yu, H., Liu, H. B., Lv, S., & Huai, L. (2024). The effect of rehabilitation time on functional recovery after arthroscopic rotator cuff repair: A systematic review and meta-analysis. PeerJ, 12, Article e17395. https://doi.org/10.7717/peerj.17395
  5. MacDermid, J. C., Khadilkar, L., Birmingham, T. B., & Athwal, G. S. (2015). Validity of the QuickDASH in patients with shoulder-related disorders undergoing surgery. Journal of Orthopaedic and Sports Physical Therapy, 45(1), 25–36. https://doi.org/10.2519/jospt.2015.5033
  6. Tkachuk, G. A., & Harris, C. A. (2012). Psychometric properties of the Tampa Scale for Kinesiophobia-11 (TSK-11). The Journal of Pain, 13(10), 970–977. https://doi.org/10.1016/j.jpain.2012.07.001
  7. Cao, J., Yan, G., Guo, Y., Yan, S., & Guo, J. (2025). Early kinesiophobia and its associated factors among patients after arthroscopic rotator cuff repair: A cross-sectional study based on latent profile analysis. BMC Musculoskeletal Disorders, 26(1). https://doi.org/10.1186/s12891-025-09274-8