Advanced Shoulder Tendon Repair Rehabilitation

Passive forward flexion to 90 degrees with glenohumeral joint in neutral rotation,Passive external rotation to 0 degrees with arm at side ( scapula stabilized),Passive external rotation to 45 degrees at 90 degrees abduction with glenohumeral joint supported,Active elbow, wrist, and hand flexion/extension with shoulder in protected position,Scapular retraction and depression exercises in supine with minimal humeral movement,Pain less than 3/10 at rest with no increase during prescribed exercises

→ Advance to: Phase II

Active-assisted forward flexion to 125 degrees with scapular control,Active-assisted external rotation to 45 degrees at 90 degrees abduction,Active internal rotation to T12 level (subscapularis healing),Full passive external rotation at 0 degrees abduction (30 degrees),Sternal elevation with concurrent glenohumeral depression in sitting,No substitution patterns observed during active shoulder motion

→ Advance to: Phase III

Active forward flexion to 145 degrees with proper scapulohumeral rhythm,Active external rotation to 60 degrees at 90 degrees abduction,Active internal rotation to T7 level,Isometric external rotation at 0 degrees abduction (grade 3/5),Isometric internal rotation at 0 degrees abduction (grade 3/5),Horizontal adduction tolerance without anterior shoulder pain

→ Advance to: Phase IV

Full active range of motion in all planes (forward flexion 160, external rotation 90, internal rotation 70),External rotation strength at 90 degrees abduction greater than 4/5 (infraspinatus, teres minor),Internal rotation strength at 90 degrees abduction greater than 4/5 (subscapularis),Supraspinatus strength test greater than 4/5 (empty can test),Scapular stabilization: prone Y-T-W exercises without compensation,Biceps tendon resistance: resisted elbow flexion at 90 degrees without anterior shoulder pain

→ Advance to: Phase V

External rotation strength at 90 degrees abduction greater than 85% of contralateral side,Internal rotation strength at 90 degrees abduction greater than 85% of contralateral side,Scapular control during loaded patterns: push-up plus, wall push-off,Proprioception: closed-chain weight bearing on hands without shoulder symptoms,Plyometric exercises: wall dribbles, medicine ball throws (2-3 kg),AC joint tolerance: cross-body adduction and overhead activities without pain

→ Advance to: Phase VI

Functional movement screen for upper extremity complete without compensation,Return to work/sport specific testing (throwing, overhead, pushing),Isokinetic strength testing: external/internal rotation ratio 66-75%,Endurance testing: prone scapular holds greater than 60 seconds,No apprehension or instability symptoms with provocative maneuvers,Patient subjective outcome score (ASES) greater than 85 points

→ Advance to: Discharge

Full, pain-free range of motion equal to contralateral side,Strength within 90% of contralateral side for all rotator cuff muscles,Successful completion of sport/work specific progression,Patient demonstrates independent home exercise program compliance,No recurrent symptoms with progressive loading,Discharge criteria met: return to pre-injury function

→ Advance to: Discharge