Inpatient exercises — rotator cuff & stabilisation PDF Evidence¶
Early in-hospital exercises after rotator cuff repair or shoulder stabilisation — gentle hand, elbow and shoulder movement, with six-week sling precautions.
These are the gentle exercises to begin in hospital after a rotator cuff repair or a shoulder stabilisation. They keep the hand, elbow and shoulder moving while the repair heals.
Your exercises¶
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Wrist movement
Keep your hand moving by bending your wrist forwards, backwards and side to side.
10 times, 3 times per day
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Open and close hand
Keep your hand and fingers moving by opening and closing them, or by squeezing a stress ball.
10 times, 3 times per day
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Elbow bends
Bend and straighten your elbow.
10 times, 3 times per day
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Pendulums
This is a passive exercise. Lean forward and let your arm relax down. Use your body to move the arm gently either clockwise or anti-clockwise, along with forwards, backwards and side to side.
About 30 seconds each way, 3 times per day
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Assisted forward flexion
Sitting on a chair and leaning forward, cradle your operated arm with the other arm and gently move it upwards in front of you. Lower it back down with the help of your non-operated arm. You could also lie on your back in bed and help the arm upwards if you prefer.
10 times, 3 times per day
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Assisted abduction
Sitting on a chair and leaning forward, cradle the arm again and help it out to the side (like rocking a baby).
10 times, 3 times per day
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External rotation
Sitting on a chair, only move your arm from where it sits in the sling to pointing straight in front of you. Don't go further outwards.
10 times, 3 times per day
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Lower trapezius setting
Squeeze your shoulder blades downwards and together.
Hold 5 seconds, 5 times, 3 times per day
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Upper trapezius stretch
Use your non-operated arm to bring your ear towards your shoulder, away from the operated side.
Hold 10 seconds, 3 times, 3 times per day
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Levator scapulae stretch
Use your non-operated arm to bring your nose towards your armpit area, away from the operated side.
Hold 10 seconds, 3 times, 3 times per day
Begin these gentle exercises in hospital and continue them at home. They should be comfortable — ease back if pain increases.
Wearing your sling¶
- You are allowed to take your arm out of the sling for your exercises and for showering.
- You need to wear your sling for 6 weeks, especially when out of the house.
- You don't need to sleep in the sling.
- Use ice for pain relief if needed.
- When wearing your sling, relax your shoulder and let the sling take the weight of your arm.
- Take your painkillers before you do your exercises, and before your physiotherapy appointments.
- Unless you have arranged your own physiotherapy, an appointment has been made for you and is detailed in your discharge pack.
- If you have any problems, contact the rooms or let your physiotherapist know.
When you go home¶
Once you are home, your recovery continues with the full rehabilitation protocol for your operation: rotator cuff repair; anterior stabilisation & Latarjet; posterior stabilisation.
After your protocol¶
These early exercises are the in-hospital starting point shared by rotator cuff repair and shoulder stabilisation — they keep the hand, elbow and shoulder gently moving while the repair is protected. The doses are typical rather than fixed, and your ongoing rehabilitation is guided individually by your physiotherapist, working with the practice, based on how your shoulder recovers. This page works alongside the practice's general recovery advice — see managing post-operative pain and wound care. The full, operation-specific course continues in your own protocol (linked above). The evidence behind this early phase — the early-versus-delayed motion research after cuff repair and the immobilisation evidence after stabilisation — is summarised in the evidence section, available as a PDF from the top of this page.
Evidence & references
Inpatient (Early In-Hospital) Phase — Rotator Cuff Repair &/or Shoulder Stabilisation¶
Topic scope: This is the early in-hospital / early-protected phase of a combined pathway covering patients who had a rotator cuff repair and/or a shoulder stabilisation procedure (anterior labral/Bankart repair, Latarjet, or posterior labral/capsular repair). It deliberately stops at the point of discharge plus the first protected weeks — the gentle hand/elbow/shoulder exercises that keep the limb moving while the repair is protected by the sling. The full, operation-specific rehabilitation course lives in the parent protocols, which this page hands the patient back to once they go home:
Defining principle of this early phase — PROTECT the repair: Unlike a frozen-shoulder release (where immediate aggressive motion is the goal), a cuff repair and a labral/capsular stabilisation both create a construct that must heal undisturbed. So the early phase is the same for both: sling immobilisation, gentle/passive-only motion within safe limits, and NO active or resisted shoulder work. Tendon-to-bone and labrum-to-bone healing is weak in the first weeks, so the sling and the movement limits are the protectors. The hand, wrist and elbow are kept moving freely throughout (these don't stress the repair) to prevent swelling and stiffness; the shoulder itself is only moved passively/with assistance within the limits the surgeon and physiotherapist set.
The early in-hospital phase (what this page covers)¶
In the first hours-to-days after surgery the aims are simple and shared across both operation families:
- Protect the repair — arm in the sling, no active lifting or reaching, no loading.
- Keep the rest of the limb moving — wrist, fingers and elbow exercises to prevent swelling and stiffness (these put no stress on the cuff or labral repair).
- Gentle, assisted shoulder motion only — pendulums and assisted/passive elevation within a safe arc; for an anterior repair, external rotation is limited; for a posterior repair, internal rotation and reaching behind the back are limited (the at-risk directions are opposite).
- Pain control and a safe discharge plan — analgesia before exercise, sling instructions, and a physiotherapy follow-up arranged in the discharge pack.
The standalone protocols then drive the rest of recovery (the full sling-weaning schedule, when active motion and strengthening begin, and return to work/sport). The same first-phase principles appear at the head of each of those protocols — this inpatient page simply consolidates that shared early phase for patients who had the procedure(s) performed together or are still in hospital.
Evidence by theme¶
Theme 1 — Early vs delayed motion after rotator cuff repair (the central debate)¶
This is the best-studied question that shapes the early phase, and the corpus is rich on it. Two competing concerns: early passive motion reduces post-operative stiffness, while delayed/immobilisation may better protect tendon-to-bone healing (lower retear), especially in larger tears.
- Multiple RCTs and systematic reviews of overlapping meta-analyses converge on the same bottom line: early and delayed passive motion give superior early range of motion for the early group but equivalent final outcomes by ~6–12 months for small-to-medium tears — so timing is largely surgeon preference and does not change the end result [Saltzman 2017; Mazzocca 2017].
- For large/massive tears the balance tilts toward a delayed / protected approach to favour healing [systematic-review/meta-analysis evidence; BMC Musculoskelet Disord 2025].
- A "knowing the speed limit" theme runs through the reviews: tendon repairs are mechanically weak early, and very aggressive early therapy can compromise the construct [Thigpen 2015 review].
Practical consequence for this page: the early in-hospital phase is passive/assisted-only with the sling on regardless of which approach the surgeon ultimately chooses for the home phase — the disagreement in the literature is about how soon to progress, not about whether to protect the repair in the first days. A defining surgical decision (early vs delayed progression, and how it is size-stratified) is made by the surgeon and detailed in the cuff-repair protocol.
Theme 2 — Immobilisation after stabilisation (anterior and posterior)¶
The stabilisation literature also supports an early protected phase, though high-level evidence is sparser and protocols are more consensus-driven.
- Anterior (Bankart/capsulolabral) repair: the American Society of Shoulder and Elbow Therapists' consensus guideline recommends 0–4 weeks of absolute immobilisation, then relative immobilisation (out of the sling only for exercises) to ~6 weeks, with no forced external rotation/extension for ~3 months; early ER is progressed gradually (e.g. ~15° at 0–2 wk → ~35° at 2–4 wk → ~55° at 4–6 wk). A simple sling is used in the large majority of published protocols.
- Posterior (labral/capsular) repair: the precaution is reversed — the sling is positioned in slight abduction and neutral/slight external rotation, the arm is kept in front of the body, and internal rotation, adduction and reaching behind the back are avoided early. Posterior instability is uncommon (~3–5%), so the protocols are biomechanically reasoned (Level IV–V) rather than RCT-tested.
- Both share the same headline as the cuff-repair early phase: sling on, gentle motion within the safe arc, no active/resisted shoulder work while the labrum/capsule heals.
Early-phase timeline (consolidated; first weeks only)¶
This focuses on the shared early-protected window and is consistent with the synthesis page. The full operation-specific schedules continue in the parent protocols.
| Phase | Window | Sling | Shoulder motion | Active / strengthening | Notes |
|---|---|---|---|---|---|
| Inpatient / immediate | Day 0 — discharge | On at all times (off only for exercises & showering) | Wrist/hand/elbow moving freely; pendulums; gentle assisted/passive elevation within safe limits | None for the shoulder (no active lift, no resisted work) | Analgesia before exercises; ice for comfort; physiotherapy follow-up arranged |
| Early protected | Week 0–6 | Worn ~6 weeks, especially out of the house; not needed for sleep | Continue gentle assisted/passive motion within limits — anterior repair: limit external rotation; posterior repair: limit internal rotation / no reaching behind the back | Still no active/resisted shoulder work | The sling and the direction limits are the protectors; ease back if pain rises |
| Handover to parent protocol | ~Week 6 onward | Weaned per the operation-specific protocol | Active-assisted → active motion begins in the parent protocol, not here | Strengthening begins later (cuff repair typically ~12 wk; stabilisation per its own schedule) | Recovery continues with the rotator cuff repair, anterior stabilisation & Latarjet, or posterior stabilisation protocol |
The sling duration, the exact motion limits, and when active motion and strengthening begin are surgeon-set clinical decisions; the windows above are the typical shared early phase, not trial-derived precise cut-offs.
Key controversies / evidence quality¶
- Early vs delayed progression after cuff repair is the one well-studied question, and it is about the home phase rather than the in-hospital phase. RCTs/meta-analyses show equivalent final outcomes for small/medium tears and a protect-healing tilt for large/massive tears — the early in-hospital protected phase is common ground either way. Strong (RCT / SR-MA), but Cochrane-level certainty for any single optimal schedule remains low.
- Stabilisation immobilisation duration and sling position are largely consensus/biomechanical — there is no RCT defining the optimal early regimen, and posterior protocols in particular are extrapolated. Weak–moderate / consensus.
- The combined early-phase protocol itself is a surgeon patient-guidance consolidation, not a trial-derived schedule. It is deliberately brief and defers to the parent protocols for the full course.
Evidence-strength flags (summary)¶
- STRONG (RCT / SR-MA): early-vs-delayed passive motion after cuff repair → equivalent final outcomes for small/medium tears, protect-healing tilt for large/massive (Saltzman 2017; Mazzocca 2017; BMC Musculoskelet Disord 2025 SR-MA).
- MODERATE / CONSENSUS: anterior stabilisation immobilisation schedule (ASSET/JOSPT consensus guideline); graded early ER limits.
- WEAK / CONSENSUS (Level IV–V): posterior stabilisation sling position and precautions (biomechanical, no RCT); the consolidated early in-hospital protocol itself.
Citations¶
RAG corpus (180,000+ Orthopaedic articles)¶
- Saltzman BM, Zuke WA, Go B, et al. Early Versus Delayed Motion After Rotator Cuff Repair: A Systematic Review of Overlapping Meta-analyses. Am J Sports Med. 2017. DOI: 10.1177/0363546517692543
- Mazzocca AD, Arciero RA, Shea KP, et al. The Effect of Early Range of Motion on Quality of Life, Clinical Outcome, and Repair Integrity After Arthroscopic Rotator Cuff Repair. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2016.10.017
- Effects of early exercise and immobilization after arthroscopic rotator cuff repair surgery: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskelet Disord. 2025. DOI: 10.1186/s12891-025-08500-7
- Which is better? Early versus delayed rehabilitation after arthroscopic rotator cuff repair. Knee Surg Sports Traumatol Arthrosc. 2024. DOI: 10.1002/ksa.12129
- Thigpen CA, Shaffer MA, Kissenberth MJ. Knowing the Speed Limit (post-cuff-repair rehab progression). Clin Sports Med. 2015. DOI: 10.1016/j.csm.2014.12.007
- Rehabilitation Following Arthroscopic Rotator Cuff Repair. J Bone Joint Surg. DOI: 10.2106/jbjs.m.00034
- Anterior Shoulder Instability Part I — Diagnosis, Nonoperative Management, and Bankart Repair — An International Consensus Statement. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.07.022
Literature / consensus guidelines (URLs)¶
- The American Society of Shoulder and Elbow Therapists' Consensus Rehabilitation Guideline for Arthroscopic Anterior Capsulolabral Repair of the Shoulder. JOSPT. 2010. https://www.jospt.org/doi/10.2519/jospt.2010.3186
- Rehabilitation Protocol Variability Following Arthroscopic Bankart Repair and Remplissage: A Systematic Review. Int J Sports Phys Ther. https://pmc.ncbi.nlm.nih.gov/articles/PMC11446737/
- Current Concepts in Rehabilitation for Traumatic Anterior Shoulder Instability. PMC. https://pmc.ncbi.nlm.nih.gov/articles/PMC5685970/
- Rehabilitation Following Posterior Shoulder Stabilization (clinical commentary). PMC8168996. https://pmc.ncbi.nlm.nih.gov/articles/PMC8168996/
Published patient/rehab protocols (basis for the early-phase structure)¶
- Massachusetts General Hospital — Rehabilitation Protocol for Bankart Repair. https://www.massgeneral.org/assets/MGH/pdf/orthopaedics/sports-medicine/physical-therapy/rehabilitation-protocol-for-bankart-repair.pdf
- University of Virginia Sports Medicine — Posterior Labral Repair Rehabilitation Protocol. https://med.virginia.edu/orthopaedic-surgery/wp-content/uploads/sites/242/2021/06/Posterior-Labral-Repair.pdf
- Brigham & Women's Hospital — Arthroscopic Rotator Cuff Repair Protocol (early protected phase, tear-size stratification). https://www.brighamandwomens.org/assets/BWH/patients-and-families/rehabilitation-services/pdfs/shoulder-arthroscopic-rct-repair-protocol-hybrid-patient-therapist.pdf