Rotator cuff tears are a very common source of shoulder pain. Rotator cuff surgery becomes an option for you if you do not respond to non-surgical treatments. Whether you had or are thinking about surgery for a full thickness rotator cuff tear or a partial rotator cuff tear, recovery from rotator cuff surgery can be a lengthy process. Surgery on the shoulder, even though it is arthroscopic, usually produces significant pain and stiffness.
Volume matters … that means that the more rotator cuff surgeries your surgeon performs, the better the chance they will perform your surgery correctly. Find a surgeon who performs at least 75-100 rotator cuff repair surgeries a year. Don’t be afraid to ask. Performing the surgery properly and efficiently is the first step to achieving a good result.
Recovery from rotator cuff surgery
Not all rotator cuff surgeries are the same… so your recovery from rotator cuff surgery will vary based upon what procedure you had. Some patients have had a rotator cuff repair. A rotator cuff repair involves stitching the tendon or muscle back to the bone that it was once attached to. Some patients simply have the shoulder, or a partial rotator cuff tear cleaned up or smoothed out.
Below are general guidelines… if you have questions, it’s better to ask your surgeon first before beginning any new activity.
Patients who are recovering from rotator cuff surgery know all too well that surgery on the shoulder is usually not tolerated well. While some patients have very little pain, most have significant discomfort for a few days to a few weeks. Some tips that will assist you in preparation for rotator cuff surgery or will assist you if you’re already recovering from rotator cuff surgery are as follows. First and foremost… listen to your surgeon’s instructions. For those of you who had a repair, this is particularly important. It is not unusual to see people in the office with no sling, despite clear instructions to remain in a sling and not to use the arm. I’ve heard every reason there is
(I think) why you do not have the sling on … but remember. Your rotator cuff is being held to the bone by a few stitches. If you move the shoulder, you run the risk of causing failure of the repair because the sutures will saw their way through your rotator cuff. Your surgeon will let you know when it is ok to start moving the shoulder. Many of you will have elbow pain from being in the sling. I personally allow my patients to stretch the elbow a few times a day, but you should check with your surgeon first to see if it’s ok. Pain at night, or being unable to sleep is a very common complaint when recovering from rotator cuff surgery. Sleeping in a recliner, or in a bed with many pillows behind you will help many of you be able to sleep. Rolling up a small towel, or placing a small pillow behind your shoulder to hold your shoulder forward will also help you. Night pain can remain an issue for a few months following surgery.
Stiffness during recovery from rotator cuff surgery
Stiffness is a big issue many patients will have to deal with after rotator cuff surgery. Stiffness is more common following repairs, and it is very common in diabetics. It turns out that some patients have a genetic predisposition to developing stiffness. It is very important to identify those of you early on in the recovery process so that we can start your therapy sooner than we usually like to. For the majority of people, the stiffness occurs because you need to remain in a sling and use your arm very little during the initial 6 weeks or so following a repair. We may start you on a passive motion protocol with a physical therapist before the 6 week time frame, but that will depend on the type of tear you had, the type of repair you had and your surgeon’s preference. We can not be too aggressive with motion in early phases of a recovery from rotator cuff surgery or else we risk having the repair fail. When I allow my patients to begin to move their shoulder I find that many enjoy using a product called The Rotater to aid them in stretching their shoulder. Once your surgeon gives you the go ahead to move the arm, it is very important that you follow the instructions and move the arm throughout the day. A physical therapist will typically be used to assist and guide you through this process. If you are uncertain about whether or not you can move in a various direction or use the arm for certain activities ask your surgeon first!
Strength training following rotator cuff surgery
Recent scientific studies (Spring 2013) show that between 3-5 months after surgery is when you are at greatest risk of re-injury or re-tearing your rotator cuff tear. This is probably the most critical period in the recovery from rotator cuff surgery. It takes many months for a repaired rotator cuff to become strong enough to allow you to use it to lift weights, push or pull heavy objects or use it for more than typical activities of daily living. This is simply the biology of tendon healing! You do not heal faster than everyone else :-). When recovering from rotator cuff surgery, it is very important that you listen to us.. please — when we restrict you from certain activities. Most academic shoulder surgeons will not allow their patients to begin aggressive strength training for at least three months following rotator cuff surgery. It is also more important to concentrate on getting back your motion during the initial phases of recovering from rotator cuff surgery. For those of you who did not have an actual repair, but instead had the joint “cleaned out” or “debrided”, you can typically return to strengthening your shoulder as soon as your motion is near normal.
Return to sports after rotator cuff surgery
This is where most of you get very upset with us. It will be many many months before you are allowed to return to sports following a rotator cuff repair. This is meant to protect the rotator cuff as it continues to bond to the bone. This is a very long biological process … thus you will need to avoid contact sports, etc for nearly 6-12 months, depending on the size of your tear, quality of your tissue and the preferences of your surgeon. For those of you who simply had the shoulder cleaned out or smoothed out, we will typically let you return to sports as soon as your strength has returned to normal. Again, check with your surgeon first. For most of you who are currently recovering from rotator cuff surgery, there is a light at the end of the tunnel. Many of you have heard from your friends that it will be a year before your shoulder feels “normal”. For some of you that will be true. For some of you, you will recover far faster.
Have the surgery performed correctly the first time
As I stated before… volume matters. Make sure you are under the care of someone who performs many rotator cuff repair surgeries. That is critical to the success of a rotator cuff repair, and it is a critical first step in recovery from rotator cuff surgery.