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.
Our recent Expert Series explored:
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 — and involves a long recovery process.
Recovery from rotator cuff surgery
Not all rotator cuff surgeons are created equal. Volume matters … that means that the more rotator cuff surgeries your surgeon performs (within reason), 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.
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. 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. Some patients even 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. 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. Once your surgeon gives you the go ahead to move the arm, it is very important that you follow the instructions. 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 around 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! Most academic shoulder surgeons will not allow their patients to begin aggressive strength training for at least three months following rotator cuff surgery.
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. 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.