What to expect when you are expecting….a rotator cuff repair!

Due to the success of my what to expect when you expecting…a total knee replacement blog, I have decided to do a blog on rotator cuff (RTC) repairs.  A rotator cuff repair is another common surgery that many people will encounter and may be confused about.  In this blog I will be reviewing what the typical recovery process is like after undergoing a rotator cuff repair surgery.

rotator cuff repair

The Surgery

The day of the surgery it is good to get to your appointment at least 30 minutes early to get paperwork filled out and clear your mind.  The nurses will prep and clean your shoulder and then the anesthesiologist will come in and give you a regional block as well as put you to sleep.  Most surgeries will take anywhere from 45 minutes to 1 hour.   You will then be in the recovery room for at least 1 more hour following the shoulder surgery.  Make sure to have a driver there to take you home as your arm will be in a sling for the next 6 weeks.

Day 1 to 3 weeks- Acute Recovery

I like to call this stage the acute recovery stage as not much happens in terms of therapy.  During this period you will be in your sling pretty much 24/7.  Shoulder surgery does come with a good amount of pain that can usually be controlled with pain medication.  It’s recommended to stay on top of your pain by taking the pain medications every four hours.  Most people will do that for the first 3-7 days, and then be able to ween off the pain meds to only 1-2 times a day.  But I always tell patients, take them if you need them, as it’s definitely better to stay ahead of the pain rather than let it get out of control.  One good thing to do is get out of your sling (carefully) and let your elbow stretch out as well as let your arm dangle at your side.  Pendulums or rocking the baby can be started at this stage which is passive range of motion (ROM) of the shoulder that can be done at home.

3 weeks to 6 weeks- Post-acute recovery

This stage is when you are still in the sling but doing therapy on a regular basis becomes more of a priority.  While you are in therapy you can start some passive ROM and assisted ROM.  During this stage pain usually is less and your therapist should be monitoring your pain during ROM activities.  Therapy should not be “painful”, but you will have some discomfort with getting the shoulder out of the sling and having it moved around more.  You are still not allowed to actively lift your arm at this point.

6 weeks to 12 weeks- Post sling recovery

The sling comes off!  This is definitely a big event in the life of a post surgical RTC repair patient.  At this point you can start some increased assisted ROM and even some light active ROM with your shoulder.  This is an important stage for gaining the remainder of your ROM back and beginning to work back into your activities of daily living.  You should still not be lifting anything greater than 3lbs above shoulder height as the tendon repair is still not fully healed by this point.  By the end of 12 weeks the goal is to have full active ROM and hopefully be able to progress to some strengthening exercises without any pain.  Pain usually subsides quite a bit during this stage, but still can be anywhere from a 2-4 on the pain scale.

12 weeks to 6 months – Late Recovery

In this stage of the ballgame the tendon should be pretty well healed to the bone and the risk of re tearing the rotator cuff is slim.  This is the stage when you can start some real strengthening exercises again.  Most of the exercises will consist of strengthening the muscles around the rotator cuff, and also strengthening some of the rotator cuff muscles that were not involved in the surgery.  The rotator cuff is made up of 4 muscles that turn into tendons as they attach to the bone.  Usually only 1 to 2 of the tendons are repaired during a RTC repair surgery.  But it is a good idea to strengthen all the rotator cuff muscles to help support the recently repaired ones.  For the sports players out there it is safe to return to your overhead sport activities by the 5th to 6th month of recovery time.  The goals before returning to sports is full pain free ROM, adequate scapular and shoulder stability, and 0-1/10 pain with activities.

The full recovery of a rotator cuff repair can take anywhere from 1 to 2 years depending on the individual.  So it is important to continue your rehab exercises for at least 1 year after your rotator cuff repair.

If you have questions or concerns about your rotator cuff repair or are in need of physical therapy after a rotator cuff repair surgery, please don’t hesitate to call!