This content was updated for accuracy and relevance on 1/3/24.
A rotator cuff is a group of four muscles and tendons that aid the shoulder in various movements while also providing stability to allow the shoulder to stay in place throughout different functional movement patterns.
Functional movements include:
- Reaching behind your back to tuck your shirt in
- Reaching overhead
- Using your arm for sports-related activities
Injury to the rotator cuff can be either a strain or tear due to an accident or injury or wear and tear over time. The pain from rotator cuff injury can significantly impact your everyday activities, prompting you to seek medical care. Your doctor may initially advise you to rest, ice, and take over-the-counter pain medication such as ibuprofen. They often also prescribe physical therapy to allow for improved range of motion, shoulder strength, function, and decreased pain. If a rotator cuff repair surgery is needed, you can still take precautions before, during, and after for a better recovery. The rotator cuff injury can sometimes feel like a shoulder impingement, so it’s important to diagnose it properly. Here’s more of what you should know about .
Types of Rotator Cuff Surgeries
If physical therapy does not initially help, and you have consistent pain and limited daily function due to the pain or restricted movement and shoulder strength, you and your doctor may collaboratively decide to proceed with rotator cuff shoulder surgery.
Surgical procedures, ranging from least invasive to most invasive, include arthroscopic rotator cuff surgery, mini-open, and open repairs. The best surgical repair procedure for you will depend on the severity of your rotator cuff tear and the severity and duration of your symptoms.
Arthroscopic Repair
Arthroscopic repairs are mostly used for rotator cuff tears of small to medium-sized tears (<3 cm). During this procedure, small incisions are made where a camera and instruments can be used to repair the soft tissue tear.
Mini-Open Repair
The second type of for a is the mini-open repair. This repair is both an arthroscopic and open surgery technique. Arthroscopy is utilized to evaluate the tear and remove any loose cartilage. Then an incision is made approximately 1 to 5 inches to repair the tear with the use of sutures.
Open Repair
The third, and most invasive technique is an open repair. During this procedure a portion of a larger shoulder muscle (the deltoid) is detached, allowing the surgeon to access and repair the torn soft tissue. This surgical rotator cuff repair procedure is primarily utilized for massive or complex tears.
Your physician will determine which procedure is most appropriate for you as it varies depending on the rotator cuff tear size and the number of rotator cuff tendons involved. The rotator cuff surgery recovery time will vary for this more invasive repair, but can take up to 4-6 months.
Do’s and don’ts after rotator cuff surgery
So depending on the torn rotator cuff, the surgery will look different for each patient. But regardless of what surgical rotator cuff repair your physician performed on you, you must adhere to some general activity guidelines and precautions postoperatively to allow for optimal healing. Here are some rotator cuff surgery recovery tips you should know.
Do’s
- Stay compliant with wearing your sling. The sling allows your shoulder to stay immobilized so the tendons can heal. Your physician will tell you when you can stop wearing the sling. Make sure to consult with your physician before terminating the use of the sling. During the initial phases, the sling will only be removed to perform exercises in physical therapy.
- Ensure the sling is on at night and avoid sleeping on the surgical side.
- Sleeping will be challenging at first. You may find it more comfortable sleeping in a somewhat upright position. Recliners are usually a good option where you can help maintain your affected arm supported by your sling and along the recliner’s armrest.
- Move your fingers to aid in swelling management. Ice is also an excellent tool to use to help manage swelling. Make sure you are not putting ice directly onto your skin. Always put a layer between your skin and the ice.
- Take your prescribed medication to help in pain reduction. This will help during your physical therapy sessions as your physical therapist helps you to regain your range of motion.
- Protect your incision site. If showering, ensure the incision is properly covered with a plastic bag or watertight bandage approved by your physician. A sponge bath may be easier until suture removal.
- Stay active with walks. Little by little, increase the distance of your walk. Walking helps prevent blood clots and allows good blood flow nutrients for good rotator cuff recovery. Remember to wear your sling during your walks.
- Be diligent about watching your incision. Watch for any signs of infection. Some signs of infection include redness, swelling, warmth, dehiscence, and running a fever. If any of these symptoms are present, call your doctor.
- Attend regular physical therapy sessions. Your sessions will focus on stretching and gentle activities allowed by the type of surgery you had.
Don’ts
- Do not push, pull, or lift anything with the surgical arm.
- Do not drive until cleared by your physician.
- Do not remove the sutures until the wound is healed.
- Do not apply ointments directly onto the incision.
- Do not try to rush recovery. A specific timeline is set out regarding when it is appropriate to start certain activities. Your physical therapist and surgeon will guide you through it.
- Do not perform any activities outside of the direction of your physician and physical therapist.
These guidelines can aid in further and quick healthy .
What is the fastest way to recover from rotator cuff surgery?
The fastest way to recover from surgery is to adhere to instructions from your surgeon and physical therapist. There is no faster recovery. There are known healing times for bone, muscle, and tendon.
To allow your body to heal optimally, you need to listen to the healthcare professionals overseeing your care and respect the healing process. Recovery ranges from 6 months to a year.
Regardless of the surgical procedure, your surgeon will provide guidelines to you and your physical therapist. You must adhere to these recommendations. Do not try to rush your recovery regardless of feeling good.
Every phase of the post-operative guidelines correlates to the body’s natural healing times, and these phases allow for optimal healing. Attending physical therapy sessions and adhering to the home exercise program prescribed by your physical therapist is very important to allow a safe and effective recovery.
Do rotator cuff injuries get worse over time?
If not treated appropriately, a rotator cuff injury can get worse over time. Rotator cuff injuries can progress towards other complications, including:
- earlier onset of arthritis
- bone spurs
- further damage to other rotator cuff tendons
As time goes on, stiffness will increase, the pain will intensify specifically along the front or side of the shoulder, and the pain will start affecting sleep. This will translate to limited function in raising the affected arm overhead, reaching the arm behind the back, and lifting or carrying anything to shoulder or past shoulder height.
How Physical Therapy Can Help
Physical therapy has numerous benefits for assisting with a healing rotator cuff. Whether it’s before surgery or after, physical therapy can help to ensure that you have a successful recovery.
Before Surgery
Before surgery, physical therapy can help regain the loss of range of one and improve both shoulder blade and rotator cuff strength of both the affected and non-affected rotator cuff muscle(s). This will allow for improved post-surgical physical therapy, as you will be coming out of surgery with a stronger baseline in both ranges of motion and strength, which will only help with your recovery.
After Surgery
You can expect four major phases in your recovery after your rotator cuff surgery.
Phase 1
The first phase is called the passive range of motion phase. Only your physical therapist or physician can move your shoulder for you during this phase. This allows the shoulder to be moved within ranges without straining the repaired rotator cuff tendon(s). This usually lasts approximately six weeks but varies depending on the surgical technique.
Phase 2
The second phase is the active range of motion phase. The tendon(s) have healed at this point, and it is safe to allow rotator cuff activation. During this phase, your physical therapist will work with you to start safe range of motion activities. This phase usually lasts up to 12 weeks from the surgical date.
Phase 3
The third phase is the strengthening phase. During this phase, gradual progression of the rotator cuff and shoulder blade muscles will begin by utilizing resistance bands and light weights. During this phase, it is imperative that you do not rush the weight too quickly.
Phase 4
The last phase is the full activity phase. This phase can last anywhere from 4-6 months. During this phase, a gradual return to higher-level activity will begin. Every surgery is different based on the surgeon’s technique, so be sure to work very closely with your physical therapist and physician to allow an optimal recovery from rotator cuff surgery.
See related: Total Joint Shoulder Surgery Recovery
with Ivy Rehab
If you are struggling with shoulder pain and have not yet spoken to a doctor, now is the time. At Ivy Rehab, we specialize in treating rotator cuff injuries. Let us help you get back to doing the things you love. Let us guide you before and after your rotator cuff surgery. For location information or to request an appointment online, visit our website.
Article By: Anakaren Lopez PT, DPT, CSCS
Anakaren began her physical therapy career four years ago. Anakaren loves working with the orthopedic population and believes in the importance of providing exceptional personalized care tailored to meet an individual’s physical goals to allow improved quality of life. She graduated from the Ivy Rehab HSS Orthopedic Residency Program in 2021 and is looking to become board certified in orthopedics. She is currently certified as a strength and conditioning specialist and a Pilates instructor. She currently treats patients at Ivy Rehab Physical Therapy in Edison, NJ.
