Rehab After Rotator Cuff Surgery

rotator cuff rehab
Rehab is a key to successful rotator cuff surgery.. Tetra Images / Getty Images

Rotator cuff surgery is a common treatment of a torn rotator cuff. The surgical procedure is sometimes the easiest and most straightforward aspect of treatment, and the rehab and recovery is the most challenging. People having rotator cuff surgery should understand each step of rehab as a good outcome is highly dependent on the healing and rehabilitation that follows surgery. Here is a timeline of the major steps following rotator cuff surgery:

Day of Rotator Cuff Surgery:

Rotator cuff surgery is an outpatient procedure. Overnight stays in the hospital are generally unnecessary. The surgical procedure usually takes a few hours, depending on the extent of work needed to repair the torn tendons.

After surgery your arm will be placed into a sling. A sling that holds the arm slightly away from the side (an abduction sling) is generally recommended for rotator cuff repair surgery, as these hold the tendons in a more relaxed position. You will remain at the hospital until your pain is adequately controlled.

The First Days After Rotator Cuff Surgery:

The first days after rotator cuff surgery are focused on ensuring that your pain control is adequate. Your doctor will prescribe medications to help with discomfort. Always try to prevent the pain from becoming severe by taking smaller doses of pain medication at the early signs of discomfort, rather than large doses when the pain is more severe.

Trying different types of medication can also be helpful; many doctor recommend alternating prescribed narcotic medications with an anti-inflammatory medication. And don't forget about icing the shoulder. Ice application may be the most important part of pain control.

Sleeping at Night:

Sleeping after shoulder surgery can be a challenge.

Even a moderate ache in the shoulder can prevent a good night's sleep. Many patients find it most comfortable to sleep in a semi-upright position after rotator cuff surgery; a recliner is perfect. If you don't have a recliner, just get a lot of pillows and create a back rest in bed to allow you to sleep in a seated position with the elbow pointing down. A sleep-aid medication may be as helpful as a pain medication, as getting a good night's sleep can do as much for pain control as anything else.

Recovery Phase 1: Passive Motion:

The first phase of recovery is passive motion only. This may last up to 6 weeks, depending on the size of the rotator cuff tear and the strength of the repair.

Passive motion means the rotator cuff muscles and tendons are not doing any work. When the rotator cuff muscles contract, tension is placed on the repair that was performed. Passive motion means that the shoulder moves without placing tension on the repair.

In order to perform passive motion, your therapist will move your shoulder for you.

The therapist can also instruct you on how to move your own shoulder without contracting the rotator cuff muscles.

Recovery Phase 2: Active Motion:

Active motion is initiated when there is sufficient healing of the tendons to allow them to start moving the arm, but before any extra resistance is applied. You may be limited to active motion for up to 12 weeks from the time of surgery. Active motion means that you can move your own arm, but not against resistance.

Recovery Phase 3: Strengthening:

The strengthening phase of recovery is the most important. Because of the injury, surgery, and early phases of recovery, the muscles of the rotator cuff have become weak. Once the repair has adequately healed, it is important to begin strengthening the muscles to allow you to resume your normal activity level.

The rotator cuff muscles do not need heavy weights for effective strengthening. A skilled therapist can instruct you on techniques to isolate the proper muscles for strengthening such that only light resistance bands or weights can provide an excellent workout.

Recovery Phase 4: Full Activity:

Full recovery after rotator cuff surgery often takes 4 to 6 months and in some cases longer. The critical factors that determine the length of the recovery are the size of the rotator cuff tear, the ability to adequately repair the tendons, and the commitment to rehabilitation.

Knowing when to progress from one phase of rehab to the next is an art. Not all people will progress through rehab in the same way, and each individual must adhere to their prescribed rehab protocol. Discuss any specific questions you have about your rehab with your surgeon.

Bottom Line

This is a broad outline of the stages of rehabilitation that follow rotator cuff surgery. Keep in mind, that every patient, every tear, and every surgery is a little different. While having these steps is a helpful guideline, each patient needs to discuss their particular progress with their surgeon. The progress may be faster or slower depending on a number of factors. While it is tempting to compare progress with friends, family members, or new acquaintances from the therapy office, their recovery may not be the same as yours! Make sure you know where you might need a little extra protection or extra time to get your shoulder back to peak condition.

Sources:
Millett PJ, et al. "Rehabilitation of the Rotator Cuff: An Evaluation-Based Approach" J. Am. Acad. Ortho. Surg., October 2006; 14: 599 - 609.

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