The recovery from surgery
There are two important principles in the rehabilitation.
1. Protecting the repair
2. Preventing stiffness
Protecting the repair
The rotator cuff is repaired using stitches and plastic or metallic “anchors” which fix the torn tendon back on the bone. Initially, the success of the operation is dependent on the ” hardware”. Over the subsequent twelve weeks the tendon will knit onto the bone. Protection of the repair during this early phase of healing is therefore extremely important. Protect the repair by being careful not to use your shoulder actively, that is, do not lift your arm away from your side under its own power. Unless we tell you otherwise, you may use your hand for typing or writing as long as your arm is supported. The nursing staff may instruct you on how to change clothes and wash. You may rest with your arm supported on pillows for periods out of the sling to let your skin breath. However, raising the arm actively, even a small amount places demands on your repair and should be avoided. We will tell you how long these restrictions need to be in effect. During this time you should leave your sling on and you should not drive!
While your shoulder is healing, gentle passive motion is helpful in preventing stiffness. Passive motion means that the shoulder is moved, but not under its own power. Your operated shoulder is moved by your other hand while the muscles of the operated shoulder are completely relaxed.
Remain in the sling until your first visit unless showering.
At the first visit we will show you how to do some gentle stretches finger walks)
You may perform finger and wrist exercises such as squeezing a ball several times a day.
You can move your shoulder passively by standing up and bending over at the waist, allowing the operated arm to dangle down in a relaxed way (see diagram). Your good, non-operated arm can lift the operated arm which is relaxing, allowing the good arm to take all the weight.
Dos and Don’ts
Do wear the sling as specified, usually full time for 4-6 weeks
Do use your hand and forearm for eating, writing etc.
Do perform finger, wrist, and elbow movements and hand strengthening
Don’t actively lift your arm for at least the first 6 weeks
Don’t leave your sling off unless performing exercises or showering for the first 6 weeks unless specified.
Don’t lift any weights above shoulder height for at least 3 to 6 months unless specified.
With your forearm resting on a table you may use your fingers to “walk” your arm
The rehabilitation need to be significantly varied based on a number of factors which may delay tendon healing. These include
- large longstanding tears with significant tendon retraction
- degenerative changes in the tendon,
- cigarette smoking,
- Other diseases and medications.
A conservative rehabilitation and compliance with the rehabilitation is critical in the healing, especially in the first 12 weeks. It is always a balancing act between stiffness and damage to the repair.
A number of studies have shown “aggressive” early range of motion exercises do not decrease the risk but are associated with increased risk of damage to the repair.
Therefore there is little to be gained trying to quickly restore range of motion, placing the tendon at risk of retear.
The rehabilitation phases with typical time periods in brackets are:
- Phase 1: Immediate postoperative period, minimal motion
- Phase 2: Protection and passive motion
- Phase 3: Protection and active motion
- Phase 4: Early strengthening
- Phase 5: Advanced strengthening
(weeks 24- 52)
Physiotherapists are experts in applying the appropriate rehabilitation programs. They monitor exercises to make sure you are doing them correctly. They develop new exercises and modify existing ones for maximum benefit.
Careful exercise to strengthen and rehabilitate the rotator cuff muscles is an important aspect of treatment. But they must not be performed until specified as per above protocols. These programs are often initially developed with the help of a physiotherapist and then continued at home as a home exercise program. They consist of stretching and mobilization exercises followed by a specific strengthening program. Formal Physiotherapy commences about 6 weeks after surgery.
Return to Activities
For the first 6 weeks after surgery you will remain in a sling most of the time. Physical activities/duties with the operated arm are not possible during this period apart from short periods for stretching exercises and washing. Driving is also not recommended
At 6 weeks after surgery, you may commence very light active use of your arm, that is, without any resistance. You remain unfit for any manual duties using the operated arm. You may start to drive an automatic car at this stage if you have achieved an adequate comfortable range of motion.
You are therefore fit for essentially clerical duties only.
At 12 weeks following surgery, resisted active use of the arm will be permitted. You may commence light duties using the operated arm. You will however have significant restrictions using the arm above shoulder level and away from the body. At that stage, the shoulder remains very weak.
At 24 weeks following rotator cuff repair surgery, strong tendon to bone healing should have occurred and some significant improvement in your strength will have returned. It is hoped a more aggressive return to pre-injury activities/duties can be pursued. Nevertheless at this stage some restrictions may still apply.
Full recovery from surgery may take 12 months and it may be this period of time before you can return to pre-surgery activities/duties.