Rehabilitation After Rotator Cuff Repair Surgery
Rehabilitation after surgery is as important as the surgery itself. Patients that do not follow the strict protocol set forth by our Naples orthopedic surgeon, Dr. Mead, do not do as well with their overall function as those that fully participate in their recovery. Rehab protocols are usually based on the patient’s quality of tissue, size of tear, quality of repair, and scientifically demonstrated tissue healing times. Post-operative rehabilitation is broken down into 4 phases. The timeframes for these phases are usually based on the size of tear and quality of the tissue repaired.
Rotator Cuff Rehabilitation Phases:
Phase I- Weeks 1-4. The Immediate Post-Surgical Phase
Patients are expected to wear the sling at all times, including to sleep at night and for showering. A second sling will be prescribed to use in the shower. You may be surprised how many people fall in the shower and reactively use their operative arm to brace their fall. The goals of this phase are to maintain the integrity of the rotator cuff repair and diminish pain and inflammation. You may use your hand to use a computer or write but may not carry anything heavier than a can of soda. Arm movements away from the body are not allowed as they may result in re-tearing of the tendon. You should not drive while wearing a sling as it may be illegal in some states and is not safe.
Phase II- Weeks 4-6. The Protection Phase
Patients are allowed to start gentle passive range of motion under the direction of the physical therapist. This reduces stiffness and prevents frozen shoulder while maintaining the integrity of the repair. The sling may be removed to perform these exercises, but most be worn at all other times. The goals of this phase are again to maintain the integrity of the rotator cuff repair and to not overstress the healing tissue but to gradually restore your range of motion.
Phase III- Weeks 6-12. The Active Phase
Patients are allowed to discontinue use of the sling and are progressed to active range of motion under the direction of the physical therapist. The goals of this phase are to achieve full active range of motion (you moving your shoulder) while still not overstressing the healing tissue. You will now be able to use your operative arm for feeding, bathing, and other activities of daily living. Patients are still not allowed to lift anything including pushing, pulling or sudden jerking motions.
Phase IV- Weeks 12+. The Strengthening Phase
Patients are allowed to begin strengthening now that full range of motion has been achieved. The goals of this phase are to maintain motion and gradually introduce strength and stability exercises in order to return to full activity. It is important to not lift anything too heavy until ready.
When it Comes to Rotator Cuff Surgery Recovery, Size Matters!
Small rotator cuff tears do not heal on their own. Patients function well with small tears but experience weakness and pain while sleeping. The tears will get bigger over time and more difficult to repair. These tears can be treated arthroscopically. Patients typically wear a sling for 4-6 weeks. Passive range of motion with a physical therapist begins around week 4. Active range of motion begins 6 weeks after the operation. Strengthening will begin at 3 months post-operative. Return to most activity occurs at 4 months.
Large rotator cuff tears can also be repaired arthroscopically but sometimes require a mini-open approach. Often times Platelet Rich Plasma Therapy (PRP) is recommended to aid in healing. Patients typically wear a sling for 6 weeks. Passive range of motion with a physical therapist begins around week 4. Active range of motion begins 6 weeks after the operation. Strengthening will begin at 3 months post-operative. Return to most activity occurs at 6 months for these tears. These time frames may be delayed with poor quality tissue.
Massive rotator cuff tears can be repaired arthroscopically or mini-open but are sometimes irreparable. Often time special techniques are needed to repair these. Patients typically wear a sling for 8+ weeks and passive range of motion is delayed until 6-8 weeks post-operative. Strengthening is started after 4 months of healing and return to most activity may take up to year.
Though formal physical therapy may last only a couple of months, it is imperative that patients continue some of their physical therapy exercises (both range of motion and strengthening) for the life of their shoulder. Research has shown that patients who are compliant with such programs have better long-term use of their shoulder.
Final thoughts that can affect healing:
Smoking, namely nicotine can negatively affect your ability to heal. Studies have shown that nicotine can delay or inhibit tendon to bone healing. It is important to stop smoking at least 30 days prior to surgery and to remain nicotine free post-operatively. This includes the use of nicotine gum and patches. Anti-inflammatory medication should also be avoided during the first 6-12 weeks after surgery as they too can interfere with tendon healing.
Surgeon’s Advice | Leon Mead MD Orthopedic Doctor | 730 Goodlette Road North, Suite 201 Naples Florida 34102 | Phone: (239) 262-1119