The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, providing stability and allowing the arm to rotate and lift. When one or more of these tendons tear, surgery may be necessary to reattach the tendon to the upper arm bone (humerus) and restore function. Recovery from this procedure is a methodical process that typically spans several months, progressing from immobilization to full strength restoration. Healing is highly individualized, depending on the tear’s severity and the patient’s biological factors, but the overall rehabilitation follows a predictable, phased approach.
Initial Immobilization and Pain Management
The first four to six weeks following surgery are dedicated to protecting the repaired tendon while it begins to heal to the bone. The arm is kept immobilized in a sling, often an abduction sling that holds the arm slightly away from the body to reduce tension on the repair site. Wearing the sling continuously, including during sleep, is necessary to prevent accidental movement that could compromise the surgical repair. For simple tears, some protocols may recommend a shorter sling duration, but the decision is based on the surgeon’s assessment.
Managing acute pain is a primary focus during this initial post-operative period. Patients are typically given a nerve block during surgery, which provides pain relief for the first 12 to 24 hours. As the nerve block wears off, a combination of prescription pain medication and over-the-counter anti-inflammatory drugs is used to control discomfort. Applying cryotherapy, or ice, to the shoulder regularly is also highly effective at reducing swelling and managing pain.
The Structured Rehabilitation Phases
Rehabilitation is structured into sequential phases to ensure the repair is protected while gradually restoring movement and strength. Physical therapy usually begins within the first few weeks, though the initial focus is strictly on passive motion. During the Passive Range of Motion (PROM) phase, which lasts about four to six weeks, the therapist moves the patient’s arm without the patient using the shoulder muscles, preventing stiffness without stressing the healing tendon.
The next stage is the Active-Assisted Range of Motion (AAROM) phase, typically starting around six to eight weeks post-surgery. At this point, the patient starts to move the arm independently, often with assistance from their other arm or a device, and is usually cleared to stop wearing the sling. The goal here is to regain control and further increase the range of movement without lifting against gravity or resistance, as the tendon-to-bone attachment is still relatively fragile.
The final phase is the Strengthening phase, which generally begins around twelve weeks post-surgery, once the tendon-to-bone healing is considered more secure. This stage focuses on rebuilding the muscle strength and endurance lost during immobilization. Exercises using resistance bands, light weights, and functional movements are introduced to stabilize the joint and restore power. This strengthening work often continues for several months, with formal physical therapy typically lasting between two to four months or more, depending on the tear’s severity.
Timeline for Returning to Daily Activities
The return to daily activities is marked by functional milestones that correlate with the healing phases of physical therapy. Simple tasks, such as light desk work, using a keyboard, or lifting very light objects like a cup of coffee, are often possible within the first few weeks, provided the upper arm remains close to the body. Individuals with sedentary jobs may be able to return to work within one to two weeks, assuming demands on the operated arm are minimal.
Driving is an important functional milestone that is typically restricted until the patient is out of the sling and has regained adequate control of the arm, often six to eight weeks post-surgery. Lifting moderate to heavy objects, such as a gallon of milk or groceries, is avoided for a longer period, generally between three to six months, to prevent re-tearing the repair. Heavy chores, strenuous manual labor, or overhead sports are restricted for the longest period, often six to twelve months, to ensure the tendon is fully healed and conditioned.
Key Factors Influencing Recovery Duration
The stated recovery timelines represent an average, but the actual duration is heavily influenced by specific patient and injury characteristics. The size and complexity of the original tear are major determinants; a small tear may allow for recovery in four months, while a massive tear could require a year or more. Older age negatively affects the rate of tendon healing, as do underlying health conditions like diabetes, smoking, or poor bone quality.
The surgical technique can also play a role, as arthroscopic repair often results in less post-operative pain and a potentially quicker initial recovery compared to open surgery. The most significant factor, however, is the patient’s strict adherence to the prescribed physical therapy regimen. Consistent, correct execution of exercises is necessary to prevent shoulder stiffness and ensure the progressive restoration of strength and range of motion.