The rotator cuff is a complex group of four muscles and their tendons that surround the shoulder joint, providing both stability and the ability to lift and rotate the arm. When these tendons tear, a person often experiences significant pain, weakness, and limited mobility. Rotator cuff surgery (RCS) is necessary when non-surgical treatments like physical therapy, rest, and injections have failed, or when the tear is complete or very large. The procedure aims to reattach the torn tendon back to the head of the humerus (upper arm bone). Success depends heavily on preparation, meticulous post-operative care, and dedicated physical rehabilitation.
Preparing for Surgery and the Procedure Day
Preparation involves medical clearances and practical adjustments to your living environment. Before the procedure, pre-operative testing typically includes blood work, an electrocardiogram (EKG), and sometimes a chest X-ray. You must disclose all medications and supplements, as you will be instructed to stop blood-thinning medications, aspirin, and NSAIDs about seven days prior to reduce bleeding risk.
Home preparation should minimize the need to use the affected arm during initial recovery. Set up a comfortable recovery area, often using a recliner, as sleeping semi-upright is usually preferred. Arrange for a support person to drive you home and assist with daily tasks like cooking. Ensure you have loose-fitting, button-up or zip-up shirts that can be easily worn over the sling. On the day of the procedure, you will meet with the anesthesiologist to discuss options, often including general anesthesia combined with a nerve block. The nerve block provides significant pain relief for the first eight to twenty-four hours after surgery.
Immediate Post-Surgical Care and Pain Management
The immediate post-surgical period focuses intensely on pain control and protecting the repaired tendon. You will be placed in an immobilizing sling, often with a pillow component, which must be worn constantly for four to six weeks to prevent movement that could compromise the repair. The sling may only be removed for specific physician-approved exercises and for showering, carefully supporting the affected arm with your other hand.
As the initial nerve block wears off, usually within the first day, start taking prescribed oral pain medication before the pain becomes severe. The regimen typically combines scheduled acetaminophen and a narcotic for breakthrough pain. Surgeons often advise against NSAIDs for the first four weeks due to their potential to interfere with tendon-to-bone healing. Applying ice or using a cold therapy unit for twenty-minute intervals multiple times a day is highly effective for reducing swelling and discomfort. Wound care involves removing the surgical dressing after forty-eight hours, keeping the small incisions clean and dry, and covering them with adhesive bandages.
The Phased Rehabilitation Process
The success of rotator cuff repair depends on a structured, multi-phase physical therapy (PT) program designed to gradually increase stress on the healing tendon.
Protection Phase (Weeks 1–6)
The primary goal of this initial phase is tissue healing and preventing shoulder stiffness without stressing the repair. The patient’s arm remains in the sling, and only Passive Range of Motion (PROM) exercises are performed. During PROM, the therapist or a device moves the arm without any muscle activation from the patient.
Active Range of Motion (AROM) Phase (Weeks 6–12)
This phase begins once the surgeon determines initial tendon-to-bone healing is sufficiently progressed. The central milestone is the patient starting to move the arm independently, without assistance, and without lifting external weight. Exercises advance to include active-assisted range of motion, where the unaffected arm helps the surgical arm move, and gentle isometric exercises to reactivate the shoulder muscles.
Strengthening Phase (Weeks 12–24)
This final stage introduces resistance exercises using bands or light weights to rebuild the strength of the rotator cuff and surrounding muscles. The focus shifts toward improving muscular endurance and preparing the shoulder for daily life and complex activities. Progression is monitored based on the patient’s pain level and demonstrated strength, with full tendon healing taking approximately three to six months.
Long-Term Milestones and Activity Return
After rehabilitation, the focus shifts to regaining full functional strength and resuming normal life activities. Patients with sedentary jobs can often return to work within one to two weeks, using the affected arm minimally. Resuming manual labor or jobs requiring repetitive overhead work or heavy lifting takes significantly longer, often three to four months, to ensure the repaired tendon can handle the strain.
Return to driving is typically permitted only after the patient is no longer wearing the sling and has discontinued narcotic pain medication, usually between seven and twelve weeks post-operation. The ability to lift light objects, such as a gallon of milk, returns once active motion is established. Lifting anything substantial remains restricted until the Strengthening Phase is well underway. While many patients feel recovered within four to six months, maximum strength gains and full functional recovery continue for six to twelve months. Full return to complex, high-demand activities or sports may take up to a year, and some patients with large tears may retain residual weakness.