Rotator cuff surgery repairs torn tendons in the shoulder, reattaching them to the upper arm bone to restore stability and function. Recovery requires significant commitment to a structured, phased process of healing and rehabilitation. Understanding the expected timeline and the specific goals of each stage helps manage expectations and ensures the best possible outcome. Success relies heavily on protecting the tendon repair during the initial weeks and progressively building strength afterward.
Immediate Post-Operative Care
The first one to two weeks focus on protecting the surgical site and managing discomfort. A specialized sling or immobilizer is mandatory, often worn constantly for the first four to six weeks to keep the arm immobile while the tendon heals. Active movement or strain during this period risks disrupting the fresh tendon repair.
Pain management is an immediate priority, often starting with a nerve block administered during surgery. Once the block wears off, a scheduled regimen of oral pain medications, including narcotics and anti-inflammatories, controls discomfort. Frequent application of cold therapy helps reduce post-operative swelling and inflammation.
Wound care involves keeping incision sites clean and dry until the first post-operative visit, typically within 7 to 14 days. While showering is usually permitted, the dressing must be protected to prevent moisture exposure. Light, non-strenuous exercises for the elbow, wrist, and hand are encouraged several times a day to promote circulation and prevent stiffness.
The Structured Rehabilitation Timeline
Recovery is divided into sequential phases of physical therapy designed to progress shoulder function without compromising the healing tendon. The entire process often takes six to nine months, though some patients require up to a year for a full return to all activities.
Phase 1: Passive Range of Motion
This phase typically begins two to six weeks post-surgery and lasts four to six weeks, depending on the tear size and surgeon protocol. The goal is to restore mobility in the shoulder joint without engaging the repaired rotator cuff muscles. The physical therapist, or the patient’s opposite hand, moves the affected arm through a controlled range of motion, which prevents stiffness and ensures the repaired tendon is not strained.
Phase 2: Active Range of Motion
Starting around six to twelve weeks, the patient progresses to active range of motion, moving the arm using their own muscles. The tendon is stable enough for light, unassisted use, but heavy lifting or resistance is strictly avoided. The focus shifts to regaining control and coordination, often involving self-assisted stretches using a cane or pulley system. Gentle isometric exercises may also be introduced late in this phase to re-engage the muscle without moving the joint.
Phase 3: Strengthening
This final phase usually starts around 12 weeks post-surgery and continues for many months, focusing on rebuilding muscle power and endurance. Exercises are progressively loaded with resistance, starting with elastic bands and light weights to recondition the shoulder musculature. The therapist introduces compound movements that mimic daily activities and eventually sport-specific motions. This aims to restore the strength necessary for full functional recovery, as strength deficits can persist if rehabilitation is not diligently pursued.
Milestones for Returning to Daily Activities
Functional milestones occur parallel to the clinical rehabilitation phases. Sedentary work, such as a desk job, can often be resumed within one to two weeks, provided the sling is worn and the arm is not used for reaching or typing. Use of a computer mouse with the operative arm may be delayed until the active range of motion phase begins, around six to eight weeks.
Driving is prohibited for six to eight weeks, especially if the surgery was on the dominant arm, as the patient must be off narcotic pain medication and able to react safely. Light household activities, like cooking or dressing, are gradually incorporated within the first two months. Lifting anything heavier than a cup of coffee is typically restricted for the first three months. Returning to physically demanding activities, such as heavy manual labor or overhead weightlifting, is generally not permitted until at least six months post-surgery and requires clearance from the surgeon and physical therapist.
Recognizing Potential Setbacks
Patients should remain vigilant for signs of complication or setback, requiring immediate contact with the surgical team. Signs of infection include a persistent fever above 101°F after the initial 48 hours, excessive redness or warmth around the incision sites, or foul-smelling drainage. Sudden, severe, and persistent pain not relieved by medication, especially after trauma, could suggest a failure of the repair or a tendon re-tear. Symptoms of nerve irritation, such as numbness, tingling, or weakness that extends beyond the hand and wrist, also warrant urgent medical evaluation.