Rotator cuff surgery reattaches torn shoulder tendons to the bone, aiming to restore function and relieve pain. Success depends significantly on the patient’s strict adherence to post-operative instructions. The initial healing phase is delicate, as the tendon is vulnerable, and recovery often requires patience for up to a year to achieve maximum recovery. Understanding the actions that compromise the repair is the most important factor for a successful outcome.
Immediate Post-Operative Errors
The period immediately following surgery, typically the first four to six weeks, is when the newly repaired tendon is most fragile. Failing to maintain the immobilization protocol is the most damaging mistake a patient can make. The sling is worn full-time to prevent gravity and sudden, uncontrolled movements from pulling the tendon away from the bone anchor points. Prematurely removing the sling risks a significant re-tear.
Ignoring wound care instructions can introduce infection, the most common short-term complication. Patients must avoid submerging the incision in water—meaning no baths, hot tubs, or swimming pools—until cleared by the surgeon, typically for two to four weeks. Driving is universally prohibited during the immobilization phase because the sling interferes with the ability to steer and react quickly. Also, prescribed narcotic pain medications impair judgment and reaction time, making driving dangerous.
Another common error is attempting to sleep on the operated side, which puts direct, compressive pressure on the repair site. For the first four to six weeks, patients should sleep either upright in a recliner or propped up in bed with pillows. Wearing the sling while sleeping is mandatory to prevent accidental rolling onto the surgical side or unconsciously moving the arm. Keeping the arm protected allows the tendon-to-bone interface to begin its slow healing process.
Avoiding Harmful Movement and Stressors
The new tendon-to-bone attachment cannot withstand significant strain during the initial healing phase, making any active use of the arm a dangerous mistake. Active movement means using the shoulder muscles to lift the arm without assistance, which places direct tension on the repair. For the first six weeks, the restriction on lifting and carrying is absolute, often set at zero pounds. This means avoiding lifting even light objects like a cup of coffee or the arm’s own weight.
The actions of pushing and pulling are equally detrimental and must be avoided. Patients should not use the operated arm to push themselves up from a chair, assist in getting out of bed, or push open a heavy door. These movements generate significant force across the shoulder joint, which can mechanically disrupt the suture line holding the tendon in place. Pulling actions, such as tugging a stuck zipper or opening a heavy refrigerator door, must be performed exclusively with the non-operated arm.
Reaching prohibitions are specifically tied to the direction of movement, with reaching away from the body or behind the back being particularly hazardous. Reaching out to the side or away from the body increases the lever arm on the shoulder, exponentially increasing the strain on the repaired tendons. Sudden, uncontrolled movements, such as quickly reaching out to catch a falling object, are the most common ways patients inadvertently compromise their repair. The primary function of the post-operative sling is to minimize the potential for these reflex-driven, rapid movements.
Common Mistakes During the Rehabilitation Phase
Once the initial immobilization period is complete, the focus shifts to physical therapy (PT). Errors during this phase can be just as damaging as early movement. Skipping PT sessions or stopping the program prematurely is a common mistake, often driven by the patient feeling “better.” Non-compliance significantly increases the risk of developing joint stiffness, potentially progressing to a frozen shoulder that limits long-term range of motion.
Another frequent error is over-zealousness, where patients mistake therapeutic discomfort for harmful pain. Normal muscle soreness, aching, or stretching sensations are expected components of PT. However, sharp, tearing, or shooting pain that persists for more than 30 minutes after an exercise session signals that the patient is pushing too hard. Ignoring this severe pain and pushing through it can compromise the structural integrity of the healing tendon.
Patients often unconsciously substitute movements by using other muscles to compensate for shoulder weakness during exercises. For instance, they may “hitch” the shoulder, elevating the shoulder blade (scapula) or using the upper trapezius muscle instead of isolating the targeted rotator cuff muscles. This substitution prevents the repaired tendon from strengthening properly and reinforces poor movement patterns that limit functional recovery.
Finally, failing to report persistent, severe pain or a sudden loss of motion to the physical therapist or surgeon is a mistake that delays intervention. Open communication is essential, as these signals may indicate an unexpected complication, such as a re-tear or capsular issue. The full restoration of strength and mobility requires a commitment to the entire, gradual process, not just the initial weeks of protection.