Rotator cuff surgery reattaches torn tendons to the upper arm bone, requiring a highly controlled healing environment. The success of the repair relies entirely on keeping stress off the newly fixed tendon during recovery. The first six to twelve weeks are critical, as the tendon is weakest and most vulnerable to re-injury, which can compromise the surgical outcome. Strict adherence to post-operative restrictions is necessary to protect the repair and ensure a successful recovery.
Immediate Mechanical Stressors to Avoid
The most immediate threat to a healing rotator cuff is any action that pulls, pushes, or places a load on the repaired tendon. During the initial phase, often lasting six weeks, maintain a zero-tolerance policy on using the operative arm for any work. This means prohibiting lifting even lightweight items, with a common restriction being nothing heavier than a coffee cup or a smartphone.
Avoid all forceful motions, such as pushing yourself up from a chair or pulling open a heavy door, which generate significant strain on the shoulder. Sudden, jerking movements, like reaching out reflexively or bracing for a fall, must also be prevented. These uncontrolled forces can easily exceed the strength of the surgical repair and cause a re-tear.
A proper sling is required full-time to keep the arm immobilized and protected, including while sleeping. Do not remove the sling unless specifically instructed for hygiene or exercise. Strictly avoid specific arm positions that stretch the repair site, such as reaching behind your back or reaching out to the side away from your body. Any active motion that lifts the arm overhead should be prohibited entirely during the early passive range of motion phase.
Restrictions on Common Daily Activities
Common daily tasks can inadvertently compromise the healing tendon, requiring temporary restrictions to prevent accidental injury. Driving is prohibited for an extended period, generally six to twelve weeks, or until you are completely out of the sling and off narcotic pain medication. The inability to steer or react quickly, especially during an emergency stop, creates a sudden, forceful jerk that can stress the repair and poses a major safety concern.
Dressing and undressing requires careful management to avoid unauthorized movements of the operated arm. Never pull clothing over your head; instead, use loose-fitting shirts that button or zip in the front. When dressing, always put the shirt on the operated arm first. When undressing, remove the shirt from the unoperated arm first to minimize shoulder movement.
Sleeping can be challenging, but you must not lie on the operated side for at least six weeks. Many patients find it more comfortable to sleep in a recliner or propped up in bed with pillows to keep the arm elevated and supported in front of the body. Maintaining proper support prevents the arm from stretching across the body.
For hygiene, keep the incision site clean and dry, avoiding tub bathing or swimming until cleared by the surgeon. In the first few days, you may need to sponge bathe. When showering, let water run over the shoulder and gently pat the area dry. This prevents infection and protects the incision until the skin barrier has fully closed.
Mistakes to Avoid During Physical Therapy
Physical therapy is a structured, multi-phase process that must be followed precisely; attempting to accelerate the process is a common error. A significant mistake is discontinuing therapy prematurely once pain has subsided and basic function returns. Restoring full strength and endurance requires months of continued, progressive strengthening exercises, often extending beyond the formal therapy period.
Avoid the temptation to push past the boundaries set by the therapist, especially by performing exercises that cause sharp or escalating pain. While general muscle soreness is normal, sharp pain signals that the tendon is being overloaded or stressed, risking a structural re-tear. Do not perform exercises unapproved by your therapist, such as using weight machines or returning to resistance training too soon.
During the initial phase, the therapist guides the arm through its range of motion, which is called passive range of motion. Patients must avoid performing this passive movement themselves or allowing unauthorized individuals to do it. Only the trained therapist should apply the specific forces needed to maintain mobility without stressing the repair. Trying to force the arm to move beyond the prescribed range can directly compromise the healing tendon anchorages.
Warning Signs You Must Not Ignore
Recognizing signs of a complication requires immediate contact with your surgeon’s office. Signs of infection include fever, chills, excessive redness around the incision, spreading warmth, or foul-smelling or discolored drainage. Infections can occur within the first few days to weeks and require urgent medical intervention to prevent long-term damage.
Sudden, severe, or escalating pain not managed by prescribed medication is a serious warning sign. This type of pain, particularly if it develops unexpectedly, may signal a structural issue like a tendon re-tear, requiring prompt assessment. Also watch for signs of nerve involvement, such as new or worsening numbness, tingling, or weakness radiating into the hand or forearm.
Bleeding or excessive swelling from the incision site should also be reported immediately. While minor drainage is expected, uncontrolled bleeding or a sudden increase in swelling may indicate a problem beneath the skin requiring medical attention. These symptoms indicate that recovery is not progressing as planned and must be addressed by a medical professional.