The success of shoulder surgery depends significantly on the patient’s commitment to the post-operative plan. Surgery corrects the underlying mechanical issue, but the ultimate restoration of function requires diligent recovery efforts. Following the prescribed instructions for immobilization, pain control, and rehabilitation is the most direct route to achieving a positive, long-term outcome. The immediate steps taken after leaving the operating room establish the foundation for the entire recovery journey.
Immediate Post-Operative Care
The first 48 to 72 hours focus on protecting the surgical site and managing initial swelling. Your arm will be placed in a specialized sling designed to immobilize the shoulder and protect the repaired structures. For procedures like rotator cuff repair, the sling must typically be worn continuously, including while sleeping, and only removed for specific hygiene or therapist-approved exercises.
Proper incision care is important to prevent infection and promote healing. The surgical dressing must be kept clean and completely dry. Submerging the incision in a bath, hot tub, or pool is prohibited until cleared by the physician, often for 10 to 14 days. If the initial bandage becomes saturated with fluid, reinforce it with additional dressing rather than removing it entirely, as some drainage is expected initially.
Managing swelling is achieved through the application of cold therapy to the shoulder, which minimizes inflammation and pain. Apply cold therapy for 15 to 20 minutes at a time, with an hour or more break in between. Take care not to place ice directly on the skin or dampen the dressing.
Pain Management and Comfort Strategies
Controlling post-operative pain is important for comfort and for enabling participation in early rehabilitation exercises. A nerve block administered before surgery provides significant pain relief for the first 8 to 12 hours, but discomfort will increase as it wears off. Pain management typically involves a combination of prescribed narcotic pain relievers and NSAIDs or acetaminophen. These should be used on a scheduled basis rather than waiting for pain to become severe.
Taking prescribed medication about 30 minutes before bedtime can help ensure a more comfortable night’s rest. Finding a comfortable sleeping position is a common challenge, and most patients find relief sleeping in a semi-reclined position for the first few weeks. This position reduces gravitational stress on the joint and helps prevent inadvertently rolling onto the operated arm.
The Physical Therapy and Rehabilitation Process
Physical therapy (PT) is essential to the recovery process, beginning soon after surgery to prevent stiffness and restore function without compromising the surgical repair. Rehabilitation is structured into distinct phases, each with specific goals that progress the patient from protection to full strength. The initial phase, often lasting four to six weeks, focuses on protecting the repair and involves passive range of motion (PROM) exercises. During PROM, the therapist or the patient’s non-operative arm moves the surgical arm gently, ensuring the repaired muscles and tendons are not actively engaged.
The second phase transitions the patient to active-assisted range of motion (AAROM), where the patient uses their own muscles to move the arm, often with assistance. This is followed by the active range of motion (AROM) phase, where the goal is to move the arm independently against gravity. The final stages introduce progressive strengthening exercises, including isometric contractions, resistance band work, and light weights, to rebuild muscle strength and endurance.
Adherence to the home exercise program (HEP) is as important as supervised clinic sessions. Consistent, gentle movement is necessary to prevent scar tissue from limiting mobility. The HEP must be performed daily to maintain gains and prepare the shoulder for the next phase of recovery. Progression between phases is determined by the surgeon and therapist based on tissue healing time and the patient’s demonstrated mobility.
Resuming Activities and Recognizing Warning Signs
Gradually integrating back into daily life requires practical adjustments to protect the healing shoulder. Dressing is easier using loose-fitting, button-up shirts; always put the operative arm into the sleeve first and remove it last. When showering, keep the incision dry by covering it with a waterproof dressing or bag. Many patients find it helpful to keep the operative arm gently pressed against the stomach for protection.
Timelines for resuming activities vary based on the procedure, but general guidelines exist. Driving is typically restricted for four to six weeks, or until the patient is out of the sling and has regained sufficient strength and reaction time. Non-strenuous, desk-based work can often be resumed within a few days to a week. Jobs involving lifting or physical strain may require several months of recovery.
Avoid lifting anything heavier than a small plate or glass for the first two to three weeks, as excessive strain can jeopardize the surgical repair. Patients must be aware of specific warning signs that indicate a potential complication requiring immediate medical contact:
- A persistent fever of 101 degrees Fahrenheit or higher, which may signal an infection.
- Excessive drainage or spreading redness at the incision sites.
- Sudden severe pain that does not respond to prescribed medication.
- New numbness or tingling in the hand or fingers.
- Swelling in the forearm or hand that does not resolve after elevation and icing, which could indicate an issue with circulation or nerve compression.