The four-week mark after rotator cuff surgery is a significant point in the initial healing journey. Understanding typical experiences during this period helps manage expectations and reduce apprehension. While recovery timelines vary, recognizing common physical changes, therapy goals, daily adjustments, and potential warning signs is important.
Typical Physical Changes and Sensations
At four weeks post-surgery, patients commonly experience a gradual decrease in severe pain. However, a dull ache or occasional sharp twinges might still be present, particularly during movements or at night. Pain management remains important, often involving prescribed medications and cold therapy.
The shoulder will also feel stiff and tight, a result of the necessary immobilization following the procedure. Initial healing is actively underway, with incisions typically well-closed and scar tissue beginning to form.
While significant bruising may have subsided, some residual swelling around the shoulder joint might still be noticeable. Improvements in initial mobility are often observed, but any sudden or sharp pain during movement, or increasing pain, warrants attention.
Physical Therapy Activities and Goals
Physical therapy plays a central role in rehabilitation following rotator cuff surgery, with specific activities and goals tailored to the four-week post-operative phase. The primary focus is on continuing passive range of motion (PROM) exercises. Here, a physical therapist or another arm gently moves the affected arm without the patient actively engaging the repaired muscles. This approach helps reduce stiffness and gradually restore mobility while protecting the healing tendon.
Patients may also begin active-assisted range of motion (AAROM) exercises around the four to five-week mark, using their unaffected arm or tools like a cane or pulley to assist movement. Gentle pendulum exercises, involving controlled circular motions of the arm while leaning forward, are commonly performed to lubricate the joint and improve range of motion.
Additionally, scapular exercises, focusing on controlled movements of the shoulder blade, help maintain stability and posture, which can be affected by prolonged sling use. The overarching goals are to protect the surgical repair, reduce stiffness, and slowly reintroduce gentle muscle activation.
Daily Living Adjustments and Precautions
Navigating daily life at four weeks post-rotator cuff surgery requires continued adjustments and adherence to precautions to protect the healing repair. Patients typically need to avoid activities involving lifting, pushing, pulling, or reaching overhead or behind the back with the affected arm. Weight-bearing on the surgical arm should also be avoided.
Sling use generally continues for four to six weeks post-surgery to immobilize and protect the shoulder. While the sling may be temporarily removed for prescribed exercises or showering, it should be worn consistently, especially when walking or standing, and often during sleep.
For comfortable sleeping, many individuals find relief by sleeping in a semi-upright position, such as in a recliner or propped up with pillows, to avoid pressure on the surgical site. Personal care activities like dressing and showering often require one-handed techniques or assistance.
The affected arm can be used for very light tasks like eating or drinking, ensuring movement is restricted to the elbow and wrist. Driving is generally not recommended while wearing a sling or taking narcotic pain medication, a restriction that typically lasts until around the four to six-week mark.
Recognizing Potential Issues
While some discomfort and limitations are expected during the four-week recovery period, certain symptoms warrant immediate attention from a healthcare provider.
A sudden, severe increase in pain, or pain that worsens significantly despite medication, could indicate a problem. New or increasing redness, warmth, or swelling around the surgical site, especially if accompanied by fever or chills, may be signs of an infection.
Other concerning symptoms include any pus draining from the incision, or a significant loss of sensation such as numbness or tingling in the hand or fingers. A noticeable and unexpected reduction in the shoulder’s range of motion or function should also be reported. Prompt communication with the surgical team is important if any of these warning signs develop.