Expert insight from Dr. Richard Cunningham, Orthopaedic Surgeon at Vail-Summit Orthopaedics & Neurosurgery

A successful rotator cuff repair surgery usually eliminates associated shoulder pain and restores shoulder strength and function. However, understanding how to recover properly is just as important as the procedure itself.

Given that every rotator cuff tear is slightly different, every surgical repair is also slightly different. However, there are some commonalities with every rotator cuff repair surgery. While every recovery is different, knowing what to expect can help you prepare, stay on track with rehabilitation, and achieve the best possible outcome.

“The surgery is only the beginning,” says Dr. Richard Cunningham. “A successful result depends on protecting the repair, allowing the tendon time to heal, while also slowly restoring range of motion, strength and function.”

Quick Takeaways

• The first 6-8 weeks after rotator cuff surgery focus on protecting the repaired tendon.
• Rotator cuff repair surgery is typically a fairly painful procedure but nerve blocks administered by a skilled anesthesiologist help pain tremendously.
• Physical therapy progresses gradually to restore motion and strength.
• Full recovery often takes 6-12 months depending on numerous factors such as tendon tear size and the amount of tendon retraction.
• An experienced rotator cuff doctor near me can help ensure a sound surgical repair and also guide every stage of recovery.

The First 6-8 Weeks After Rotator Cuff Repair Surgery

Immediately after rotator cuff surgery, your shoulder will be placed in a sling to protect the repair. While it may be tempting to test your shoulder, it’s important to avoid active movements that would place stress on the healing tendon.

During this phase, your priorities include:

• Controlling pain
• Protecting the surgical repair by wearing the sling and avoiding activating the repaired muscles and tendons
• Trying to get decent sleep, as this is a common patient complaint after this surgery
• Beginning gentle, passive shoulder motion exercises such as pendulum exercises which gently move the shoulder without stressing the tendon repairs

“Protecting the repair in the first 6-8 weeks is critical,” Dr. Cunningham explains. “The tendon needs time to begin to attach back to the bone before we stress the tendon attachment in any way.”

Is Rotator Cuff Repair Painful?

Patients frequently wonder, “Is rotator cuff repair painful?”

Unfortunately, rotator cuff repair surgery is quite painful in the first few weeks for most patients. Smaller single tendon repairs without significant retraction typically cause modest amounts of postoperative pain. Massive, multi tendon tears with severe retraction can result in severe pain. However, advances in regional nerve blocks, and newer pain medication regimens have made recovery much more manageable for patients.

“The first week is usually the most uncomfortable,” says Dr. Cunningham. “For an average sized rotator cuff tear and repair surgery, patients undergo a nerve block which can last up to 5 days. During the first week, most patients require oral pain medications fairly regularly. In the second week, most patients can get by with Tylenol during the day but still require pain medications at night. Typically, most patients are off of any prescription pain medications after 2 weeks, with some stopping after a few weeks and some requiring prescription pain medications for a longer period of time.”

Physical Therapy Is Essential

In the first 6 weeks, patients are instructed to do passive range of motion consisting of pendulum exercises. Dr. Cunningham recommends that patients do these pendulum exercises five times a day for a few minutes a time. Depending on the tear pattern, Dr. Cunningham may have a patient only do pendulum exercises on their own or he may start them in PT one time a week for the first 6 weeks. If a patient is started in physical therapy, the physical therapist will only do passive range of motion of the shoulder and not start active motion for 8-10 weeks depending on the tear size. Passive motion is where a patient is not engaging the shoulder muscles to move the shoulder. Active motion is where one is utilizing the shoulder muscles to move the shoulder.

Your physical therapist will gradually guide you through various rehabilitation, phases that include:

• Passive motion to help restoring limited shoulder motion while not stressing the repair
• Active motion and more aggressive stretching to restore full shoulder range of motion.
• Gentle strengthening to not overload or inflame the tendon but to begin to wake the muscles up.
• More aggressive strengthening and preparing one for returning to sports or physically demanding work

Trying to advance too quickly can place unnecessary stress on the healing tendon.
“The shoulder often feels better before the tendon is fully healed,” Dr. Cunningham says. “That’s why following the rehabilitation plan is so important.”

When Can You Return to Normal Activities?

Recovery timelines vary depending on the size of the tear, tissue quality, and individual healing.

In general for an average sized rotator cuff repair surgery:

• By 6 weeks from surgery, patients are only doing passive range of motion exercises. They usually have 50% of their normal range of motion. They are off of all prescription pain medications, but they may still require some Tylenol at night. They feel very weak.
• By 12 weeks from surgery, patients have 90% of their normal range of motion and they feel tight at the end range of motion in all planes. They can lift their arm overhead most of the way under their own power, but they still quite weak especially with overhead motions.
• By 16 weeks, patients should have full range of motion, no pain, but still have weakness although strength has improving considerably. One could ski and ride a bike outdoors at this point.
• By 6 months from surgery, patients are doing very well with no pain, full shoulder range of motion, and with good strength.
• It can take up to 9 months for one to have a full return of strength as most patients have had some degree of tendon tearing for years and have lost strength over a period of years.

Choosing the Right Surgeon Matters

Rotator cuff tears can range from small partial tears to large, multi-tendon, complex tears. An experienced rotator cuff doctor near me can successfully repair most large, complex tears and provide the best outcome possible. Large tears that are retracted require specialized releases in order to get a retracted tendon back to its native attachment site so it can heal properly.

From diagnosis to rehabilitation, having a clear plan helps patients regain confidence and safely return to the activities they enjoy.

Looking Ahead

If you’re asking, “what is the normal recovery after rotator cuff repair surgery”, it is best to seek out an experienced rotator cuff repair surgeon such as Dr. Cunningham, who has done thousands of these repairs. If a patient is patient and compliant with the rehabilitation protocal, participates in physical therapy, has close follow-up with the shoulder surgeon, then the vast majority of patients have a great outcome and can return to having a pain free shoulder with full strength and function.

If you’re looking for an experienced rotator cuff doctor near me, Dr. Cunningham can evaluate your shoulder injury, discuss your treatment options, and help you understand what to expect after rotator cuff surgery so you can recover with confidence. Contact our team today!