So, you’ve had Rotator Cuff Surgery… Now What?

In 2018 alone, 460,000 American’s had surgery to repair a torn rotator cuff, and in 2023, that number is expected to climb over 600,000 patients (iData Research). With the rising incidence of rotator cuff repairs in this country as well as the ever increasing cost of healthcare, there has been an increased demand placed on rehab professionals and patients alike to better understand and streamline the rehab process to achieve better outcomes. 

To better understand the post-op recovery and timeline following rotator cuff repair, let's dive into a brief anatomy lesson. Your rotator cuff (no, not rotary cup or rotator cup) is a group of 4 muscles and tendons in your shoulder. The cuff acts in harmony to both move and stabilize your joint. These muscles, the supraspinatus, infraspinatus, subscapularis, and teres minor act as a force couple to approximate, or “suck” the head of your humerus (ball) into the glenoid fossa of your shoulder blade (socket). Simply put, as your shoulder lifts utilizing a majority of the force from the large deltoid muscles, the 4 muscles of your rotator cuff work to keep the ball and socket joint in alignment. Additionally, these muscles also have isolated movements to rotate your shoulder both directions.

Injuries possibly requiring surgical repair to the rotator cuff commonly happen in one of two main ways:

1. Chronic tears: When the above force couple does not work, whether due to a.) poor anatomy b.) weakness or c.) overuse , the tendons of the rotator cuff (most frequently supraspinatus) become frayed and dysfunctional. This hits a critical point where pain and loss of motion, strength and function are diminished. 
2. Acute injury: When a person falls on an outstretched arm, falls on an arm stuck behind them, or performs a hard lifting task the rotator cuff cannot handle, a traumatic acute tear to the muscle can occur. These tears can range from small to full thickness tears, and can accompany any of the 4 muscles.

These injuries typically happen in adults in their 60's-80's, with those ages accounting for 78.3% of all full thickness tears. Surgery to repair these damaged muscles will be recommended after a failed course of conservative care using physical therapy, active rest/recover and possible injections/medications.

So, you’ve had the rotator cuff surgery…now what?

Let’s quickly answer the first question everyone always has: how long will the recovery take? 

It depends.

If I had a crystal ball, I’d know exactly how long the recovery is going to take and I’d have a boatload of money. I still don’t have either. That being said, the typical recovery time for patients falls around 3–5 months.

The main goals of recovery from rotator cuff surgery are:

1. Decrease postoperative pain and swelling
2. Protect the repaired tissues
3. Restore full passive range of motion (ROM) 
4. Restore full active ROM 
5. Build strength of cuff and upper extremity musculature
6. Improve biomechanics of upper extremity
7. Regain full functional use of involved extremity

With the help of your physical therapist, this recovery will go in chronological order, and will follow a guided protocol with the input of your surgeon and treating therapist. Most rehab protocols are standard and follow the same guidelines, however surgeon and PT preference as well as specific tissues repaired and patient recovery factors will have an impact on timeline.

Stage 1: 0–6 weeks

1. Decrease postoperative pain and swelling 
2. Protect the repaired tissues 
3. Restore full passive range of motion (ROM)

• Beyond protecting the surgically repaired tissues, the single most important part of achieving full recovery is to establish pain free and full PASSIVE ROM within the first 6 weeks. This means seeking PT services immediately following your surgery.
• Passive meaning no moving of the shoulder yourself - this is done with manual techniques by the treating therapist, and through passive exercises prescribed.

As known shoulder guru Mike Reinold states, “It is extremely easy to lose motion following surgery. This is one of the common “rookie mistakes” I see with new PT’s. Passive range of motion should be initiated immediately following surgery in a gradual and cautious fashion. Studies have shown that passive range of motion into flexion and external rotation actually decreases strain in the rotator cuff repair [and aide in a more efficient recovery].”

Stage 2: 6–10ish weeks

1. Maintain full passive range of motion (ROM)
2. Restore full active ROM
3. Build strength of cuff and upper extremity

• Once full passive ROM is established and ~6 weeks post-op, you can begin to actively use your arm to regain your active ROM.
• In this phase, it is important to maintain the passive ROM you have achieved. Subsequently, you will gain active range of motion of the shoulder and strength of the isolated rotator cuff, scapular muscles and total upper extremity as tolerated.

Stage 3: 10+ weeks

1. Maintain ROM and strength of cuff and upper extremity
2. Improve biomechanics of upper extremity
3. Regain full functional use of involved extremity

• This is where all the fun begins. Once motion and baseline strength are established and the surgery is healed, it is time to train what your shoulder needs to function in your daily life.
• This stage of recovery is geared at improving the biomechanics of your shoulder in order to allow it to respond to the specific demands you will place on it (albeit work, sport, recreation, etc.). 
• This stage of recovery may look different for say, a competitive baseball player vs. a retired passive individual. This stage is based on the patient's specific functional demands of the shoulder. However, the same principles remain for all patients: the body will adapt to the stresses we apply to it. Therefore, we must train this area to react and support the functional requirements it will need to prevent this injury from reoccurring. 



To wrap it up, think basic: get to PT immediately after surgery. Start passive motion, move to active motion, and once moving fully, build strength and function of the shoulder as tolerated. As always, the recovery and therapy process differs for every patient, this is just an overarching breakdown of the rehabilitation process. For specifics on timeline, exercises to perform, and medical questions, please consult with your physician, surgeon and physical therapist