Recovering from rotator cuff tear can be a lengthy process! The initial injury can seriously impact your daily life and, unfortunately, it takes time to see improvement due to surgery. Even though it is arthroscopic, rotator cuff surgery can result in some pain and stiffness.
What causes a rotator cuff tear?
Most people diagnosed with a rotator cuff tear do not recall a single, isolated traumatic event. It’s possible they may have felt a pop when moving their shoulder, but they didn’t fall or get into an accident. When doctors find a tear, in this scenario the cause of the rotator cuff tear is usually “degenerative tendinosis.” Tendinosis is a condition when your rotator cuff tissue simply wore out, like your favorite pair of blue jeans or that sock you just poked your toe through. Trauma is another cause of rotator cuff tears, but traumatic tears are far less common than degenerative tears.
Doctors and medical experts agree that the most common cause of rotator cuff tears is degeneration of your rotator cuff tissues. It’s an unfortunate consequence of genetics, aging and our cumulative activities. Trauma can also cause the rotator cuff to tear. As we will explore in future posts, the cause of your tear will matter when we discuss treatment strategies with you.
Not all rotator cuff surgeons are created equal. Experience matters! You want to select a surgeon who successfully performs rotator cuff surgeries and keeps up to date on the best tools and techniques. Don’t be afraid to ask your doctor about his or her experience. Performing the surgery properly and efficiently is the first step to achieving a good result.
Below are general guidelines, if you have questions, it’s better to ask your surgeon first before beginning any new activity.
Patients who are recovering from rotator cuff surgery may have difficulty anticipating how much discomfort they will experience post-surgery. While some patients have low levels of pain, most have significant discomfort for a few days to a few weeks. Some tips that will assist you in preparation for rotator cuff surgery or will assist you if you’re already recovering from rotator cuff surgery are as follows.
First and foremost, listen to your surgeon’s instructions and follow them to the best of your ability. For those of you who had a repair, this is particularly important. It is not unusual to see people in the office with no sling, despite clear instructions to remain in a sling and not to use the arm. Many patients report significant improvement in pain when using a cold compression sleeve on the shoulder. Having a sling which is comfortable and immobilizes the arm is critical. Certain immobilizers which grasp the wrist tend to stay on better. Your rotator cuff is being held to the bone by a few stitches. If you move the shoulder, you run the risk of causing failure of the repair because the sutures will saw their way through your rotator cuff. Some patients will try a compression sleeve to aid their comfort. Some report that it is beneficial, while others do not. Sleeping can be an issue. Many have found a shoulder support pillow system helpful.
Your surgeon will notify you know when it is the appropriate time to start moving the shoulder. Many of you will have elbow pain from being in the sling. There are doctors who allow their patients to stretch the elbow a few times a day, but you should check with your surgeon first to see if it’s all right. Pain at night, or being unable to sleep is a very common complaint when recovering from rotator cuff surgery. Sleeping in a recliner or in a bed with many pillows behind you will help many of you be able to sleep. Rolling up a small towel or placing a small pillow behind your shoulder to hold your shoulder forward will also help you. Night pain can remain an issue for a few months following surgery.
Stiffness can be a stressful issue many patients will have to deal with after rotator cuff surgery. Stiffness is more common following repairs, especially for diabetics. Some patients even have a genetic predisposition to developing stiffness. It is very important to identify those of you early on in the recovery process so that the doctors can start on your therapy sooner than later.
Doctors may advise their patients to start with a passive motion protocol with a physical therapist before the 6-week time frame, but that will depend on the type of tear you had, the type of repair you had and your surgeon’s preference. We cannot be too aggressive with motion in early phases of a recovery from rotator cuff surgery or else the healing process won’t work efficiently. Once your surgeon gives you the go ahead to move the arm, it is very important that you follow the instructions. A physical therapist will typically assist and guide you through this process. If you are uncertain about whether or not you can move in a various direction or use the arm for certain activities ask your surgeon first!
Recent medical studies show around 3 to 5 months after surgery is when you are at greatest risk of re-injury or re-tearing your rotator cuff tear. This is probably the most critical period in the recovery from rotator cuff surgery. It takes many months for a repaired rotator cuff to become strong enough to allow you to use it to lift weights, push or pull heavy objects or use it for more than typical activities of daily living. This is simply the biology of tendon healing! Most academic shoulder surgeons will not allow their patients to begin aggressive strength training for at least three months following rotator cuff surgery.
This is the frustrating part for many athletes. It will be many months before patients are allowed to return to sports following a rotator cuff repair. This is meant to protect the rotator cuff as it continues to bond to the bone. This is a very long biological process, thus it is best for the patient to avoid contact sports, etc. for nearly 6 to 12 months, depending on the size of the tear, quality of your tissue and the preferences of your surgeon. Again, check with your surgeon first.
For most patients who are currently recovering from rotator cuff surgery, there is a light at the end of the tunnel. Many of you have heard from your friends that it will be a year before your shoulder feels “normal”. For some of you that will be true. For some of you, you will recover far quicker than others.
While patients can take steps to help themselves, osteoporosis is a serious health concern and, as such, medical professionals should be involved in any major decisions about bone health. If you live in or around San Antonio, reach out to the South Texas Spinal Clinic at (210) 614-6432 for help.