If you have a torn rotator cuff tendon you may have shoulder pain, weakness or limited movement. Your orthopaedic surgeon may recommend surgery to repair this torn rotator cuff. One of the biggest questions you may have is what the recovery time is and when you can return to work or leisure activities.
In this guide, you’ll learn about the rotator cuff, the surgical process, how long you’ll be away from work and sports, and what to expect for the first 6 months after a rotator cuff repair.
The rotator cuff and shoulder joint
Rotator cuff tears and disease are very common. They often result from ageing and wear and tear. They can also occur as a result of a fall or sporting injury. Impingement of the front of the scapula (acromion), where bone rubs into the tendon is believed to be a major cause of cuff tears in individuals older than 40 years of age.
The rotator cuff is important in stabilising the shoulder joint, enabling shoulder movement, and giving the shoulder and arm power and strength. Four muscles and their tendons constitute the rotator cuff. The rotator cuff attaches the humerus to the shoulder blade and helps to lift and rotate your arm.
Subscapularis is the muscle at the front of the shoulder which helps rotate the arm inwards. Over the top of the shoulder are supraspinatus and infraspinatus, which help elevate or lift the arm. Teres minor is the muscle at the back of the shoulder, which helps rotate the arm outwards.
There is a lubricating sac called a bursa between the rotator cuff and the bone on top of your shoulder (acromion). The bursa allows the rotator cuff tendons to glide freely when you move your arm. When the rotator cuff tendons are damaged or injured, the bursa can become inflamed and painful.
Rotator cuff tear symptoms
Sometimes the shoulder can compensate in the setting of a torn rotator cuff from wear and tear by using the other intact tendons and muscles. This is why we try pain relief, physiotherapy and exercises in the first instance when it’s a long-standing condition.
Unfortunately, some shoulders cannot compensate for the tears and remain painful, weak, and have poor movement despite these non-operative treatments. Shoulder pain at night is worse, especially when you lie on this affected side. This is when surgical rotator cuff repair is contemplated.
Rotator cuff tendon tears cannot heal themselves once they become full thickness or complete tears and require surgical reattachment of the tendon to bone.
When the tear is a result of a new injury or fall, surgical repair results in the best long-term function so this is often recommended by your surgeon as first line treatment. Treating a rotator injury with exercises and pain relief will still leave the shoulder painful and dysfunctional in the long term.
Early repair means that the tendon can be re-attached accurately before the tendon shortens, moves into the wrong place or the muscle becomes replaced by fat.
Rotator cuff tear surgery
Surgical repair of torn rotator cuff tendons helps alleviate pain and restore shoulder movement and strength.
This surgery is done as a day procedure. Being prepared for the day of the surgery and what to expect can by read in my rotator cuff surgery recovery tips guide.
The surgery is performed with a general anaesthetic, however before you are put to sleep, the anaesthetic specialist will perform a nerve block that numbs the entire arm.
This is performed by finding the nerves that supply the shoulder and arm with an ultrasound machine and introducing local anaesthetic around the nerves using a small needle. This means that you require less medications during your anaesthetic to combat pain, which means waking up less nauseous and groggy.
The shoulder should be pain free for a period afterwards. As the block wears off and some pain develops in the shoulder, we can manage this comfortably with tablets. It is common to require some pain relief for about a week after surgery.
Keyhole surgery technique
The surgery itself can be performed using keyhole and minimally invasive techniques. This avoids larger cuts that could potentially cause more pain, infection or delays in shoulder rehabilitation and return to activities. With these keyhole incisions, the tendon is reattached to the bone using anchors and stitches with the help of special arthroscopic instruments.
The aim is to reattach the tendon securely to assist in quicker healing and rehabilitation. Using these advanced techniques, the tendon is secured to bone and tested to ensure that movement and exercises can start promptly.
During the surgery, the inflamed tissue above the rotator cuff tendons which is called bursa is removed. The bursa is a normal structure in the shoulder which helps lubricate the joint and assists in buffering between the bone and rotator cuff tendons. This bursa often is aggravated in shoulder disease and becomes inflamed and painful. Using a special instrument, the bursa is removed using these same keyhole incisions.
The bone above the bursa is also resected to clear the space where the shoulder tendon moves during shoulder movement. This bone can form a spur which digs into and can cause rotator cuff tears itself. The entire shoulder and all its structures will be examined at the time of surgery via the arthroscope to ensure nothing else is affected.
The keyhole surgical cuts are closed with dissolving stitches and covered with small waterproof dressings. This means that you can shower, wash, and bathe as normal immediately after the surgery. The dressings are left intact for two weeks so the small wounds can heal. At the two-week review with your surgeon, the dressings are removed and there is no need for removal of stitches.
You will spend the first 4 weeks after surgery in a sling.
You can take off the sling when resting, showering and doing exercises involved in your rehabilitation. One of our physiotherapists will see you before your discharge to teach you the exercises you need to perform immediately to start the rehabilitation of your shoulder.
After rotator cuff surgery
After rotator cuff repair is performed you will leave the hospital on the same day. Your shoulder should be numb and pain free and you will be in a sling.
You should start taking tablets for pain relief later that day, before the shoulder block wears off. So, when some feeling returns in the shoulder, the pain should be manageable and you should remain comfortable.
Rotator cuff tears can cause difficulties with sleeping because of pain. After surgery to repair the tear and clean out the shoulder, your pain will settle down and should improve to give you a good night’s rest. The pain is often worsened as a result of the inflamed bursa and will settle down after its removal during the operation.
Depending on your job responsibilities, your surgeon will discuss with you on a timeline to return to work. You are more likely to return to work faster at a desk job than a job that requires physical labor that involves lifting.
Week 4
Your arm will remain in a sling for 4 weeks but you can take it off to do exercises, shower, and when resting at home. You cannot drive a car for the first 4 weeks at a minimum.
Week 6
After the first 4 weeks, you need to be comfortable enough, have adequate movement, and some strength before you can return to driving, which usually takes about 6 weeks.
Rehabilitation
You’ll need rehab after rotator cuff surgery. This will start at 1 to 4 weeks and lasts 4 to 6 months. You cannot drive a car for 6 weeks, and it may take 4 weeks to return to work if you have a desk job. If you have to lift at work, you’ll need to wait at least 3 months.
Rehabilitation plays a vital role in getting you back to you daily activities. A physical therapy program will help you regain your shoulder motion and strength.
Phase 1: 0-4 weeks
The goals here are to:
- Reduce pain
- Protect the surgical repair of the tendon
- Optimize tissue healing
- Maintain and regain range of motion
- Minimise muscle inhibition
During this phase, the physiotherapists will teach you to move your shoulder passively up to shoulder height (90 degrees) and rotate outwards to 20 degrees. With passive exercises, your therapist will teach you how to support your arm whilst moving it to these limits. At this time, some basic and gentle shoulder strengthening exercises should be done.
You should perform these exercises a few times per day, out of the sling. These exercises should be within comfort levels and prevent the shoulder from becoming stiff, whilst still protecting the repaired tendon.
Phase 2: 4-8 weeks
The goals during this phase include:
- Discard the use of the sling
- Preserve the integrity of the rotator cuff repair</li
- Restore functional range of movement including full elevation
- Re-educate cuff recruitment and scapular control during range of movement
- Re-educate sensorimotor/proprioceptive function
During this phase, exercises are focused on improving your range of movement, introducing active movements where the muscle and tendon are activated whilst teaching your tendon and muscle to regain strength and function. Hydrotherapy (water exercise program) is highly encouraged during this phase.
Phase 3: 8 weeks onwards
The goals during this phase include:
- Restore full range of movement
- Establish optimal neuromuscular control of shoulder girdle musculature
- Restore optimal cuff and scapular control through range and under load
- Optimise function specific power, strength and endurance
- Transference movement pattern correction and cuff/scapula control to functional tasks
- Return to work, sports and recreational activities
By 8 weeks the tendon healing is strong enough to allow more movement and strength exercises. It is during this extended phase that full active movement is achieved and shoulder power and strength can be attained.
More importantly, once you have enough strength and movement you can return to physical movement at your job, sporting, and recreational activities.
4 – 6 Months
The full result from rehabilitation often takes between 4 to 6 months after surgery to achieve end range strength, power, and endurance. These final stages are important to achieve to ensure that you don’t suffer these injuries into the future. Although it is a slow process, your commitment to rotator cuff rehab is key to a successful outcome.
