When you first get home, you will have a large bulky dressing on the shoulder. Do not get this wet. Do not change the dressing, we will do this for you at your first appointment 3-4 days after the surgery. Then, typically we put band aids on the poke holes and allow you to shower over the band aids. Sponge baths until then!
Although arthroscopic rotator cuff repair has revolutionized shoulder surgery, allowing evaluation and repair of multiple structures thru a minimally invasive approach, it is, regrettably, not magic. The surgery eliminates bone spurs and re-attaches the torn tendon or tendons back down into the bone but good healing of the tendon down into the bone is required for good long term results. This is the rate-limiting step of the operation and good function and pain relief are dependent on the degree of healing and the quality of the tendon. In other words, a small, recent tear in a healthy individual will heal sooner and better than a huge, chronic, atrophied tear in a patient in poor health. We know from our research that tendon healing down into the bone takes at least 4 months and patients continue to improve up to a full year after surgery. The surgeon typically sees you monthly as you heal. The therapist sees you 2-3 times/week however, and reports your progress to the surgeon.
Protection of the repair is important during healing. During the first 4-6 weeks following surgery a sling is worn to protect the arm. Our physical therapists will instruct you in passive range of motion exercises to perform during this time. “Passive” means that you don’t fire any muscles to move the shoulder–you can move it with the other arm, the therapist can gently stretch it, or it can hang to do pendulum exercises. Passive range of motion exercises can be viewed in a video by clicking the link below:
After 4-6 weeks we wean you out of the sling over a 1-2 week period. This means you can take the sling off while sitting around or relaxing, increasing your time out of the sling until you are completely free of it. You can sleep out of the sling after 4 weeks from surgery. At this point, our therapists will allow some gentle active range of motion exercises, (see video)
The next phase of rehabilitation is gentle strengthening of the shoulder muscles and rotator cuff. Since these are small muscles, only small weights or rubber resistance bands are required. If you are used to heavy weight lifting, these can seem ridiculous at first but after proper instruction by the physical therapist you will understand the rationale. Typical strengthening exercises are shown in the videos section.
It must be stressed that compliance with the post-operative care is just as important as the surgery. The therapist works closely with the surgeon to modify the rehab protocol based on the size of the tear, the quality of the tissues, and the patient’s progress. We prefer to use our own therapists, if possible, as they have extensive experience in rehab of rotator cuff surgery.