rotator cuff

What to Expect in Your Recovery After Shoulder Rotator Cuff Repair Surgery

Michael Fu, MD

Shoulder Rotator Cuff Repair Surgery

Shoulder rotator cuff repair surgery is a common procedure aimed at fixing tears of the rotator cuff, a group of muscles and tendons that surround the shoulder joint. These tears can result from acute injury or chronic degeneration and can lead to pain, weakness, and decreased range of motion in the shoulder. The recovery process is crucial for regaining full function and involves several stages, including immobilization, physical therapy, and gradual return to activities. This article will discuss what patients can expect during the recovery period following shoulder rotator cuff repair surgery.

Immediate Postoperative Period

Patients typically go home the same day after surgery. The first few days after surgery are focused on pain management and protecting the repair. Patients will typically leave the hospital with their arm in a sling to immobilize the shoulder and promote healing. Pain is managed with cold therapy, either through ice packs or a cold therapy machine, as well as medications including acetaminophen and opioids for short-term use.

It's essential to follow our instructions on wound care to prevent infection. This includes keeping the surgical area clean and dry and watching for signs of infection, such as increased redness, swelling, or discharge from the incision site.

Early Recovery Phase (Weeks 1-6)

During the early recovery phase, the primary goals are to reduce inflammation and begin gentle movements to prevent stiffness without compromising the repair. The sling remains a critical component of recovery, and its use is required for approximately 6 weeks. During this time, patients often feel more comfortable sleeping sitting up a bit, either in a recliner or on a wedge in bed. Patients are able to use their hand for gentle work on a computer or phone.

Physical therapy often starts at two weeks after surgery with passive exercises. A physical therapist will move the arm for the patient to help maintain joint mobility without using the repaired muscles. These exercises gradually progress to active-assistive exercises, where the patient starts to engage the muscles but with assistance.

Intermediate Recovery Phase (Weeks 6-12)

As healing progresses, the focus shifts to regaining strength and mobility. The sling is typically discontinued during this phase, and patients begin more active exercises. These exercises aim to strengthen the shoulder muscles, improve flexibility, and increase the range of motion. It's important to progress gradually and avoid activities that put too much stress on the repaired tendon.

Physical therapy becomes more intensive, incorporating resistance training and exercises that mimic daily activities. Patients may also start using light weights or resistance bands under the guidance of their therapist.

Late Recovery Phase (Months 3-6)

The late recovery phase is where significant improvements in strength and function are expected. Patients continue to advance in their exercises, focusing on strengthening the entire shoulder complex to support the repaired rotator cuff. Activities become more challenging, and the intensity of workouts increases, always under the supervision of a healthcare professional.

During this period, patients may begin to return to activities such as running and swimming, but with caution. It's essential to listen to the body and avoid overdoing it, as the tendon is still healing and strengthening.

Full Recovery (6 Months to 1 Year)

Full recovery from rotator cuff repair surgery can take anywhere from 6 months to a year, depending on the severity of the tear, the patient's overall health, and adherence to the rehabilitation program. By this stage, most patients experience significant improvement in pain, strength, and function. However, it's crucial to continue with strength and flexibility exercises to maintain shoulder health and prevent future injuries.

Factors Affecting Recovery

Several factors can influence the recovery process, including the size of the tear, the quality of the tendon tissue, the patient's age, and their overall health. Smokers and patients with certain health conditions, such as diabetes, may experience slower healing times.

Adherence to the rehabilitation program is perhaps the most critical factor in successful recovery. Patients who closely follow their physical therapist's and surgeon's instructions typically see the best outcomes.

Conclusion

Recovery from shoulder rotator cuff repair surgery is a gradual process that requires patience, dedication, and adherence to a comprehensive rehabilitation program. While the journey can be challenging, most patients can expect to return to their daily activities and enjoy a significant reduction in pain and improvement in shoulder function. It's important to maintain realistic expectations and communicate regularly with the healthcare team to address any concerns and adjust the recovery plan as needed. With the right approach, patients can achieve a successful recovery and regain a good quality of life.


About the Author

Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS) in New York City (NYC) and New Jersey (NJ), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu is an expert at shoulder rotator cuff repair surgery, shoulder instability surgery, and shoulder replacement. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.

Journal Club - Return to Sport After Rotator Cuff Repair

Michael Fu, MD

Journal Club is a recurring series where we highlight the latest orthopedic shoulder research, and discuss potential applications and ramifications for our patients.

Title

Return to sport after rotator cuff tear repair: A systematic review and meta-analysis

Authors

Shahnaz Klouche, MD, Nicholas Lefevre, MD, Serge Herman, MD, Antoine Gerometta, MD, Yoann Bohu, MD

Journal

American Journal of Sports Medicine. Volume 44, Issue 7. August 27, 2015.

Abstract

Background

One of the most frequent demands from athletes after rotator cuff tear repair is to return to sport, if possible at the same level of play.

Purpose

The main goal of this study was to determine the rate of return to sport after treatment of rotator cuff tears.

Study Design

Meta-analysis and systematic review.

Methods

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed to perform this systematic review and meta-analysis of the results in the literature, as well as for the presentation of results. A search of the literature was performed on the electronic databases MEDLINE, Scopus, EMBASE, and the Cochrane Library. The quality of the included studies was evaluated according to the MINORS (Methodological Index for Nonrandomized Studies) checklist. Inclusion criteria were studies in English evaluating return to sport after treatment of traumatic, degenerative, partial or full-thickness rotator cuff tears in patients practicing a sport regularly, whatever the level, all ages and sports included. The main judgment criterion was the number of patients who returned to a sports activity after treatment of a rotator cuff tear. The criterion was analyzed in 2 ways: return to sport (yes/no) and the level of play (identical or higher/lower level).

Results

Twenty-five studies were reviewed, including 859 patients (683 athletes), all treated surgically after a mean follow-up of 3.4 years (range, 0.3-13.4 years). The level of sports was recorded in 23 studies or 635 (93%) athletes and included 286 competitive or professional athletes and 349 recreational athletes. The most commonly practiced sports were baseball (224 participants), tennis (104 participants), and golf (54 participants). The overall rate of return to sport was 84.7% (95% CI, 77.6%-89.8%), including 65.9% (95% CI, 54.9%-75.4%) at an equivalent level of play, after 4 to 17 months. Of the professional and competitive athletes, 49.9% (95% CI, 35.3-64.6%) returned to the same level of play.

Conclusion

Most recreational athletes return to sports at the same level of play as before their injury, but only half of professional and competitive athletes return to an equivalent level of play.

Keywords

Return to sport, rotator cuff tear repair, professional athletes, systematic review, meta-analysis


Discussion - Return to Sport After Shoulder Rotator Cuff Repair Surgery

The shoulder joint is a complex structure that includes bones, ligaments, tendons, and muscles, which provide the joint with incredible range of motion and function. This range of motion, however, comes at the expense of inherent joint stability. Compared to the hip joint, for example, the bony socket of the shoulder (glenoid) is much smaller and flatter, thus providing much less bony stability.

To compensate for this lower degree of static shoulder stability, the rotator cuff provides significant dynamic stability to the shoulder joint. The rotator cuff is a set of four muscles and tendons that surround the ball and socket of the shoulder, and acts to pull the head into the socket, thus keeping it stable and centered through shoulder function. The rotator cuff is also an initiator of a number of critical shoulder movement as well, such as lifting your arm away from the body, reaching behind your back, and external rotation.

As detailed in our rotator cuff tear page, through a combination of intrinsic and extrinsic factors, rotator cuff tears are a common cause of shoulder dysfunction. Symptoms often include significant pain, weakness, loss of range of motion, and sleep disturbance. These symptoms affect patients’ ability to participate in sports and other recreational activities as well. Unfortunately, if symptoms persist despite non-operative treatments such as physical therapy, injections, rest, and pain medications, surgery to repair the rotator cuff and other structures in the shoulder may be necessary.

Intra-operative image during shoulder arthroscopic rotator cuff repair surgery.

During rotator cuff repair surgery, the torn tendon is compressed against the bone using sutures and anchors. To achieve a good, lasting outcome after surgery, however, requires biological healing to occur between the bone and the tendon. This healing process occurs uneventfully for most patients, but for some, the tendon fails to heal after surgery, and the risk of failure is associated with factors such as older age, osteoporosis, more chronic tears, re-injury, smoking, and diabetes, among others.

In our practice, many of our patients undergoing shoulder rotator cuff repair are recreational or competitive athletes. One of the most important discussions we have before surgery resolves around the probability of being able to return to their activities and sports after surgery.

The study highlighted above provides useful data to help guide these surgical discussion. In this meta-analysis of 859 patients treated for rotator cuff tears, the authors found that 84.7% of patients were able to return to sport, with 65.9% able to return to their previous level of play. Among higher level competitive and professional athletes, however, there was a lower rate (49.9%) of patients returning to their previous level of sports.

Whether someone is able to return to sport after rotator cuff repair surgery is based on a number of different factors, including surgical factors as discussed previously, as well as the specific sports and activities that the patient wants to return to. From a surgical standpoint during rotator cuff repair, if the tendon quality is poor and the patient is hoping to return to high level sports, we may consider augmenting the tendon repair with allograft, which is tissue from an organ donor. Physical therapy also plays a critical role, initially with regaining range of motion and strength, and then more importantly helping patients achieve sport-specific function.


About the Author

Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS) in New York City (NYC) and New Jersey (NJ), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu is an expert at shoulder rotator cuff repair surgery, shoulder instability surgery, and shoulder replacement. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.

In the News - Delaying Rotator Cuff Surgery for 12 Months or Longer May Double the Odds of Needing Revision Surgery

NEW YORK, Oct. 19, 2020 /PRNewswire/ -- Delaying surgery for 12 months or more after a rotator cuff tear diagnosis is associated with almost twice the odds of needing a subsequent revision surgery compared to having surgery between six weeks and one year after diagnosis, according to a retrospective study of records from thousands of patients across the United States by investigators at Hospital for Special Surgery (HSS).

The revision rate for patients with rotator cuff tears who delayed surgery for 12 months or more was 15.2 percent, versus 9.9 percent for those who had surgery within six weeks and 8.3 percent for those who received surgery within the routine period of six weeks to 12 months of diagnosis.

Arthroscopic rotator cuff repair

Arthroscopic rotator cuff repair

"Patients who have not responded to non-operative approaches for rotator cuff tears frequently ask how long they can delay surgery," says Michael C. Fu, MD, MHS, a sports medicine surgeon at HSS and lead author of the study. "Our research was designed to investigate the relationship between delaying surgery and the need for subsequent revision due to failure of the initial rotator cuff repair." The study was published online first on October 1 in the journal Orthopedics.

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About the Author

Michael Fu Head Shot (1).jpg

Dr. Michael Fu is an orthopedic surgeon and shoulder specialist at the Hospital for Special Surgery (HSS), the best hospital for orthopedics as ranked by U.S. News & World Report. Dr. Fu treats the entire spectrum of shoulder conditions, including rotator cuff tears, shoulder instability, and shoulder arthritis. Dr. Fu was educated at Columbia University and Yale School of Medicine, followed by orthopedic surgery residency at HSS and sports medicine & shoulder surgery fellowship at Rush University Medical Center in Chicago. He has been a team physician for the Chicago Bulls, Chicago White Sox, DePaul University, and NYC’s PSAL.

Disclaimer: All materials presented on this website are the opinions of Dr. Michael Fu and any guest writers, and should not be construed as medical advice. Each patient’s specific condition is different, and a comprehensive medical assessment requires a full medical history, physical exam, and review of diagnostic imaging. If you would like to seek the opinion of Dr. Michael Fu for your specific case, we recommend contacting our office to make an appointment.