The timeline for beginning physical therapy will be dictated by your surgeon, and is dependent on the size and extent of your tear, the quality of the surrounding tissues, and the degree of surgical repair that was performed during the procedure. Sometimes, this means gentle, passive motion within a few weeks of surgery, but, in most circumstances, physical therapy and shoulder motion is not started until 4-6 weeks after surgery. You’ll begin with passive movements, and slowly increase the intensity as you heal and get stronger.
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What is rotator cuff surgery?
If you have shoulder pain and been diagnosed with a rotator cuff injury, the course of action your physician will recommend depends on the severity of the injury. For milder injuries, you may simply need to rest the shoulder. However, if you have a rotator cuff tear, surgery to repair or replace tendons connecting your arm to your shoulder may be necessary.
Your physician will explain various nonsurgical and surgical options for treating your rotator cuff injury. Surgical procedures to fix a torn rotator cuff include:
Arthroscopic tendon repair
This minimally invasive surgery for rotator cuff repair involves inserting a tiny camera, called an arthroscope, into a small incision to examine your internal shoulder structures in depth. Your surgeon then repairs the torn tendons through your arthroscopic incision using small, precise surgical tools. Unless more invasive surgery is required, shoulder arthroscopy for rotator cuff repair is an ideal option because recovery is faster and pain is typically milder.
Open tendon repair
If you have a more significant or complicated tear to your rotator cuff, your surgeon may need to make a larger incision to get a clearer view of the injury. Recovery time from this procedure is typically longer than it is for arthroscopic rotator cuff repair. The healing period can vary based on your overall health and how strictly you adhere to physical therapy.
Shoulder replacement
Your surgeon may perform a partial or total shoulder replacement for a severe injury they can’t correct through other methods. Various shoulder replacement procedures include:
- Total shoulder replacement: This procedure may be necessary for significant shoulder damage. In this case, your surgeon replaces the shoulder joint’s ball and socket.
- Partial shoulder replacement: Unlike a total shoulder replacement, this process involves replacing only the damaged portion of the joint. Your surgeon will replace the damaged area while preserving the healthy section.
- Reverse shoulder replacement: This type of rotator cuff replacement surgery can be highly effective when rotator cuff tendons can’t be repaired and severely affect your shoulder joint. In a reverse procedure, your surgeon reverses the position of the ball and socket, allowing your deltoid muscle to control arm movement instead of the rotator cuff.
When not to have rotator cuff surgery
Like any surgical procedure, rotator cuff surgery comes with risks and potential post-procedure complications. If you have other medical conditions, such as cardiovascular disease, uncontrolled diabetes, or a weakened immune system, you may not be a suitable candidate for surgery. Your physician may also advise against rotator cuff surgery if you’re of advanced age.
Nonsurgical treatment of rotator cuff injuries
Not all rotator cuff injuries require surgery. If the damage is minimal and caught early, your physician may recommend noninvasive treatment methods to reduce inflammation and alleviate pain.
Physical therapy
Your care team may advise physical therapy before resorting to rotator cuff surgery. A physical therapist can tailor exercises to your injury to restore your shoulder’s strength and range of motion. If nonsurgical treatment fails to resolve your problem and you undergo surgery for a torn rotator cuff, a physical therapy regimen can also help after the procedure as you heal.
Steroid injections
If shoulder discomfort significantly impacts your day-to-day routine and sleep, an injection can alleviate the pain. Keep in mind that steroid injections typically only offer temporary relief and don’t repair or heal rotator cuff tears. They can also weaken the structures surrounding your shoulder joint, negatively affecting post-surgery healing if you eventually elect to undergo a surgical procedure.
Medication management
In certain instances, you may be able to manage your shoulder discomfort with over-the-counter pain medications or nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and acetaminophen.
How much does rotator cuff surgery cost?
The average cost of shoulder surgery in the U.S. is around $16,000, but costs can vary significantly depending on where you live. Many insurance plans, such as Medicare and Medicaid, cover the cost of rotator cuff surgery when it’s mandatory.
How to prepare for rotator cuff surgery
Recovering from surgery for a torn rotator cuff can take several months, so being prepared upfront can help make your recovery period easier. Follow these steps as you prepare for surgery:
- Meet with your surgeon: You’ll need to consult with a surgeon before deciding whether surgery is the best treatment option for alleviating your shoulder pain. Your surgeon will discuss the procedure with you in detail and make you aware of potential risks and expected outcomes. They’ll also address any questions and concerns you have, so you may want to be prepared for this conversation with a list of your questions.
- Adjust your medications: A couple of weeks before your procedure, your surgeon may advise you to adjust the medications you currently take, or to stop them temporarily. Medications are adjusted temporarily because they could interfere with anesthesia. These types of medications include, among others, blood thinners and anti-inflammatory drugs. If you’re unsure about any adjustments, make sure to follow up with your doctor.
- Adhere to pre-surgery therapy: Follow all physical therapy instructions your care team has given you, to ensure you’re at your strongest during your procedure.
- Arrange for assistance: After rotator cuff surgery, your mobility will be limited. Make sure you have someone who can drive you home from the hospital and assist you with daily tasks as you recover, including grocery shopping, housecleaning, and picking up prescriptions.
- Prepare mentally: Getting in a good head space before surgery can help alleviate stress and anxiety as you approach your surgical procedure. Setting expectations and clarifying any points of confusion about the process are great ways to keep yourself calm. Practicing self-care and meditation, along with other relaxation techniques, can help build resilience and reduce discomfort and unease.
What happens during rotator cuff surgery
On the day of your surgery, bring any medical and insurance information and arrange for a loved one to accompany you. Follow all presurgical instructions your care team has given you, including guidance on when to stop eating, drinking, and taking medications.
Before undergoing anesthesia, your care team will take all your vital signs and answer any last-minute questions you may have. You’ll then get prepped for surgery.
How long does rotator cuff surgery take?
Rotator cuff surgery is an outpatient procedure. Unless your surgeon encounters unexpected complications, you can expect surgery to take from one to three hours.
How long does it take to recover from rotator cuff surgery?
Your recovery generally depends on factors like the type of procedure, the extent of the damage, and your overall health. Most people who have rotator cuff surgery regain their strength and mobility within four to six months. Recovery times tend to be longer if you’re over 65 or don’t adhere to your surgeon’s post-surgery rehabilitation instructions.
You’ll typically be able to go home the same day as your procedure. Your shoulder will likely be sore and swollen for several days. You may also have to wear a sling for the first few weeks to keep your arm and shoulder immobilized.
You’ll have a limited range of motion for the first two to six weeks after surgery. Your physician or physical therapist may recommend stretching exercises involving your elbow, wrist, and hand, but you won’t be able to move your arm forward, back, or away from your body.
How long pain persists following rotator cuff surgery depends on factors like how traumatic the injury was, the type of surgery, your age, and whether you participated in physical therapy before the procedure. You’ll experience the most significant pain within the first 48 hours as the anesthesia wears off. After a week or so, you should feel some relief, and the pain level will gradually decrease over the next few months.
To ensure your rotator cuff repair heals correctly, your physician will explain the steps required to recover. These directions include things to avoid, such as the following:
- Never remove your sling until your surgeon says it’s okay.
- Don’t skip physical therapy sessions.
- Avoid raising your arm above your head or behind you until you are told it is ok to do so.
- Adhere to the weightlifting limit recommended by your surgeon.
- Don’t jump back into physical activities too soon, and, once your surgeon or physical therapist clears you to resume activities, go easy at first.
- Avoid sleeping on the affected side for at least six weeks.
- Don’t take anti-inflammatory or pain medications unless prescribed by your physician.
FAQs about rotator cuff surgery
Only around 20% of people with rotator cuff tears typically require surgery to correct the problem.
It’s typical to experience some pain immediately following rotator cuff repair surgery. Your physician can prescribe medication to help manage the pain. Applying ice to the area can also alleviate discomfort caused by swelling and inflammation.
Your physician will likely recommend keeping your surgical incision from being submerged in water for several days following your procedure. Some surgeons recommend the use of a shower chair for stability; a detachable shower nozzle, so you can better direct the flow of water away from your incision area; and either waterproof bandages or a plastic bag and tape to cover the healing incision. Pump soap is also recommended, as you’ll be showering with one arm, and it is easier to dispense and use pump soap than a squeeze bottle or bar soap.
You’ll have to wear a sling for about four to six weeks after rotator cuff surgery. You can remove the sling while doing range-of-motion exercises, bathing, and dressing. Your care team will give you instructions on how to sleep after rotator cuff surgery. They’ll advise wearing the sling when you go to bed to keep your shoulder stable while you sleep. You’ll also want to sleep propped up at an angle, as this will reduce strain on the shoulder joint.
