Hopefully you never have been – and never will be - diagnosed with a rotator cuff tear. Generally speaking, they’re a real challenge to get over and have a huge impact on your daily life.
Contrary to what you may hope for, cuff tears do not heal without surgery. In fact, the natural history for these tears is to progress over time, possibly resulting in catastrophic loss of arm function and pain that accompanies most routine activities involving the use of your arm.
Surgery is frequently recommended to those patients who have persistent pain and struggle with normal daily activities. But while surgery might be a necessary part of the healing process, setting realistic expectations for the months following surgery should have equal weight.
If a rotator cuff repair surgery is in your future, read on to see what you can expect while on the road to recovery: You’ll need to sleep in a recliner for a few weeks or more after surgery. This helps maintain the shoulder in an optimal healing position, but more importantly, it prevents pain. Lying flat on your back will cause the shoulder to slide into extension – essentially shearing the repair site and causing pain.
The sling won’t come off for at least four weeks, and maybe six depending on the preference of your surgeon. The sling serves as a protective device to prevent the musculature in your shoulder from activating and tugging at the integrity of the repair. Taking it off prematurely could gravely jeopardize your chances of healing and could ultimately result in a second surgery.
Expect high levels of pain after surgery. Rotator cuff repairs are notoriously uncomfortable – and for good reason – the cuff is loaded with millions of nerve endings that are sensitive to any mechanical changes in their environment.
Plan on attending physical therapy for a minimum of three months. Most patients require four to six months before full resolution of the problem is achieved. A word of warning – those patients that have irregular attendance or a poor work ethic at home are likely to have a less favorable outcome, so work hard during your rehab to ensure you recover fully.
It will be about two months before your arm can elevate over your head. That’s about how long it takes to restore most of your active motion. Lifting things overhead is a different story, however, and that function normally returns around the three to four month mark.
Older patients do just as well as younger ones. There are always tissue considerations to factor in, but on the average, patient self-reported outcome surveys for those who have surgery and finish rehab are excellent across the board. In the absence of either surgery or conservative therapy, outcomes are not as good unfortunately, and patients who chose to manage it on their own have far less than fifty percent satisfaction with the quality and health of their shoulder. It takes one full year before your arm feels like it’s yours again. Even after therapy is finished, it takes a little while before you’re comfortable performing all of the activities you used to – so don’t panic – traditionally, rotator cuff rehab has always been a slow process.
Gloucester resident Joe DiVincenzo is a physical therapist and clinical specialist in manual therapy. He writes “On the Mend” weekly. Questions may be submitted to Joe by email at firstname.lastname@example.org.