Shoulder injuries are some of the most common injuries an adult can have. Athletes that put frequent stress on their shoulders, such as swimmers or weightlifters, can be impacted by strains or tears in the rotator cuff. But shoulder injuries aren’t exclusive to athletes. People who have jobs that frequently require an overhead motion, like stocking shelves or working in construction, can also be affected.
If you are experiencing rotator cuff pain, more likely than not, your doctor has recommended a combination of rest, physical therapy, anti-inflammatory medicines and/or steroid injections. All of these are common treatments to help alleviate shoulder pain. But, if your injury is too great or these treatments are continually ineffective, it may be time to see if rotator cuff surgery is right for you.
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What is the Rotator Cuff?
Think of all the times you’ve raised your hand over your head. You’ve likely done it thousands upon thousands of times throughout your life—raising your hand in school, reaching for something on a shelf or doing some kind of overhead motion as you exercise.
The rotator cuff is what allows you to do this. The rotator cuff is a combination of muscles and tendons that hold the shoulder together. It centers the upper arm bone’s head, “the golf ball” on the shoulder blade, “the tee”, and allows you to effortlessly lift your arm. It is one of the most important parts of your shoulder, if not the most important.
Common Rotator Cuff Injuries
Common types of injuries include rotator cuff tendonitis or rotator cuff tear. While tendinitis can be treated with treatments such as anti-inflammatories, ice/heat and rest, a rotator cuff tear can sometimes require surgery.
If you are experiencing shoulder pain, whether gradual or sudden because of an injury, a physician will help determine what type of care is more appropriate for you. They will perform a physical assessment, checking your range of motion, before moving onto further tests. If an injury is suspected, they may order an X-ray, MRI or ultrasound to determine the damage and its severity.
More likely than not, your doctor will recommend other avenues before suggesting operating. But, if you have torn your rotator cuff, which occurs when one or more of the rotator cuff tendons are no longer attached to the appropriate bone, your doctor may recommend surgery.
Determining if Rotator Cuff Surgery is Right for You
Even if your doctor has suggested surgery, it is important to be an advocate for your own health. What to do before rotator cuff surgery? Ensure that you feel comfortable and confident going into the surgery by asking your physician the right questions.
Some good questions for you to ask your surgeon include:
- Are there any alternatives to this surgery?
- What are the risks of not performing this surgery?
- How long will recovery take?
- How many times do you do this procedure every year?
- What are the risks of this surgery? What is your complication rate?
The final two items on this list are especially important to ask. Shoulder surgeons perform rotator cuff repairs much more frequently than a general orthopedic surgeon, who may only do them occasionally. This also means that an experienced surgeon usually has a lower complication rate, which means you’ll be on the road to recovery as soon as possible.
Preparing for Rotator Cuff Surgery
If you have decided that rotator cuff surgery is right for you, then your physician will determine the type of surgery you need. There are two primary types of shoulder surgery:
- Arthroscopic Surgery: In this procedure, your surgeon will make a small incision for a camera and light and then perform the shoulder repair using miniature surgical instruments through another small incision. NOTE: This type of surgery is more common than open surgery.
- Open Surgery: In this procedure, your surgeon will make a larger incision and perform the surgery with standard surgical tools and equipment. This is a more invasive procedure and is primarily used if your injury is larger or more complicated.
Your care instructions may vary depending on what type of surgery you have, so follow the specific post-care instructions that your doctor gives you.
Before the date of your surgery, your physician will talk about what to expect and share a list of pre-surgery instructions with you. This list may vary from patient to patient, so use the one given to you by your doctor.
While preparing for rotator cuff surgery, you’ll want to consider:
- Discontinuing the use of certain medications or supplements. Medications like ibuprofen, aspirin and naproxen can make blood clotting difficult.
- Checking in with your other physicians, such as those that treat your other medical conditions like heart disease or diabetes.
- Contacting someone to assist you with normal day-to-day activities after your surgery, especially if you live alone.
- Following all instructions on when to stop eating and drinking.
- Adequately adjusting your living area to make regularly handled items are in easy to reach locations.
Your doctor may also suggest discussing rehabilitation with your physical therapist before the operation as well as what to expect after the surgery is complete.
What to Expect After Rotator Cuff Surgery: Recovery From Rotator Cuff Surgery
You will feel tired for a few days after the procedure, so be sure to get plenty of rest. Your normal sleeping position may be difficult for you; if this is the case, many patients find that a semi-upright position works best for them.
If you have a recliner chair, this may be a good place for you to sleep for the first few days after your surgery. Otherwise, propping yourself up with pillows is a good solution. Whatever position you choose, it is also recommended to place a pillow behind the healing arm to provide support and prevent against a sore shoulder in the morning.
In addition to soreness, the affected shoulder will be swollen, and you may notice similar swelling in your hand and arm. This is all normal and will begin to get better within a few days. Regularly opening and closing your hand as well as moving your wrists will help with the swelling. Icing your shoulder will help as well.
Take your pain medications exactly as your doctor has prescribed them, and don’t wait for your pain to become severe. Take your medication at the first sign of pain so that it will be fully in effect before the pain intensifies.
Lastly, your arm will be in a sling to prevent it from moving around too much after surgery. You’ll likely have to wear this for several weeks, and you may need help doing daily activities for a few days, such as getting dressed or preparing meals. Make sure you make plans to have someone help you until you’ve had some time to heal.
If you have recently gone through a rotator cuff surgery, the experts at ATI have provided some helpful tips for pain management and recovery.
Physical Therapy After Rotator Cuff Surgery
Once the surgery is over and you’ve had some time to recover, there’s no doubt that you’ll be looking forward to getting back to normal. However, rotator cuff surgery recovery time can take six months or more.
There are four primary phases of this recovery period:
- Phase 1 – Passive Motion: This phase typically lasts 6 weeks. Since the muscles and tendons are unable to move on their own, a physician or physical therapist will provide support through passive motion.
Passive motion means that the provider will methodically move your shoulder for you rather than having you try to do it on your own. Your provider will also educate you on how to properly move your shoulder without engaging your rotator cuff muscles. - Phase 2 – Active Motion: The second phase is 6-12 weeks from the surgery date. With the guidance of your physical therapist, you will begin moving your shoulder on your own and performing home exercises. During this phase you will work towards increasing your range of motion, reducing shoulder stiffness and improving motor control.
- Phase 3 – Strengthening: Arguably the most important phase, strengthening typically occurs 12-16 weeks post-surgery. Again, your therapist will guide you through resistance band and light weight training to develop and strengthen your muscles in addition to your at-home exercises.
- Phase 4 – Full Activity: It can take four to six months to reach this final phase. Many things can impact your rotator cuff surgery recovery time including the severity of your injury, surgery outcomes and your commitment to your physical therapy after rotator cuff surgery.
Rotator cuff surgery recovery looks different for everyone, so don’t get discouraged if it takes you a little more time to reach Phase 4. In addition, it is important to remember to not do too much during the rotator cuff surgery recovery process. Overexerting yourself to heal faster can cause more damage.
Exercises After Rotator Cuff Surgery
Physical therapy after rotator cuff surgery plays an enormous role in recovery. As was already mentioned, your muscles will weaken after your procedure, so the only sure way to get to Phase 4 is with a proper treatment plan.
Your physical therapist will be able to customize a plan specifically for your situation. They will then guide you through the proper exercises in accordance with that plan. While during the first phase, you will work strictly with your therapist. Once you have moved on to Phase 2, your therapist will likely give you a few exercises that you can do at home in between your sessions.
Here are three common exercises to help after rotator cuff surgery:
1. Assisted Shoulder Flexion
This exercise should be done either lying down or sitting in a chair with a back. Interlace your fingers together and lift your arms over your head with your elbows as straight as possible. Hold this for around ten seconds and then low your arms slowly. Repeat ten times, three times per day.
2. Walk-Up Exercise
You’ll need a wall or door frame for this. Place your hand against the wall or frame at about chest height with your elbow straight. Use your fingers to walk up the surface as far as you can, then hold for ten seconds. Repeat five to ten times, three times per day.
3. Circular Pendulum
For this exercise, the only thing you may need is a sturdy surface you can hold on to with your free hand for stability. Bend forward at the waist 90 degrees and let your recovering arm hang limply under you. Rock your body in a circular motion to move your arm.
Move it clockwise ten times, and then counterclockwise ten times, three times per day. Your arm should be as relaxed as possible throughout the exercise, with the movement happening through your shoulder joint.
Physical Therapy After Rotator Cuff Surgery is Vital
Rotator cuff repair is no small thing, and you need to have a plan before your surgery, immediately after and throughout your rehabilitation. Your physical therapist will play a key role in this, helping you from phase to phase and ensuring you’re doing the proper exercises to get back to your normal range of motion.
Let us be a part of your rotator cuff surgery recovery. Visit our website to learn more about ATI Physical Therapy and to find a physical therapist near you so you can get the rehabilitation services you need.