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🏥 Recovery Guide2024-01-17

Rotator Cuff Repair Recovery: Week-by-Week Guide

Recovery from rotator cuff repair requires patience — full healing takes 6–9 months. This guide covers your sling protocol, physical therapy phases, pain expectations, and when to return to activity.

Educational content only. This article is not medical advice. Always consult a qualified orthopedic surgeon or physician for diagnosis and treatment.

Recovery Overview

Rotator cuff repair recovery is one of the longer orthopedic recoveries because tendon-to-bone healing is inherently slow — the repair must be protected while new vascular tissue grows into the tendon attachment. Moving too aggressively too soon risks re-tear.

General timeline:

  • Sling use: 4–6 weeks
  • Passive motion phase: 0–6 weeks
  • Active-assisted motion: 6–10 weeks
  • Strengthening begins: 10–16 weeks
  • Return to sport/overhead: 4–6 months
  • Full healing: 6–9 months

Night 1: Managing the Nerve Block Wear-Off

The interscalene nerve block typically lasts 12–18 hours. As it wears off overnight, pain increases significantly. This is the most critical night of recovery.

  • Take your prescribed pain medication BEFORE the block wears off, not after
  • Ice the shoulder continuously
  • Sleep in a recliner or propped up in bed — lying flat increases shoulder swelling and pain
  • Have all medications, ice, and water within reach before you go to sleep
  • Have someone available to assist you

Weeks 1–2: Sling and Pain Management

  • Wear the abduction sling 24 hours a day, including during sleep
  • Only remove sling for hygiene (bathing, dressing) and prescribed exercises
  • Prescribed exercises typically begin day 1 at home: Pendulum exercises — leaning forward and letting the arm swing freely by gravity; grip squeezing; elbow flexion/extension
  • Gentle wrist and hand exercises to prevent stiffness
  • Ice for 20 minutes, 4–5 times daily
  • Begin weaning narcotics by week 2; transition to scheduled NSAIDs and acetaminophen
  • Sponge bathing or waterproof wound cover for showering

Weeks 3–6: Early Passive Motion

  • Formal physical therapy begins, typically week 2–3
  • Passive range of motion: The therapist moves your arm through ranges — you do NOT use your shoulder muscles
  • Goals at 6 weeks: full forward flexion passively, 90° external rotation
  • Continue sling use per surgeon's protocol
  • Sleeping comfort often improves at week 3–4
  • Many patients return to sedentary desk work at 3–4 weeks (one-handed or with sling)

Weeks 7–10: Active-Assisted Motion

  • Sling discontinued (most patients at 6 weeks)
  • Begin using the arm for light daily activities — eating, typing, reaching to shoulder height
  • PT progresses to active-assisted and then active exercises
  • The arm will feel weak and stiff — this is expected
  • Pulley exercises for shoulder elevation
  • Begin isometric (no-movement) strengthening exercises

Weeks 11–16: Strengthening Phase

  • Active rotator cuff strengthening begins with resistance bands (very light)
  • Scapular stabilization exercises
  • Progressive resistance training as pain allows
  • Functional movements: reaching overhead, lifting light objects
  • Return to driving (typically around week 8–10 when sling is off and control is adequate)

Months 4–6: Return to Activity

  • Return to recreational activity: golf at 4–5 months, swimming at 5–6 months
  • Overhead athletes (baseball pitchers, swimmers) may require 6–9 months before sport return
  • Gradually increase exercise intensity with PT guidance

Complications to Watch For

  • Re-tear: Sudden return of severe pain and weakness after a period of improvement suggests re-tear — call surgeon immediately
  • Frozen shoulder: Progressive increasing stiffness rather than improving — tell your PT and surgeon
  • Infection: Redness, warmth, increasing drainage, or fever — call surgeon

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