Rotator cuff repair recovery, week by week

In a rotator cuff repair, the surgeon stitches the torn tendon back onto the bone. It takes around 12 weeks for the tendon to heal firmly and months more to become strong. In the early weeks, the stitches alone are holding it.

The size of the tear, the quality of the tendon and your age all affect the plan. A large repair is usually protected for longer. Your surgeon will tell you how long to wear the sling and what you can move. Follow those instructions over any general timeline, including this one.

You will usually wear a sling for 4 to 6 weeks, including at night. Do not use the arm to lift, push or pull, and do not lift it away from the body using its own muscles.

Sleeping is often the hardest part. Many people sleep better propped up on pillows or in a reclining chair for the first weeks, with a pillow supporting the arm.

Safe movement in this phase: bend and straighten the elbow, move the wrist and fingers, and squeeze a soft ball several times a day. Pendulum exercises, letting the arm hang and sway gently, are often started early if the surgeon allows. Gentle neck movements and shoulder blade squeezes help with the neck and upper back stiffness that comes from wearing a sling.

Your physiotherapist may move the arm for you (passive movement) or teach a family member how to do it safely, within the limits your surgeon sets.

The sling comes off and you start moving the arm with help, for example using the other arm, a stick, or sliding the hand up a wall or along a table. Then you move it on your own, without weights.

Expect stiffness and some aching, especially at night. Progress can feel slow. Light everyday use of the arm at waist height, such as eating or writing, is usually allowed. Avoid lifting anything heavier than a cup of tea, and avoid sudden movements like reaching to catch something.

Once the tendon has healed enough, usually around 12 weeks, strengthening begins with resistance bands and light weights and builds gradually. Shoulder blade control is part of this, because the shoulder blade is the base the arm moves from.

Driving is usually possible somewhere between 6 and 12 weeks, once you can control the steering wheel with both hands. Riding a two-wheeler often takes longer, because of the grip and the jolts from potholes. Desk work may be possible from 2 to 6 weeks with the arm in a sling. Manual work and lifting jobs usually take 4 to 6 months.

Most people can use the arm for most daily tasks by 6 months. Overhead strength, sports and heavy lifting continue to improve up to a year. Sports such as badminton, swimming, cricket bowling and gym pressing should only return after your surgeon and physiotherapist agree, and gradually.

Plan help for the first 6 weeks: cooking, washing clothes, lifting a pressure cooker or a water bucket, tying a sari or dhoti, combing and plaiting hair, and fastening a blouse all need two arms or reaching behind.

Loose, front-opening clothes are easier. Put frequently used items between waist and shoulder height. Avoid reaching to the top shelf or pulling down a rolling shutter until your physiotherapist says the shoulder is ready.