It is very important that you receive proper physiotherapy advice. A Physiotherapist from Extend Rehabilitation will te Hospital will come and instruct you while you are still in Hospital the morning after surgery. They will instruct you in passive range of movement exercises which should be done at home 3 - 4 times per day only. You should do them for approximately 10-15 minutes at the very most. The aim of physiotherapy or the shoulder exercises in the first 6 weeks is to maintain adequate range of movement of the shoulder. It is very important that you do not undertake active movements involving the shoulder as this can gradually loosen the sutures and undo the operation.
One thing you should do regularly is to make a fist and straighten the fingers out fully. Doing this frequently will help drive the fluid out of your hand and forearm. At any time you wish, you can take your arm out of the sling and straighten your elbow. It is desirable to do this at least three or four times per day.
You will have been provided with a sling which you should wear at all times other than when you are doing your exercises. I would prefer that you stay in the sling the majority of the time. You MUST sleep with your arm in the sling. You may take the arm out to move the elbow out straight – without moving the shoulder – at any time, and you can do this in the shower. While showering you should simply let your arm hang down by your side, and you can bend or tilt your body so that your arm moves away from the shoulder so that you are able to clean your armpit.
Pain control is very important after rotator cuff surgery. It is a painful operation. I use a number of methods for pain control:-
A pain pump (catheter), which is a small tube, is placed into the operation site. The area is then infiltrated with local anaesthetic which is designed to decrease the pain and therefore decrease the amount of narcotics that you need. This is most often (but not always) quite successful in reducing the pain for you. This catheter will be left in for 48 hours only. There is a bacterial filter attached so there is no danger of infection. I have been using this technique for over 20 years with no significant problems. It has been studied scientifically by myself and others and found to be very effective.
We will start you on oral pain relief medication and anti-inflammatory medication as soon as you are able. The anti-inflammatory medication can have side-effects and the most important side-effect is gastrointestinal bleeding. If you have a previous problem with stomach ulceration or peptic ulcer you need to notify us prior to surgery so that appropriate post-op medication can be arranged.
The recovery period for rotator cuff surgery is quite extensive. The pain will require attention for the first week or two with regular medication. After that it tends to settle down and not require regular medication. It will still be sore, and will still hurt when you do the exercises. If you push the exercises too much it will hurt a lot and you may require some medication.
It is important that you realise that rotator cuff surgery takes 6-12 months to recover from fully. By this I mean that the rehabilitation period takes this long. Your shoulder muscles will be weak and the shoulder will become somewhat stiff because of the surgery.
After 6 weeks you will be allowed to come out of the sling and start very gentle active movements, gradually increasing. You will not be allowed to start significant strengthening exercises until 12 weeks have passed. It will take 12 weeks, or thereabouts, to fully regain the range of movement without pain. It will take 6 - 12 months before you have what you consider to be good strength in your shoulder. You will not be able to participate in sports such as tennis until at least 6 months post-op and ideally you should not participate in this sort of sport for 12 months. If things are going well I would expect that you would get back to activities such as golf or lawn bowls after 6 months.
It is important to emphasise the overall results from rotator cuff surgery. Overall, 80% of people have what they consider to be successful surgery. The shoulder function returns to normal and they don’t have to alter their daily activities because of their shoulder.
15% of people consider that their surgery reduces the pain but does not restore a normal shoulder to them. They have ongoing troubles of some sort, which means that they have to alter some activities. These people usually consider that the surgery has been worthwhile however.
5% of people are left the same and consider their surgery to be unsuccessful.