Being told that you need rotator cuff surgery can be an intimidating prospect.
One of the main concerns is how much physical therapy you will need after surgery. How long will therapy take? And when will you finally be back doing what you want to do?
The truth is, most people need at least some physical therapy after rotator cuff surgery. But for some, it’s much shorter than they might expect.
The length of time you do therapy often depends on one key factor.
That factor is whether you have some kind of tissue “repair” at the time of surgery.
To illustrate we will give an example of two identical twin brothers who were both told that they had “rotator cuff tears” but whose rehabilitation courses were far different. We’ll call one Pat and the other Phil.
Pat and Phil are 62. They talk everyday on the phone and both love to do woodworking. Recently both twins developed shoulder pain: Pat on the left and Phil on the right (they are mirror image twins).
Pat’s pain started slowly. He noticed it most after stacking wood planks on high shelves. He couldn’t remember any injury per se, just that his shoulder had been hurting for the last few weeks and it was disrupting his sleep.
Phil, on the other hand had an accident. He slipped in his workshop one day and fell directly onto his right shoulder. He thought his pain would go away on it’s own too. But it didn’t.
The brothers’ primary care doctors had each of them try physical therapy and get MRIs. Both were told that they had rotator cuff tears.
The therapy did not help so they both ended up getting arthroscopic surgery by same shoulder surgeon…on the same day.
But when the brothers reconvened after their surgeries, they were confused.
Both brothers had surgery on their respective rotator cuffs. But the surgeon told Phil that he would need 4-6 months of physical therapy and told Pat that he would need only 2-3 months.
Why the difference?
We actually left out a key piece of the story earlier that makes all of the difference.
What I neglected to tell you was that, while it’s true that they both brothers had “rotator cuff tears” their tears were not the same.
Pat’s tear was not as bad. When the surgeon did Pat’s arthroscopic surgery, he found that the rotator cuff was “frayed” but not completely torn off of the bone. He had a partial tear. He was thus able to just smooth it out or “debride” it and allow Pat to move his shoulder actively immediately after surgery. He would be able to start strengthening it as soon as he was more comfortable.
Phil wasn’t so lucky. When he fell off the ladder he tore 2 of his rotator muscles completely from the bone. They needed to be reattached with sutures. His rehab would be far longer.
The surgeon told him that because he had to put stitches through the tendons and repair the tissue (not just smooth it out) that the body would need more time to heal the tendon to bone. He would also need to “protect the repair.” In other words, Fred would have to wait to do “active” motion on his healing left shoulder to make sure that the tendon didn’t detach again before it had a chance to heal. He wouldn’t be able to d strengthening exercises for 3 months.
Two twin brothers. Two seemingly similar problems. But two very different rehabilitation programs.
In general rotator cuff tears that require “repairs” with stitches require longer rehabilitation- sometimes twice as long. This is because you have to protect the repaired tissues while they heal. In other words: you can’t stress the healing tissue much until it has knitted together.
If you need rotator cuff surgery, the duration and speed at which you progress will depend in large part on whether your surgeon repaired your rotator cuff with stitches or not.