Recovering At Home

Most patients return home a day or two after surgery. At home, it is extremely important to perform physical therapy exercises as directed, usually five times a day.

Patients should begin moving the shoulder through its full range of motion as soon as possible after surgery in order to prevent the formation of scar tissue. This is performed passively, or with the use of the opposite arm to assist. If the shoulder is not moved properly, scarring may cause it to stiffen. Stiffness may cause discomfort and limit the ability of the shoulder to function. Ice should be applied to the shoulder after exercising.

Patients often notice some skin discoloration near the wound or in the upper arm. There's no need to worry. The hand or forearm may also swell. Usually this swelling will go down if the arm is elevated appropriately.

The First Twelve Weeks After Surgery

During the first twelve weeks after surgery, it's important to follow two basic principles:

• Perform physical therapy exercises regularly. Moving the surgically repaired arm through its full range of motion is crucial to prevent scarring and stiffness.

• Strictly control activity when not exercising. Be extremely careful not to lift the surgically repaired arm away from the body. Don't use it to push or pull anything.

The arm should always be kept in the sling when you are standing or walking. When sitting or lying awake in bed, you can release the sling without removing it. The sling should be worn at night until satisfactory control of the arm is regained. Remove the sling only to exercise or take a shower.

The injured arm should be used only for exercise. It's okay to use the hand for writing, eating, or drinking, as long as the arm is moved only at the elbow and wrist. Under no circumstances should the injured arm be used to reach for or lift something. It should not be lifted above the head or moved away from the body.

Once the sutures are removed, you can shower without covering the incision. The arm should be supported while taking a shower.

Don't drive for at least six weeks after surgery or until the sling is discontinued. Driving with one arm is unsafe, and the surgically repaired arm shouldn't be moved away from the body. It's also easy to re-injure the shoulder in an accident or an emergency stop.

Exercises For The Shoulder

Physical therapy exercises should be performed at least three and preferably five times every day. Each exercise should be repeated 10 to 15 times, with the number of repetitions gradually being increased. Positions should be held for a three to five seconds.

The initial goal of physical therapy is to restore the full range of motion to the surgically repaired shoulder. Within one to three weeks after surgery, it should be possible to move the arm as much as the uninjured shoulder.

There are two types of physical therapy exercises:

• In passive exercises, the arm that was operated on is moved by the physical therapist, a family member, or the patient's healthy arm. They are designed to restore flexibility (range of motion) to the injured shoulder. Passive exercises are performed during the early weeks of recovery.

• During active exercises, a person moves the injured arm and shoulder without outside assistance. These exercises are done after muscles and tendons have had time to heal.

Physical therapy can be very difficult. Though some pain and stiffness are to be expected, tell your physical therapist and/or physician if the pain is severe.

Full rehabilitation from rotator cuff surgery typically lasts for 9 to 12 months.

Beginning Exercises

• Forward elevation of the arm. This exercise is performed while lying on the back. It's designed to move the surgically repaired arm through its full range of motion.

  Begin with the injured arm laying at your side and your elbow straight.

  • The physical therapist slowly lifts the injured arm, moving it through a 180-degree arc, until it is alongside your head. You should use your uninjured arm to lift the arm on which you had surgery. In this way you can perform your exercises without the need for assistance.

  • Don't use the muscles of the surgically repaired arm to perform this exercise. Also, don't arch your back. Keep the elbow straight.

• External rotation. Lie on your back with the elbow of your surgically repaired arm resting by your side on a small pillow or folded towel. Hold the injured arm so that the elbow is bent at a 90-degree angle and the hand is pointed towards the sky. Grasp a dowel or stick in both hands and use your good arm to push the injured arm outward, away from your body. Stop when you feel the arm stretching.

• Elbow flexion and extension. Sit in a chair with your surgically repaired arm out of the sling. Keeping your elbow against your side, slowly flex and extend your injured arm so that you are moving the elbow joint through its full range of motion. This is an active exercise; use the muscles of the injured arm to do it.

• Grip exercises. While sitting, squeeze a rubber ball. For this exercise, keep the surgically repaired arm in a sling. Keep the elbow at your side. This exercise helps to maintain strength in your muscles. It also helps to reduce swelling.

Advanced Exercises

Starting around six to eight weeks after surgery, physical therapists usually recommend several new exercises. These include active range of motion exercises, in which the muscles of the surgically repaired arm are used to move the shoulder through its entire range of motion.

Some exercises simply stretch the shoulder. Strengthening exercises begin later and involve stretching rubber bands or lifting light weights TO STRENGTHEN the rotator cuff and shoulder muscles.

Perform these exercises five times a day, repeating each one 10 to 15 times. Your physical therapist will give you goals and instruct you on how to increase the number of repetitions or the amount of weight you lift.

As with the beginning exercises, although you may experience some discomfort and pain, you should tell your doctor and physical therapist if you feel sharp or severe pain.

• Internal rotation. Bend your surgically repaired arm behind your back and place your thumb against the base of your spine. Slide this thumb slowly up your backbone and down again.

  If necessary, hold one end of a towel with the hand that is behind your back and the other end above your head with your good arm. Use the uninjured arm to lift the injured arm.

• Cross-body adduction. Hold your surgically repaired arm in front of you at shoulder level with the elbow straight. Move this arm across your body, towards the uninjured shoulder. To stretch the injured shoulder more, use your healthy arm to pull the injured arm across your body.

Strengthening Exercises

• External rotation. Attach one end of a piece of long rubber tube to the knob of a closed door. (Your physical therapist will give you the tubing or tell you where to buy it.)
  • Stand perpendicular to the door, with your healthy arm nearer to it.

  • Hold the elbow of your injured arm at your side and bend at a 90-degree angle.

  • Grab the free end of the rubber tube in the hand of your surgically repaired arm and pull the tube outward, away from your body.

  • Hold the rubber tube so that it's taut enough to provide resistance.

• Internal rotation. Attach the rubber tube to the doorknob, as in the external rotation exercise described above.
  • Once again stand perpendicular to the door, but turn around so that your injured arm is closer to the door.

  • Hold the elbow of your injured arm at your side and bend at a 90-degree angle.

  • Grab the free end of the rubber tube in the hand of your surgically repaired arm and pull the tube inward, towards your body.

  • Hold the rubber tube so that it's taut enough to provide resistance.

• Pressing. Lay on your back with your surgically repaired arm to your side, at shoulder height and aimed away from your body. Hold a light weight in your hand. Keeping your injured arm straight, slowly lift the weight until your arm is pointed towards the sky.