Rotator cuff surgery repairs torn tendons in the shoulder, and the initial weeks focus entirely on protecting the delicate surgical site. The three-week mark is a significant transition point in recovery. At this stage, the most intense post-operative pain has generally subsided, and the focus shifts from pure immobilization to the controlled reintroduction of movement. This period sets a secure foundation for rehabilitation, balancing tendon healing with maintaining joint flexibility.
Physical Limitations and Daily Activities
Three weeks post-surgery, the primary directive remains strict protection of the healing tendon-to-bone connection. Most protocols require full-time use of a sling, often an abduction sling that positions the arm away from the body to reduce tension on the repaired rotator cuff muscles. Sling removal is typically limited to hygiene and prescribed exercises for the elbow and hand to prevent stiffness.
Weight restrictions are absolute, meaning zero lifting with the operative arm, as even a small load can pull at the surgical repair. Patients must avoid any action that requires the shoulder muscles to contract, including pushing, pulling, or using the arm to support body weight, such as pushing off a chair. This restriction makes simple daily tasks challenging, requiring one-handed techniques for dressing, bathing, and preparing meals.
Driving remains prohibited because the sling prevents the quick reaction time needed for steering, and many patients are still using narcotic pain medication. When dressing, put the surgical arm into a loose-fitting garment first and remove it last to minimize shoulder movement. For showering, surgeons advise removing the sling but keeping the arm hanging passively at the side, leaning forward to wash the armpit without actively lifting the shoulder.
Expectations for Pain and Medication Use
By the third week, the sharp, severe pain experienced immediately after surgery typically transitions into a more manageable, persistent soreness. This reduction in acute pain generally allows for a significant reduction in the reliance on prescription narcotic pain relievers. Patients are often encouraged to wean off opioids and manage residual discomfort with over-the-counter options, such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs), if permitted by their surgeon.
Although the most intense swelling has decreased, residual inflammation is still common, and consistent cold therapy remains an important part of pain management. Using a cryotherapy device or ice packs for 10 to 20 minutes several times a day helps modulate the inflammatory response and provide localized relief. Pain can still spike, particularly at night, and many patients continue to find comfort sleeping in a semi-reclined position.
Navigating Early Physical Therapy
The three-week mark often coincides with the initiation of formal physical therapy, focused on protecting the integrity of the healing tendon. The primary goal is restoring range of motion without stressing the repair site, meaning movement is restricted to Passive Range of Motion (PROM). During PROM exercises, the therapist or the patient’s opposite arm moves the operative arm, ensuring the shoulder muscles remain completely relaxed.
Active Range of Motion (AROM), where the patient uses their own shoulder muscles to lift the arm, is strictly avoided. This is because AROM risks pulling the repaired tendon away from the bone. Gentle, gravity-assisted exercises, such as pendulum swings, may be prescribed to encourage movement and blood flow in the joint. These early therapeutic movements prevent excessive scar tissue and stiffness, often called “frozen shoulder,” while prioritizing biological healing.