The recovery process following rotator cuff surgery is a carefully phased journey, and the four-week mark represents a significant transition point. Recovery depends on factors like the size of the tear, tissue quality, and the specific surgical technique used. Generally, four weeks post-operation is when the initial protective immobilization phase begins to transition into a more active functional recovery phase. The goal at this stage is to preserve the integrity of the tendon repair while carefully beginning the work of restoring mobility to the shoulder joint.
Physical Status and Comfort Level
At four weeks, the body’s initial response to surgical trauma has largely subsided, and the focus shifts from acute healing to tissue repair. Surgical incisions should be fully closed and dry, with any external stitches or staples typically removed by this time. Residual bruising and mild swelling around the shoulder and down the arm are normal consequences of the body clearing fluid and inflammation.
The nature of the pain often changes noticeably around this milestone. The intense, sharp pain immediately following the operation generally lessens, giving way to a duller ache or muscle soreness. This new discomfort is frequently associated with the gentle movement and stretching introduced in physical therapy sessions. Most individuals manage their discomfort effectively with over-the-counter pain relievers, reducing reliance on prescription opioids.
Sling Usage and Movement Restrictions
The use of an immobilizing sling remains a major part of daily life at four weeks, though protocols vary significantly between surgeons. For many patients, the sling is still required full-time, including while sleeping, to protect the tendon-to-bone repair site. Exceptions for sling removal are limited to personal hygiene, like bathing, and during prescribed physical therapy exercises.
Strict movement restrictions are still in place because the repaired tendon requires several weeks to anchor firmly to the bone. Patients must not lift anything heavier than a small object, such as a coffee cup or remote control, with the affected arm. Active motion that engages the repaired rotator cuff muscles, especially reaching behind the back or forcefully rotating the arm outward, is strictly prohibited to prevent a retear. Driving is generally not permitted while the arm is immobilized in a sling, as the device prevents the quick, protective movements necessary for safe operation.
Transitioning to Active Physical Therapy
The four-week period often marks the beginning of a phased transition in the physical therapy protocol, moving beyond simple passive movement. Immediately following surgery, therapy consisted of passive range of motion (PROM), where the therapist or your other arm moved the operated limb without muscular effort from the shoulder. This was done to prevent stiffness and scar tissue from limiting movement while the tendon healed.
The focus now shifts toward introducing active-assisted range of motion (AAROM) exercises. These exercises allow limited use of your own muscles, often with the assistance of a cane or the opposite hand. This careful reintroduction of muscle activation restores basic neuromuscular control and begins moving the joint through its new, limited range. The physical therapist guides this process to ensure no tension is placed on the newly repaired tendon.
A common initial exercise is the use of pendulum swings, performed by bending over and allowing the operated arm to hang freely. These movements use gravity and gentle body rocking, and are considered non-stressful because they do not require the rotator cuff muscles to contract against resistance. Gentle isometric exercises, which involve contracting the shoulder muscles without moving the joint, may also be introduced. The goal of this phase is to carefully increase overall mobility and prevent joint stiffness without compromising the repair’s structural integrity.
Recognizing Recovery Complications
While pain and discomfort are expected parts of recovery, certain symptoms warrant immediate contact with the surgical team to rule out complications. A sudden, severe increase in pain that does not respond to medication, especially after a specific incident, could signal a potential re-tear of the repaired tendon. This acute pain is distinctly different from the dull soreness associated with physical therapy.
Signs of infection at the incision site require prompt medical attention. These indicators include:
- Increasing redness.
- Persistent warmth.
- Swelling that seems to be worsening instead of improving.
- Discharge of pus or foul-smelling drainage from the wound.
A fever above 101 degrees Fahrenheit may indicate a systemic infection. Numbness or persistent tingling in the hand or fingers, if not present immediately after surgery, should also be reported, as it could suggest nerve irritation or compression.