Can I drive 6 weeks after rotator cuff surgery?

Can I Drive with a Shoulder Sling?

The sling is one of the biggest annoyances following shoulder surgery, but it is important for your recovery. To attempt to drive with a shoulder sling can be very dangerous. You need active use of both arms to deal with unexpected surprises encountered on the road while driving. This is particularly the case with high speed driving (freeways and highways) where reaction time is more important.In most cases, the shoulder sling is simply to prevent shoulder movement. So, it’s okay to take it off when you are sitting at home with the arm at your side. You can take the arm out of the sling and place it on a pillow, mimicking the position that it would be in with the sling. When you are up moving around, when you are sleeping, and especially when driving the sling MUST be on.Research studies have shown that wearing a sling impairs driving and therefore I must also recommend that you delay driving (particularly high speed driving) until you are out of your sling and weaned off narcotic pain medications as well. This is for 2 to 6 weeks depending on your surgery and rehab protocol.For people living in the suburbs, being unable to drive even if it’s only for a few weeks can feel like being under house arrest! You can prepare ahead of time by stocking up your house with necessary items and getting a friend of family member to drive you around or setting up a carpool.If you are scheduled to undergo arthroscopic shoulder surgery, you will have to come in for a preoperative visit 1-2 weeks before the procedure at which time you will be fitted for the shoulder sling which you must bring to the surgery and wear as recommend in the weeks following your surgery.Dr. Patrick Denard has been voted one of the top 20 Shoulder Surgeons in North America and is the most widely published shoulder specialist in Oregon. Dr. Denard is committed to providing the highest level of Orthopedic care to his patients. Dr. Denard has advanced arthroscopy training and is able to perform the vast majority of shoulder procedures in a minimally invasive fashion, including all types of rotator cuff repairs and instability repair. These techniques allow him to repair tears that some consider “ irreparable”. Providing every patient with advanced medicine and compassionate care each and every time.

Rotator Cuff Surgery Recovery

Recovery from Rotator cuff surgery can be a long, painful and stressful process. Early on in the recovery process our goal is to minimize the risk of re-injuring your shoulder or rotator cuff. That is the main reason why we restrict your activities for a long time after surgery. Once the surgery to repair a rotator cuff is completed, you need to ensure that you allow the rotator cuff to heal. To ensure a successful recovery after a rotator cuff repair often means paying close attention to the instructions you are given. Becoming too active, too soon can lead to a new tear or injury. A full recovery from rotator cuff surgery can take 6 months to one year.

Rotator cuff tears are a very common source of shoulder pain. Surgery to repair the rotator cuff becomes an option if shoulder pain does not respond to non-surgical treatments. Surgery is often the first treatment discussed for large tears due to a severe shoulder injury.

We have published an Expert Series on the subject of rotator cuff tears, which explored:

The causes of rotator cuff tears
Night Pain and Rotator Cuff Tears
Is surgery necessary for a degenerative rotator cuff tear?
Can Rotator Cuff Tendinosis Be Cured?

Recovery from rotator cuff surgery is a lengthy process. Surgery on the shoulder to repair a rotator cuff tear usually produces significant pain and stiffness. Recovery from rotator cuff surgery is slow. This is because of the time it takes for the repaired rotator cuff tendon to heal back to the bone. You are in a sling and told not to use the arm. A sling is needed for up to 6 weeks to allow that healing process to begin. Not using the arm allows the repaired rotator cuff time to actually heal to the bone. The stiches we place are not strong enough to allow you to use the arm for normal activities until healing takes place.

Being in a sling for a number of weeks will lead to stiffness and weakness. Not only is the stiffness a normal reaction, t he stiffness in your shoulder might actually increase your chances of a better recovery after rotator cuff surgery. After the sling comes off, your activities are still limited to decrease the chance that your tear will come back again. When the sling is removed after a few weeks your rotator cuff repair is capable of lifting the weight of the arm. It is not strong enough to lift or carry objects or work overhead. That will take a few more months.

Rotator cuff surgery recovery

There are many factors that have a role in your rotator cuff surgery recovery.

Below are general guidelines… if you have questions, it’s better to ask your surgeon first before beginning any new activity. Patients who are recovering from rotator cuff surgery know all too well that surgery on the shoulder is often painful. Some patients have very little pain after shoulder surgery, but most have significant pain for a few days to a few weeks. Some tips that will assist you in preparation for rotator cuff surgery are as follows.

First and foremost… listen to your surgeon’s instructions. For those of you who had a repair, this is particularly important. It is not unusual to see people in the office with no sling, despite clear instructions to remain in a sling and not to use the arm. Using your arm too soon after surgery will cause a new tear.

Many of you report significant improvement in pain by using a cold compression sleeve on the shoulder. Having a sling which is comfortable and immobilizes the arm well is critical. Certain immobilizers which grasp the wrist tend to stay on better. I’ve heard every reason there is (I think) why you do not have the sling on. The rotator cuff is held to the bone by a few stitches. If you move the shoulder, there is a risk of causing failure of the repair.

Some of you will try a compression sleeve to aid in your comfort. Some report that it is beneficial, while others do not. Sleeping can be an issue. Many have found a Shoulder Support Pillow/System helpful after a rotator cuff injury.

Your surgeon will let you know when it is OK to start moving the shoulder. Many of you will have elbow pain from being in the sling. I personally allow my patients to stretch the elbow a few times a day, but you should check with your surgeon first to see if it’s OK. Pain at night, or being unable to sleep is a very common complaint when recovering from rotator cuff surgery. Sleeping in a recliner, or in a bed with many pillows behind you will help many of you to be able to sleep. Rolling up a small towel, or placing a small pillow behind your shoulder to hold your shoulder forward will also help you. Night pain can remain an issue for a few months following surgery.

Not all rotator cuff surgeons are created equal. Volume matters, that means that the more rotator cuff surgeries your surgeon performs (within reason), the better the chance they will perform your surgery well. Find a surgeon who performs at least 75-100 rotator cuff repair surgeries a year. Don’t be afraid to ask. Performing the surgery properly and efficiently is the first step to achieving a good result.

Stiffness during rotator cuff surgery recovery

Stiffness is a common issue many patients have to deal with after rotator cuff surgery. Diabetic patients are even more prone to shoulder stiffness. Some patients have a genetic predisposition to developing stiffness.

We may start you on a passive motion protocol with a physical therapist before the 6 week time frame, but that will depend on the type of tear you had, the type of repair you had and your surgeon’s preference. Aggressive motion too early during the recovery from rotator cuff surgery risks having the repair fail. Once your surgeon gives you the go ahead to move the arm, it is very important that you follow those instructions. A physical therapist will assist and guide you through the recovery process. If you are uncertain about whether or not you can move in a various direction or use the arm for certain activities ask your surgeon first!

Strength training following rotator cuff surgery

Recent scientific studies (Spring 2013) shows that nearly 3-5 months after rotator cuff surgery is when you are at greatest risk of re-injury or re-tearing your rotator cuff. This is probably the most critical period in the recovery from rotator cuff surgery. You can’t fight biology. It takes many months for a repaired rotator cuff to become strong enough to use it to lift weights, push or pull heavy objects. This is simply because of the biology of tendon healing! Many shoulder surgeons will not allow their patients to begin strength training for at least three months following rotator cuff surgery.

Return to sports after rotator cuff surgery

A return to sports following a rotator cuff repair will not be possible for many months. This is meant to protect the rotator cuff as it continues to heal to the bone. Rotator cuff healing is a very long biological process. You will need to avoid contact sports, etc for nearly 6-12 months. Your recovery will depend on the size of your tear, quality of your tissue and the preferences of your surgeon. Again, check with your surgeon first.

For most of you who are currently recovering from rotator cuff surgery, there is a light at the end of the tunnel. Many of you have heard from your friends that it will be a year before your shoulder feels “normal”. For some of you that will be true. For some of you, you will recover far faster.

Rotator Cuff Surgery: Arthroscopic Repair of a Torn Rotator Cuff

The rotator cuff is a set of a four small muscles in the shoulder that allow the upper arm to rotate. When a rotator cuff is torn, the tendon part of the muscle tears away from the bone of the upper arm. A rotator cuff tear can result from an injury such as a fall or heavy lifting, or from normal wear-and-tear and repetitive activities over many years. Some minor tears may be treated without surgery. Many, however, require surgical intervention to heal properly.

What is the surgery for a torn rotator cuff?
How is rotator cuff surgery performed?
When is rotator cuff surgery recommended?
Is there an alternative to rotator cuff surgery?
Do you need surgery for partial rotator cuff tears?
What is the risk of waiting to have rotator cuff surgery?
How do you select a doctor for rotator cuff surgery?
How long does it take to recover from rotator cuff surgery?
What is the success rate for rotator cuff surgery?

What is the surgery for a torn rotator cuff?

To repair a torn rotator cuff, an orthopedic surgeon reattaches the tendon to the humerus (upper arm bone) using an absorbable suture anchor. The surgery’s success is dependent on how well this interface between the tendon and bone heals.

How is rotator cuff surgery performed?

Rotator cuff surgery is performed arthroscopically. In a shoulder arthroscopy, small incisions are made and an arthroscope − a small tube fixed with a camera – is navigated to the site of the tear. We then use specially designed instruments that allow us to repair the rotator cuff with minimal trauma to the surrounding muscles and tissues.

Patients at Hospital for Special Surgery have this procedure done under a nerve block (regional anesthesia) and partial sedation rather than under general anesthesia. This minimizes the amount of pain and anesthesia medications that are given, thereby reducing nausea and vomiting. These improvements in minimally invasive techniques and anesthesia allow most of our patients to go home only a few hours after their procedure.

First, an arthroscopy of the glenohumeral joint (the ball-and-socket portion of the shoulder joint) is performed to identify and treat other associated problems, such as a biceps tendon injury, loose bodies or a torn labrum. (The shoulder labrum is a rim of cartilage that surrounds the glenoid, the cup portion of the shoulder joint.) A partial rotator cuff tear (a tear through less than 50% of the thickness of the rotator cuff tendon) can be trimmed with a shaver at this time.

The arthroscope is then placed in the subacromial space (below the acromion, a bony portion at the top of the scapula or shoulder blade), under which the rotator cuff tendon passes. A subacromial decompression is then performed to open up the subacromial space. This procedure, called an acromioplasty, involves removing a bone spur and irregularities on the underside of the acromion, which can be a cause of rotator cuff irritation and tearing. The torn tendon is then reattached to the bone with the use of suture anchors and sutures.

Rotator cuff tears

Acromioplasty

When is rotator cuff surgery recommended?

Surgery is recommended for a full thickness tear, or in those patients with a partial thickness tear who have failed conservative treatment (two months of physical therapy). If a patient tries conservative treatments and continues to have pain and difficulty with activities after two or three months, he or she may consider surgery to repair the tear.

Is there an alternative to rotator cuff surgery?

Small or partial rotator cuff tears may be treated with two months of physical therapy.

Do you need surgery for partial rotator cuff tears?

If physical therapy has not effectively restored strength and function, then surgery is the only option. Nonsurgical improvement is considered effective if a patient feels their shoulder function and strength has been restored by greater than 70% prior to beginning physical therapy.

What is the risk of waiting to have rotator cuff surgery?

Tears tend to get larger with time. The results of repairing large or massive tears are not as good as repairing smaller tears, Delaying surgery in patients who need it can result in progression of a partial tear to a full tear, the propagation of a small tear to a larger one, fatty infiltration of the damaged tendon and muscle, and muscle atrophy and weakness.

Most patients will still initially undergo a trial of physical therapy to see if surgery can be avoided, but for those who do not respond, we recognize the value of initiating surgery sooner rather than later.

How do you select a doctor for rotator cuff surgery?

It is important to select an orthopedic surgeon who has experience repairing rotator cuff tears, preferably one who completed a fellowship in sports medicine. Find a doctor at HSS who treats rotator cuff tears.

Is rotator cuff surgery done outpatient?

Yes. The surgery takes less than a half hour, and the patient is placed in a sling and can return home on the day of surgery.

How long does it take to recover from rotator cuff surgery?

It takes six to eight weeks for the tendon to heal to the bone. Complete recovery time varies by size of the tear. For a small tears, full recovery time is about four months, for large tears, six months. For severe, massive tears, a complete recovery can take anywhere from 6 to 12 months.

Patients can often return to most activities after about 12 weeks after surgery, but participation in vigorous sports may be restricted for four to six months. The goal is to achieve full range of motion and full strength.

How many weeks of physical therapy do you need for rotator cuff surgery?

Generally, a patient wears a sling for the first two to three weeks and begins physical therapy one week after surgery. The physical therapy program typically lasts for three to four months. Strengthening exercises begin after the 6- to 10-week healing period.

Do’s and don’ts after rotator cuff surgery?

Protecting the repair for the first six to eight weeks is essential to allow healing to the bone. Because patients may feel well quickly, it’s particularly important that they exercise care in protecting the joint during the healing period. Shoulder surgeons prescribe a very specific and detailed rehabilitation program following surgery which must be strictly followed.

What are the best exercises after rotator cuff surgery?

A licensed physical therapist can guide the patient on appropriate exercises. These may differ from case to case.

How long before you can drive after rotator cuff surgery?

Typically, patients can return to driving after two to four weeks.

What is the success rate for rotator cuff surgery?

Rotator cuff surgery has more than a 95% success rate for small tears. For two tendon tears, the success rate is still greater than 70%. Untreated tears tend to get bigger, so it is best to repair tears while they are small.

However, even those patients with very large tendon tears may benefit from surgery. In some cases, we can use a technique called margin conversions. This involves covering the humeral head with grafted tissue to hold the tendon in place in the joint. When the tendon tissue is insufficient for direct repair, we place a patch of donated tissue in the area. When these tissue grafts are required, shoulder surgeons usually perform a mini-open repair, rather than an arthroscopic repair.

Arthroscopic images provided courtesy of Russell F. Warren, MD.

Authors

John D. MacGillivray, MD
Associate Attending Orthopedic Surgeon, Hospital for Special Surgery
Associate Professor of Clinical Orthopedic Surgery, Weill Cornell Medical College