A. Do I have to wear a sling and if so, how often? – If your cuff tear was less than 1 centimeter in length, this is considered a small tear or repair and you may be placed in a standard sling for comfort. Typically your doctor will have you war this as needed for a week or two. Tears larger than 1 cm or complete tears will need immobilization in a sling for 5-6 weeks, only taking it off for hygiene and prescribed exercises. A wedge type maybe placed on in recovery to place the joint in the safest most optimal position for healing. Nevertheless, always follow your doctor’s post op instructions.

B. How long will recovery take? – Optimally you should be using your shoulder for normal functional activities in about 8-12 weeks. This will vary with the size of the torn rotator cuff repair, commitment to rehab, and other factors that can affect your length of recovery, include diabetes, and pre-surgical level of function and range of motion. In addition, if a well-designed program is not followed you can actually end up with a frozen shoulder, some of which require a frozen shoulder manipulation to correct.

C. When can I drive again? – Your doctor will have the final say as to when you will begin driving again, however, if your rehab goes well you should be able to drive about week 8 and/or when you can turn a steering wheel in the direction away from your body with the surgical arm without pain.

D. When can I return to work? – If your employer allows light or modified duty then you may be able to return to work after the first few weeks. Your doctor will have to sign off on a work release and give specific instructions as to what you are allowed or not allowed to do. If no light duty is available then you will have to wait until your doctor releases you without restrictions. However sometimes the doctor knows there will be some restrictions or limitations that fall outside of your previous pre-morbid capabilities. In this case he may order an FCE (Functional Capacity Evaluation) which is basically a formal test to determine what you can and cannot do. It is typically administered by a licensed physical therapist. The therapist or person giving the test will assign or recommend a “physical demand classification” after analyzing the test. This will help in placing you in a job that can accommodate your restrictions.

Above all, I cannot recommend enough that your stay consistent with your physical therapy and home program. Research well where you are going to therapy and if possible try to get one that specializes in the treatment of frozen shoulder or disorders/dysfunctions of the upper extremity.

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Afraid of the rehab??? Most of the time what was a mild shoulder injury to begin with has now turned into a problem that WILL take surgery and months of therapy to correct. While it is out of the scope of my practice act to diagnose a specific injury, I still attempt to answer a patient’s questions about what a rotator cuff tear feels and acts like, if nothing more than to give them some direction or peace of mind about their shoulder pain.

Rotator cuff tears are usually preceded by some traumatic event, whether it is a lifting action, throwing motion, or some type of event that involves a twist of the shoulder. However there are incidents where a simple “reaching out” can cause a tear. This usually is because the person had a “type III” or “hooked” acromium (sharp point at the end of the clavicle bone) which caused gradual wearing away of the cuff tendon. In either case the person typically describes a sudden sharp pain in the shoulder followed by a burning sensation. The days ahead are followed by extreme shoulder pain and weakness when attempting to lift the arm above shoulder height or possibly just reaching out for an object.

A simple test for a more severe tear is called the “drop arm test”.  The examiner lifts both of the patient’s arms out to their side and instructs them to keep them from dropping. A positive test is when patient is unable to keep the involved arm from dropping down and is typically accompanied by shrugging the same shoulder toward the ear in attempts to keep it by their side.

Smaller tears are more difficult to assess, but can be picked up by a trained examiner. The clinician decides there might be a tear through a combination of the mechanism of injury (was there an event likely to cause a tear), and assessing the strength of the cuff muscle in isolation through specific tests. If there are positive signs then the patient is sent for further tests which may involve a diagnostic injection, or possibly injecting a radiographic dye into the rotator cuff and then examining it under flouroscopy to see if any of the injected medium leaks out.

If a tear is discovered it is crucial to get treatment as soon as possible to avoid further complications and a stiff and painful shoulder requiring frozen shoulder treatment. Very small tears may be treated with cortisone followed by a course of rotator cuff physical therapy. Larger tears will likely need surgical repair.