Rotator Cuff Repair Protocol

Waking up
Most patients feel dizzy and tired for a few hours after the surgery. You can simply sleep it off. Some patients may feel nausea and even experience some vomiting as well, but with modern anaesthesia, this is very much less common, and should not last more than 2-3 hours.

Pain
Pain from the rotator cuff repair is often more bothersome than for other types of shoulder surgery. However it can be controlled with a combination of medications and a nerve block given either pre-operatively or post-operatively while the patient is still under anaesthesia (see section on Anaesthesia and Sedation to learn more).

Nurses and the anaesthetist is always on hand to help ensure you are not in too much discomfort. Unfortunately, many patients find that lying flat does aggravate the pain, so they may have difficulty sleeping in the initial few weeks after the surgery. This will certainly resolve. And this can also be controlled with oral medications which you will be prescribed.
‍
Wounds and dressings
There will be a bulky dressing over the shoulder which can be removed either on the same day (at night) or the next morning. You will find small waterproof dressings (the size of 2 band-aids placed side by side) underneath the bulky dressing. You can take a shower, but please do not take baths or soak in water until the wounds are well healed.

Stitches
Stitches used may or may not need removal after 12-14 days. This is on a case-by-case basis. But if required, this can be quickly and easily done at ours or any doctor’s office.

Going home and medications
Most patients go home from hospital either later on the same day of the surgery, or the next morning. You will be discharged with pain medications, which many patients may not even take! But if you have pain, do not be worried about taking pain medications.

The pain medications prescribed are simple, non-addictive ones which will not cause problems in the future. Antibiotics are not usually required, unless there are some concerns with regards to increased infection risks like a eczema over the skin, pimples around the area, previous tendency to get infections etc.

Arm sling
Most patients will wear a simple sling for 3 – 6 weeks. You may remove the sling and rest the arm at your side, as long as you do not try to lift your arm up. I generally do not strictly require patients to wear the arm slings all the time.

I also allow patients to sleep without their arm slings. Some patients find that they are most comfortable sleeping without their arm slings while resting their arms on a pillow. Others may find that wearing an arm sling with a pillow supporting the elbow while they sleep is most comfortable. You will probably need to try different positions to determine which is most comfortable for you.
‍
Movements
In the immediate few weeks after the surgery, simply allow the shoulder to rest. Avoid trying to raise your arm as much as possible. If it is comfortable, you can do simple pendular movements of the shoulder (bending over slightly while keeping the arm completely relaxed and limp then making small circular movements with the arm).

Initial follow up schedule
For a typical patient, the timeline is usually:

• Return home either on same day of surgery or the next morning
• Review in clinic on post-operative day (POD) 5 for first dressing change (this is advised because the hot and humid weather in Singapore often makes the skin under the dressing irritated)
• Review in clinic on POD 12 – 14 for removal of stitches and dressing. A water-resistant spray will be applied so you can shower over the healed wound without needing anymore dressings.
• Physiotherapy can commence at any time. If patients have more discomfort in the surrounding muscles, they can often get some relief with physiotherapy. But if they would rather allow wounds to heal and give the shoulder some time to settle down before commencing physiotherapy, it is also reasonable. I usually start patients on physiotherapy about 2 weeks after the surgery.

All patients will have stiffness in their shoulder after surgery. This is temporary, although it may take 3 – 6 months to regain full movements in the shoulder. The post-operative protocol below is meant as a guide and is deliberately concise so that patients will not be swamped with excessive details.

Please also note that especially for rotator cuff repairs, I may vary the timings of the protocol on a case by case basis.

Week 0 – 1: (Goal: Pain control, healing of wounds)

• Arm sling is advised. But if you are more comfortable not using one, it is fine to remove it while you are comfortably seated, and simply rest the arm on the arm rest. Avoid actively raising your arm.
• Ensure that you frequently flex and extend your elbow, wrist and fingers to avoid swelling of the extremity.
• Periodic icing of the shoulder will also help to reduce swelling and soreness.

Week 1 – 6: (Goal: Regain passive and active range of movement [ROM])

• You will need to restrict both passive and active movements of the shoulder for a period of 4 – 6 weeks.
• Work on strength of the muscles around the shoulder eg the deltoid muscles and muscles around the scapular.
• Progressive increase in passive ROM. While you can expect feeling a gentle stretch, you should not feel pain. If there is any pain, back off on the ROM!

Week 6 – 12: (Goal: Work on active and passive ROM)

• Commence active ROM, beginning first with assistance from either the physiotherapist or your other good arm.
• Work on regaining full passive ROM in the shoulder.
• For patients who are progressing faster, careful gentle strength training can be commenced.
‍
Month 3 – 6: (Goal: Achieve full active ROM and start work on strength)

• Continue to work on attaining full ROM in both passive and active ROM.
• Continue strength training of the shoulder.

Month 6 onwards: (Goal: Return to sport)

• Gradual return to vigorous work and sports.
• Work with physiotherapist and sports trainer to address any gaps in the recovery.