Recovery from rotator cuff surgery is slow, and that is expected. Most people wear a sling for about 4 to 6 weeks. Gentle movement, often with the arm supported by someone else or by your other hand, starts during that time. Your own active movement often builds from 6 to 12 weeks, strengthening follows from around 12 weeks (3 months), and full recovery often takes 6 to 12 months. Your surgeon’s protocol comes first, and timings vary with the size of the repair and with each surgeon.
The long timeline comes from biology. The stitches hold the torn rotator cuff tendon against the bone, but the tendon still has to grow back onto it, and that takes months. Your surgeon may give you different timings. Use theirs.
Key takeaways
- Sling: typically about 4 to 6 weeks, sometimes longer after a large repair.
- Early movement: usually passive or assisted, with the arm’s own muscles kept quiet at first.
- Active movement: using the arm’s own muscles often starts from 6 to 12 weeks.
- Strengthening: usually begins from around 12 weeks (3 months).
- Full recovery: often 6 to 12 months, and sometimes longer after a large repair.
- Protocol: your surgeon’s protocol comes first; timings vary with repair size and surgeon.
Where are you right now?
- First 2 weeks: pain, sleep and the sling. Start with days 1 to 3 and the night pain answer.
- Weeks 2 to 6: still in the sling, with gentle movements from your physical therapist (PT). See weeks 2 to 6 and the stiffness answer.
- 6 to 12 weeks: out of the sling and using the arm. See weeks 6 to 12 and “If it isn’t going to plan”.
- 3 months on: strengthening and returning to work or sport. See months 3 onward and the “When can I…” table.
Week by week, then month by month
- Days 1 to 3: If you had a nerve block, the arm is usually numb for the first day or so. Pain is often at its worst in the first few nights as the block wears off. The sling stays on, including in bed, except for washing, dressing or exercises as instructed.
- Weeks 1 to 2: The wound is checked, and stitches or dressings are usually dealt with around 10 to 14 days. Many people start small pendulum swings, or have a PT move the arm for them (passive movement). Keep the elbow, wrist and hand moving.
- Weeks 2 to 6: The sling stays on most of the time. Passive range slowly increases. Night pain usually starts easing in this period, though it can last longer. The tendon is not yet firmly attached to bone, so you do not lift the arm with its own muscles yet.
- Weeks 6 to 12: The sling is usually off by now. Movement progresses from assisted (using your other hand, a stick or a table to help) to active. Light use at waist height, such as eating or typing, is usually allowed. Lifting the arm often feels heavy and weak at this stage.
- Months 3 to 4: Strengthening starts with light resistance. Reaching overhead without a load is often possible by now, though not always fully.
- Months 4 to 6: Strength builds steadily. Night pain has usually settled.
- Months 6 to 12: Strength and endurance keep improving. Heavy lifting, overhead work and sports such as swimming, tennis or golf usually return here, one step at a time. After a large repair, some people keep gaining for a year or more.
Is this normal?
- Night pain: Yes. It is common in the first weeks and can last into the second or third month. Sleeping propped up with a pillow under the forearm often helps.
- Swelling and bruising: Bruising can track down the upper arm toward the elbow in the first 1 to 2 weeks. It usually settles on its own.
- Stiffness: Some stiffness is expected while the arm is protected. It should improve gradually once your movements are progressed. Stiffness that has stopped improving is worth raising with your PT.
- Clicking: Painless clicking is common as the shoulder starts moving again. A sudden painful pop with new weakness should be reported to your surgeon.
- Numbness near the scar: Small skin nerves are cut with any incision. A patch of numb skin near the scars is common and often shrinks over months.
- Low mood: Broken sleep and one-handed living wear people down, and feeling flat is common. If it lasts more than a couple of weeks or deepens, tell your doctor.
If it isn’t going to plan
It is week 10. You still need your other hand to get a mug down from the cabinet, and reaching for the seatbelt still pulls. The thought in your head is: “I have done the exercises. It should be better by now.”
The belief that usually fails here is that the shoulder will loosen up on its own once the sling comes off. A shoulder that has been protected for 4 to 6 weeks needs regular, graded movement to regain range, and later, progressive load to regain strength. If either is off for your repair, progress can stall.
Pain that is rising after week 6, stiffness that has not changed for 2 to 3 weeks, or weakness that is not improving are signs the plan may need adjusting. They do not prove the repair has failed. The route is to get assessed by your physical therapist or your surgeon. Questions worth asking:
- Is my range where you would expect for this stage of my protocol?
- Could this be stiffness, a problem with the repair, or pain coming from my neck?
- Do I need a scan, or a change to my exercises?
- What should I be able to do 4 weeks from now?
When can I…
| Activity | Typical range |
|---|---|
| Shower | Usually within the first few days with a waterproof dressing, arm kept by your side; no soaking until the wound has healed |
| Sleep in bed | Many people sleep propped up for 2 to 6 weeks; lying on the operated side often takes 3 months or more |
| Drive | Not while in the sling; often 6 to 8 weeks or later, once you can control the wheel safely |
| Desk work | Often 2 to 4 weeks, one-handed and with regular breaks |
| Lift | Light items at waist height from about 6 to 8 weeks; heavier lifting often from 4 to 6 months |
| Reach overhead | Without a load often from about 3 months; with a load often from 4 to 6 months |
| Manual work or sport | Often 6 to 12 months, depending on the job or sport |
Your surgeon’s protocol comes first. Timings vary with the size of the repair and with each surgeon.
The shoulder often feels ready before the tendon is.
Call your local emergency number or go to the emergency department if
- Sudden breathlessness or chest pain: especially with a racing heart or coughing up blood.
- A cold, pale or blue hand: on the operated side, with worsening numbness.
See a doctor today if
- Wound redness or discharge: redness spreading from the scars, increasing warmth, pus, a bad smell or a wound that opens.
- Fever: 100.4°F (38°C) or higher, or shaking chills.
- Calf swelling or pain: in one leg, even without breathlessness.
- Numbness or weakness spreading: in the arm or hand after the nerve block should have worn off, or getting worse instead of better.
- Uncontrolled pain: pain that the medicines you were given are not controlling.
Get it checked soon if
- A sudden painful pop: followed by new weakness lifting the arm.
- Pain rising after week 6: instead of slowly settling.
- Stiffness stuck for 2 to 3 weeks: once you are allowed to move the arm more.
More on this area: surgery recovery guides.
A rotator cuff repair heals over months, so judge your progress month by month, not day by day.
Written by Louise Yow, Neck & Shoulder Physio.