rotator cuff repair

Welcome to the forum.

It takes the shoulder about 1 full year before it is considered 'fully healed' at whatever degree it ends up to be.

Was your surgery an arthroscopy or an open decompression?

Acupuncture is not covered on my health plan. I will be interested to see any replies by those that have used it, too.

I have had 3 on the right and 2 on the left. They take a long time to get over. All of my pt's tell me it is the worst injury to get over. I do believe they are correct.

Bodia:
In your writings I hear a longing to hit the golf course fairways and to tinkering and building things. You mention that you have had "extensive physical therapy" post-operatively of the rotator cuff and biceps tendon repair.

I have to wonder if the discomforting pain that you are experiencing is less associated post-operative pain and more pain due to an overly zealous rehabilitation program.

"No pain, no gain" is not an universally accepted mantra.

There can be too much of a good thing. There can be too much therapy.

What does too much therapy feel like? What are the implications of an overly strenuous recovery program?

Inflammation of surrounding tissues. Adhesions. Calcifications. Tethering of scar tissue to tendons and ligaments. All of which contributes to pain.

I would encourage you to consider a more modest and gentle approach to your rehabilitation and to a longer horizon before resuming your beloved golfing and other shoulder-intensive hobbies/avocations.

Consider going back to some of the post-operative basics with your therapist and medical providers.
1. Pendulum movement, gentle circular motion, with the arm dangling at your side.

2. Use of cold/cryotherapy/ice for 10-15 minutes post prescribed exercises/range of motion.

3. Use of a small, rolled hand towel of wash cloth placed up high into the armpit. The purpose of the towel roll is to provide an upward gradient to the humeral head into the glenoid fossa.

One of the reasons that rotator cuff recovery is thwarted is owing to the nature of the humeral head and glenoid fossa. The shoulder is basically a sling-suspeded joint. The humeral head is supported in position by tendons. There is no deep bony union as is in the hip, where the femoral head sits deeply in the bony enclave of the acetabulum. You want to avoid downward forces of the humeral head. The use of a rolled hand towel or wash cloth provides a nice upward nudge.

4. Reduce the number of repetitions of your exercise program. If you are doing 15 repetitions of a given exercise/motion, cut back to 10 repetitions.

5. Make sure that your scapula is mobile and moving. In order for the shoulder to have full range of motion, the scapula must move in a prescribed ratio to the movement of the shoulder. Some people with rotator cuff repairs do poorly not due to poor surgical technique but do poorly due to a "frozen" scapula. Make sure that your therapist is making notice of your scapular movement and motility.

6. Give yourself a wider berth of period for healing and restoration.

Of these ideas, see what makes sense for you and your particular situation. Each of us is unique in our needs in healing.
- Karen -

I have had 23 surguries and I must say that my rotator cuff was by far the most painful, with the longest recovery.

I agree with Seashell, it takes 12 months or more to heal and being overly aggressive during your recovery could be part of continued extreme pain. I found that for me I was over working my shoulder which was causing/keeping the inflammation from going down. And as Seashell stated getting back to basics may help significantly; especially using ice and perfirming pendulum/gravity type excercises . I did have to get toradol injections, which helped better than the narcotics (combo of fentanyl patch, mscotin and norco). But keep in mind that toradol is a high strength NSAID, which can cause gastic issues, like bleeding ulcers, so the risks may not make it a good option. Check with your physician based on your history.

I hope your recovery gets better soon.

I had arthroscopic surgery done one my shoulder last March to repair a SLAP tear, bursitis, rotator cuff tendonosis, and bicep tendonosis. I've gained most of my mobility back, only losing some lateral movement. I still have some discomfort when I do anything over head.. At 4 months you shouldn't be in constant pain any more. I stopped taking the hydrocodone after about a week of the surgery. The pt will be painful, but if you still experience pain all the time, I'd contact your surgeon about it. The shoulder is very fragile after these surgeries, and it's possible you re injured it.

Hey bigecase I never had a manipulation is that done to get rid of scar tissue. How do they know when and if you need that procedure. I'm seeing another Ortho Doc tomorrow for a second opinion I will ask him about it.

I will comment in general about shoulder recoveries . . . my comments are not specific to any one person or situation.

The shoulder is an inherently weak joint. It is like a coat hanger with a heavily weighted winter coat dangling in suspension. There is no bony stability as is present in the hip - the hip having a deep acentabulum that receives the femoral head. The shoulder relies solely on ligamentous and tendon attachments for support and stabilization.

That said, chronic shoulder pain is not always a sign of inherent joint pathology. There can be ongoing inflammation post arthroscopic procedure and rotator cuff repair. Inflammation can last for up to 12 months - or longer. Overly aggressive physical therapy and/or rehabilitation efforts can also do more harm than good. Overly aggressive therapy focusing on expedited range of motion can further traumatize the joint and soft tissue, setting into motion hyper-esthesia and parathesias. Overly aggressive therapy can cause the surrounding musculature to become chronically fatigued. This then sets up a sequela of increased joint instability - which contributes to further muscular fatigue - which contributes to further joint instability as a continuing cycle.

Bottom Line: Low to mild chronic should pain post rotator cuff repair is not uncommon. Pain is not necessarily a sign of inherent joint pathology nor a sign that further surgical intervention is called for. In fact, further surgery can cause additional trauma and risk of reflex sympathetic dystrophy (regional pain syndrome). Conservative management is often the best course along with toning down therapy goals and expectations.

Remember too, that most of us are aging . . . the shoulder's rotator cuff is particularly vulnerable to the effects of general aging, the common tendon insertion fibers more febrile and delicate and less able to hold/heal surgical sutures and surgical anastamosis.

Tred gently in your recovery is often the best advice post shoulder arthroscopic surgery and repair.
- Karen -