Getting rehabilitation right matters as much as the operation itself. A technically sound repair can be let down by a recovery that is rushed, and an understandably cautious patient can end up with a stiff shoulder by doing too little. The way through is to follow the advice of your surgeon and your physiotherapist, and to understand roughly what is happening inside the shoulder at each stage so that the restrictions make sense. Dr Cutbush works closely with experienced shoulder physiotherapists so that patients receive consistent care through that period.
Recovery after shoulder surgery is best thought of in phases. In the early weeks the priority is protection, because a repaired tendon or labrum has very little strength of its own and depends on the sutures and anchors holding it while biology does the work. Movement is restored next, usually passively at first and then actively. Strength comes last, and it continues to improve for considerably longer than most people expect. Rushing a phase risks the repair; skipping the movement phase risks stiffness. Your programme is written around the specific operation you had, which is why it should not be substituted for a general one.
Rehabilitation also has a practical side that is easy to overlook. A sling has to be fitted properly to be comfortable and to do its job. Showering, dressing, sleeping and caring for dressings all become more awkward with one arm immobilised, and there are straightforward techniques that make each of them easier. These are shown to you before you leave hospital and are covered in the patient videos.
Wearing a sling
A sling is essential after reconstructive shoulder surgery. How long it is worn varies considerably with the procedure, from a few days to several weeks. The video below shows how to fit a sling correctly and comfortably. It was made with Extend Rehabilitation and physiotherapist Nadia.
Therapy from day one
Physiotherapy begins in hospital. A physiotherapist sees you on the ward the day after surgery. You are given an exercise programme specific to the procedure you have had, instructions for showering and dressing, and help fitting your sling.
Healing the rotator cuff
A repaired tendon and the bone it is attached to heal together through a clot that forms between them. Fibroblasts lay down collagen fibres, mainly during the first 4 to 6 weeks. Those fibres are then remodelled and reorganised over the following months: remodelling continues for 6 to 12 months, with most of it finished by 4 to 6 months. The strength of the attachment between tendon and bone keeps improving for at least 12 months after surgery. This is why a sling is needed early on, and why strengthening is introduced gradually rather than all at once.
Passive and active exercises
Your programme will distinguish between passive and active exercise, and the difference is important. A passive exercise is one in which the limb is moved by something other than its own muscles, either by a therapist or by your other arm. An active exercise is one in which the muscles of that limb do the work. Bending the elbow is a useful example: if your other hand lifts the forearm, that is passive elbow flexion; if the biceps lifts it, that is active elbow flexion. After many shoulder repairs, passive movement is permitted well before active movement, because active muscle contraction loads the repair.
Post-operative exercises
The patient videos demonstrate the shoulder exercises commonly used after surgery. Please follow the programme your own physiotherapist has given you, rather than working through all of the exercises shown. Some exercises are not safe immediately after particular operations and could place a repair at risk. If you are unsure which exercises apply to you or at what stage, contact your physiotherapist.
Recovery after your procedure
Recovery timeframes and restrictions differ with the operation. The pages below cover what to expect after the procedures most often performed.
What to do next
The patient videos covering sling use, post-operative care and rehabilitation exercises are indexed under videos. The operations themselves are described under shoulder surgery, and the conditions they treat under shoulder injuries and conditions.
The surgery FAQs answer common questions about the hospital stay, pain relief, driving and returning to work. For an appointment, see consultation, and if you are travelling to Brisbane for surgery, accommodation has information on staying nearby.
This page is general information and does not replace the programme given to you by your treating physiotherapist and surgeon. Individual circumstances vary, and recovery timeframes differ from person to person.
Exercise video library
The videos below are the full set of patient videos used after shoulder surgery at the clinic. They are grouped to make them easier to find, and each one keeps the number it was recorded under so that you and your physiotherapist can refer to it easily.
Please work only through the exercises your own physiotherapist has given you. These videos are a reference library, not a programme. Some of these exercises are not safe immediately after particular operations and could place a repair at risk. If you are unsure which exercises apply to you, or at what stage, contact your physiotherapist before starting them.
Managing day to day
These two cover the practical side of having one arm in a sling. The written guides are at how to get dressed with a sling and how to shower with a sling.
01a How to put a shirt on
01b How to have a shower
Pendulum and elbow exercises
01 Passive pendulum
02 Circular pendulum
03 Passive elbow flexion
04 Active elbow flexion
05 Hand movements
Posture and assisted movement
07 Passive forward lean
08 Posture
09 Stick extension
11 Hand to hip
Rotation exercises
12 Active external rotation
13 Passive external rotation to 20°
14 Passive external rotation to neutral
16 Isometric external rotation
17 Isometric internal rotation
Standing elevation and pulley exercises
15 Active forward lean 180°
19 Wall slides
20 Shoulder pulley forwards
21 Shoulder pulley backwards
Lying exercises
22 Lying flexion with other hand
23 Lying flexion with stick
24 Lying flexion to 90°
25 Lying hands on head
26 Lying horizontal flexion
27 Lying external rotation
Further exercise videos
The video below is part of the same series. Its title could not be confirmed, so it is listed here rather than under a heading that might describe it incorrectly. Ask your physiotherapist if you are unsure what it shows or whether it applies to you.
Guides that go with these videos
