Open Rotator Cuff Repair Recovery
Open Rotator Cuff Repair
What the operation does
The rotator cuff is a set of four tendons wrapping the top of the arm bone, lifting and steadying the shoulder. When one tears off the bone, this operation reattaches it to its footprint with anchors and strong suture — the same repair as the keyhole version, done through an incision at the front and side of the shoulder rather than through punctures.
Why it was done open
Usually because the tear was large, retracted, or complex enough that reattaching it needed direct access and direct handling of the tendon. It is also used for revision repairs, where scar tissue makes a keyhole approach difficult, and when a tendon transfer or other reconstruction may be needed in the same operation. It reflects the size of the problem rather than a less modern technique.
The tendon heals at the same speed either way
Worth being clear about. The skin heals differently and the shoulder is sorer early, but the biology that governs the timetable — a tendon knitting back onto bone — is identical. So the six weeks without lifting the arm under its own power, and the year to full strength, are the same as after a keyhole repair. The approach changes the wound, not the healing.
The deltoid, and what is different here
The main difference. Reaching the cuff means going through the deltoid, the big muscle over the outside of the shoulder — usually splitting it, sometimes lifting a portion off bone. That muscle then has to heal too, so actively raising the arm out to the side is protected a little longer than after a keyhole repair, and strengthening in that direction sits later in the programme.
The axillary nerve
The nerve supplying the deltoid runs across the outer arm just below where the muscle is split, and it is at more risk in an open repair than a keyhole one. Numbness over the outer shoulder, or difficulty lifting the arm out to the side once you are allowed to, is worth reporting. Most such problems are temporary, and gentle nerve gliding appears in the programme from the first phase for that reason.
Six weeks of not lifting
The central instruction, exactly as after a keyhole repair. Contracting the repaired tendon pulls directly on the stitches holding it to bone at a stage when nothing has healed. Someone else moving your arm, or your good arm moving it with a stick, loads nothing. Your own muscle lifting it loads everything.
Pain and stiffness early
Generally more than after a keyhole repair for the first few weeks, because there is a larger wound and a muscle that has been divided. It usually settles to a similar level by around six weeks. Night pain is the dominant symptom and often the last to go.
The scar
A scar over the front and outer shoulder, sensitive for some months and sometimes for longer where clothing or a bag strap crosses it. Once healed, gentle massage over it is often comfortable and helps desensitise it.
Whether the repair heals
A proportion of repairs do not fully heal back to bone, and that is more likely with the large tears that lead to an open repair in the first place — as well as in older patients, smokers, and people with diabetes. Many shoulders with an incompletely healed repair still function and feel well, so a scan finding is not the same as a failed operation.
Strength comes back last
Movement returns first, then comfort, then strength, usually with long gaps between them. A shoulder that moves fully and comfortably at four months may still be unable to lift a full kettle overhead. Strength continues improving out to a year and often beyond.
What you can use the arm for early
More than people assume. The hand, wrist and elbow should move from the start, and using the hand at waist height with the elbow at your side — eating, writing, a phone — is usually fine. What is out is lifting the arm away from the body, reaching overhead, reaching behind your back, and carrying anything of weight.
Sleeping
Plan for it. Lying flat is uncomfortable for weeks, and many people sleep in a recliner or propped on pillows with the elbow supported. Setting that up before the operation is worth doing, and most people need help at home for the first week or two.
Driving and work
Driving generally waits until you are out of the sling and can control the wheel with both hands without pain — commonly around six to eight weeks. Desk-based work is often possible within one to two weeks with the sling on. Work involving lifting, overhead reaching, or ladders commonly waits four to six months.
How the first year usually unfolds
Six weeks in a sling with passive movement only, and night pain dominant. Six to twelve weeks the sling goes and assisted movement builds. Three to six months brings active lifting and the first strengthening. Six to nine months brings heavier work and overhead activity. Full strength generally falls between nine and eighteen months.
Staying in touch with your care team
Tear size, tendon quality, and what else was done all change this timetable, and your surgeon knows those details. If something about your recovery is worrying you or does not match what is described here — particularly numbness over the outer shoulder, or a sudden loss of movement — contact your care team rather than waiting.
Exercises for Open Rotator Cuff Repair
An illustrated, phase-by-phase exercise program for this procedure. View the Open Rotator Cuff Repair exercise program.
Recovery education · Condition guides · Exercise programs
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This guide is general education and doesn't replace evaluation by a licensed provider. Recovery and treatment vary by person — follow the guidance of your own surgeon or care team.