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Ruminations on shoulder surgery

I tore one lobe of my biceps away from my right shoulder as shown in the shoulder diagram showing my injuries’ locations on the right in February 2024. In doing so, I tore my rotator cuff and did a lot of other damage to my shoulder joint. As Elaina, my surgeon’s Physician’s Assistant, responded to my query about protecting the joint until surgery, “Oh, don’t worry. You’ve done all the damage you can.”

Reassuring, that.

It was here that I learned that there are two different post rotator cuff surgery rehabilitation protocols.

Based on google medicine, I expected my arm to be immobilized in a complicated sling for three to six weeks. Physical therapy would have to wait until arm was “weaned” from the sling starting at about three weeks. No driving for weeks. A return to normal activities would take months. My muscles, which I work hard to maintain, would weaken a great deal. It sounded horrible to me.

Through dumb luck, I ended up with a surgical team that does not do shoulder rehabilitation that way.

My Case

My ruminations on shoulder surgery include the critical importance of the post-surgery rehabilitation process.

My surgeon’s physical therapy team had me out of my sling about 24 hours after leaving the operating room. They immediately allowed me to use my arm as much as I wanted to and could, it was incredibly weak and there was a lot of pain, with only three things forbidden: no lifting more than five pounds; no putting my hand behind my head; and no moving my arm as needed to tuck my shirt in at the rear of my pants.

There was a LOT of pain. The first 18 hours were absolutely awful, but I was off the opiate painkillers less than 24-hours after surgery.

The first “real” physical therapy session took place three days after surgery. I drove myself to the appointment without significant difficulty by using my left hand for most of the drive. In the few places my right was needed, it answered the call.

The physical therapy was an absolute misery for the first few weeks, and I was incredibly lucky at that. Shortly, however, my body was letting me know that it could do more and I was pressing the therapists to let me. My progress, increasing range of motion and decreasing pain, amazed the therapists repeatedly.

The three restrictions were lifted six weeks after the surgery. Yes, the shoulder remained, and remains at three months post-surgery, somewhat limited in range of motion – say 95% now – and strength – say 75% today and rising fast.

Why the difference

Different medical professionals have given me different explanations for the two rehab protocols. All the explanations to date have been unsatisfying at best. After modest efforts to understand, my ruminations on shoulder surgery have concluded that none of the folks I’ve asked want to explain it to me.

My recommendation

Should you be unfortunate enough to require rotator cuff surgery, include the planned rehabilitation process in your discussions with potential surgeons before selecting one. The surgery is a one-day event; the rehabilitation process takes three to six months. It should be a major factor in your decision making.

Lessons Learned

My ruminations on shoulder surgery are based on my case and mine alone. My experience included being very lucky, I am convinced that extended arm mobilization is both unnecessary and detrimental to a quick and full recovery.

Lesson the first: Rotator cuff surgery is very painful. Extremely painful.

Lesson the second: Pick the right surgeon. Mine, Dr. David Higgins, is simply outstanding, a Master Instructor with the Arthroscopy Association of North America and a former Chief of Sports Medicine for the Navy.

Lesson the third: Rehabilitation is an incredibly important part of the process. Include the rehabilitation protocol that you will follow when the surgery is complete in your selection of your surgical team.

Lesson the fourth: Don’t just do what the physical therapist tells you to do, ask “why?” This is a partnership and the more you understand what is going on, the quicker the pain will subside and the quicker you will return to full activities. I have anecdotes that illustrate this.

Lesson the fifth: Exercise pays unexpected dividends. My exercise routine up to the moment my biceps tore away from my shoulder insulated me from some of the worst of post-surgical effects and helped speed my recovery.