What are the guidelines for a work release to light duty without driving restrictions after rotator cuff repair?

Work Release Guidelines After Rotator Cuff Repair

For light duty work without driving restrictions after rotator cuff repair, return to work timing depends primarily on the physical demands of the job, with sedentary workers typically cleared at 2-4 weeks post-operatively and light-duty workers at 6-12 weeks, while driving can generally resume once off narcotic pain medications and the patient demonstrates adequate shoulder control (typically 2-4 weeks).

Return to Work Timeline by Job Category

Sedentary and Light-Duty Workers

• Patients performing sedentary or light-duty work have high rates of successful return to work after rotator cuff repair 1
• Light-duty restrictions should specify: no overhead reaching, no lifting >5 pounds with the operative arm, and no repetitive use of the operative shoulder 1
• Driving restrictions should be lifted once the patient is off opioid medications and demonstrates adequate shoulder control for steering and emergency maneuvers, typically by 2-4 weeks 2

Heavy Manual Laborers

• Heavy manual laborers are at significantly higher risk of not returning to their prior level of work after rotator cuff repair 1
• These workers require extended light-duty periods, often 3-6 months, before progressing to full duty 1

Rehabilitation Phase Considerations for Work Release

Early Phase (0-6 Weeks)

• Immobilization in a sling is standard during the first 4-6 weeks, though specific duration lacks definitive evidence 3, 4
• During this period, work release should specify: operative arm remains in sling except for prescribed exercises, no active use of operative shoulder, and sedentary tasks only with the non-operative arm 4
• Some patients at risk for stiffness may begin early passive range of motion, but this does not change the light-duty restrictions 5, 4

Intermediate Phase (6-12 Weeks)

• After 6 weeks, patients typically begin more active rehabilitation including pulley exercises, which are safe and do not compromise outcomes 6
• Light-duty work can expand to include: typing, computer work, light object manipulation with the operative arm below shoulder level, and gradual increase in activities of daily living 4, 6
• Driving is typically permitted by this phase if not already cleared earlier 2

Advanced Phase (12+ Weeks)

• Most patients achieve significant functional recovery by 12 weeks, though full strength may take 6-12 months 4
• Work restrictions can be progressively liberalized based on individual progress, with most light-duty workers returning to full duty by 3-4 months 1

Specific Work Release Wording

For a work release note at 2-4 weeks (sedentary work):

• Patient may return to sedentary work with the following restrictions: operative arm in sling at all times except for prescribed physical therapy exercises, no lifting/pushing/pulling with operative arm, may use non-operative arm for light tasks, and may drive if off narcotic pain medications and demonstrates adequate shoulder control 2, 4

For a work release note at 6-12 weeks (light duty):

• Patient may return to light-duty work with the following restrictions: no overhead reaching, no lifting >10-15 pounds with operative arm, no repetitive shoulder activities, may perform desk work and light object manipulation below shoulder level, and no driving restrictions 1, 4, 6

Common Pitfalls to Avoid

• Do not clear patients for driving while taking opioid medications, as these should be reserved strictly for rescue analgesia and impair reaction time 7
• Do not assume all rotator cuff repairs heal at the same rate—larger tears, older patients, and workers' compensation cases have less favorable outcomes and may require extended restrictions 2
• Do not release heavy manual laborers to full duty prematurely, as they have significantly higher failure rates and may require 6+ months before unrestricted work 1
• Do not mandate aggressive early rehabilitation for all patients, as individualized protocols based on tear size and stiffness risk are more appropriate, though this does not affect long-term outcomes after 6-12 months 4

Pain Management During Return to Work

• Patients should be maintained on scheduled acetaminophen 1000mg every 6 hours plus an NSAID or COX-2 inhibitor for baseline pain control 7
• Opioids should be reserved strictly for rescue analgesia and discontinued as soon as possible to allow driving and optimal work function 7
• Ice application for 15-20 minutes every 2-3 hours remains beneficial for pain management during the return-to-work transition 7