What is the typical recovery process for an adult patient with no significant comorbidities undergoing surgery to repair a supraspinatus tendon?

Recovery After Supraspinatus Tendon Repair Surgery

Recovery from supraspinatus tendon repair is a prolonged process requiring 6-12 months for complete healing, with structured rehabilitation protocols that prioritize early pain control, gradual mobilization, and progressive strengthening to optimize tendon-to-bone healing and functional outcomes.

Immediate Postoperative Period (Days 0-7)

Pain Management

• Multimodal analgesia combining paracetamol (acetaminophen) and NSAIDs or COX-2 inhibitors should be started pre-operatively or intra-operatively and continued postoperatively unless contraindicated 1
• Regional anesthesia with continuous interscalene block is superior to single-shot techniques, providing better pain control beyond the initial 6-8 hours when rebound pain typically occurs 1
• Intravenous dexamethasone increases the duration of interscalene block analgesia and reduces supplemental analgesic requirements 1
• Opioids should be used as rescue medication only, not as primary analgesics, given the effectiveness of multimodal approaches 1

Immobilization

• The shoulder is typically immobilized in a sling or abduction brace immediately after surgery 1
• Cryotherapy using ice applied through a wet towel for 10-minute periods after activities helps control pain and inflammation 2

Early Recovery Phase (Weeks 1-6)

Rehabilitation Timing

• Early motion protocols (starting POD 2-3) versus delayed protocols (starting POD 28) show no significant difference in pain outcomes, though specific protocols should be surgeon-directed based on repair tension 1
• The primary biologic goal during this phase is achieving tendon-to-bone healing, which takes precedence over aggressive mobilization 1

Activity Restrictions

• Relative rest by avoiding overhead activities and movements that reproduce pain is essential 2
• Passive range of motion exercises may begin under physical therapy guidance, but timing depends on tear size and repair quality 1

Intermediate Recovery Phase (Weeks 6-12)

Progressive Mobilization

• Active-assisted range of motion exercises typically begin around 6 weeks postoperatively
• Eccentric strengthening exercises become the cornerstone of rehabilitation and should be continued for at least 3-6 months 2
• Progressive loading must be gradual to avoid symptom exacerbation and protect the healing tendon 2

Late Recovery Phase (Months 3-6)

Functional Restoration

• Active strengthening intensifies during this period
• Return to overhead activities and sports typically occurs between 4-6 months, depending on healing progression
• Patients with intact cuff repairs demonstrate significantly better strength outcomes (7.3 kg) compared to those with failed healing (4.7 kg) 3

Long-Term Outcomes (6-24 Months)

Expected Functional Recovery

• Constant scores improve from approximately 52 points preoperatively to 84 points at final follow-up 3
• UCLA scores improve from 11.5 to 32.3 points on average 3
• Simple Shoulder Test scores show progressive improvement from 9 points at 4 months to 12 points at 12-24 months 4
• Complete tendon-to-bone healing occurs in approximately 71% of patients, with healing rates significantly lower in patients over age 65 (only 43% achieve complete healing) 3

Critical Factors Affecting Recovery

Patient-Related Factors

• Age over 65 years significantly reduces healing rates and may prolong recovery 3, 4
• Preoperative muscle atrophy and fatty degeneration of the supraspinatus and infraspinatus correlate with worse healing and clinical outcomes 1, 2
• Workers' compensation status correlates with less favorable outcomes and potentially longer recovery 1, 2

Surgical Factors

• Arthroscopic repair using tension-band suture techniques is the standard approach 2
• The suture-bridging technique shows retear rates of approximately 29% at 12 months, though functional outcomes remain good even with some structural failures 4
• Achieving tendon-to-bone healing improves strength outcomes, though some patients with incomplete healing still achieve satisfactory functional results 1, 3

Common Pitfalls to Avoid

• Do not use perioperative corticosteroid injections, as evidence regarding their effect on tendon healing is inconclusive and they may inhibit healing 1, 2
• Do not progress rehabilitation too aggressively—gradual loading is essential to prevent symptom worsening and protect the repair 2
• Do not expect full recovery before 6 months; tendon healing is a biological process that cannot be rushed 1
• Do not assume structural healing equals functional success or vice versa—some patients with retears achieve good functional outcomes, while healing status primarily affects strength restoration 3, 4

Realistic Timeline Summary

• Weeks 0-6: Immobilization and pain control phase; passive motion only
• Weeks 6-12: Active-assisted motion begins; protection remains paramount
• Months 3-6: Progressive strengthening; gradual return to activities
• Months 6-12: Continued strengthening; most functional recovery achieved
• 12+ months: Tendon remodeling continues; final strength outcomes established