Shoulder injuries – how recovery times can vary for rotator cuff tears

Best practice

When planning return to work for workers with a rotator cuff tear, be aware of the general recovery periods:

• Office workers may return to work following arthroscopic surgery after 28 days, but a longer period away from work may be required for open surgery.
• Manual workers should avoid overhead activities for 28 days if they don’t require surgery.  If these workers require arthroscopic surgery in their dominant arm, it may take ten weeks for them to return to full activities, and longer if open surgery was required.

Why this is important

• Following surgery for a rotator cuff tear, the re-tear rate for patients under 60 years of age was 14.4 per cent. While the re-tear rate for patients over 60 years of age was 24.3 per cent. Re-tearing is more common in those who had large tears or those with fatty infiltration in the muscle¹.
• Having three tendon tears rather than one or two is a potential risk factor for not returning to work².
• A common complication of any shoulder injury or shoulder surgery is frozen shoulder (adhesive capsulitis). For rotator cuff tears, between 1 to 2.5 per cent of workers will experience a frozen shoulder. Workers with frozen shoulders are off work for longer³.

The rotator cuff and types of injuries

The rotator cuff is a group of muscles in the shoulder which allows a wide range of movement while maintaining the stability of the glenohumeral joint. The rotator cuff includes the subscapularis, infraspinatus, supraspinatus and teres minor muscles.

Rotator cuff tendon injuries and bursitis of the shoulder are common conditions and easily aggravated by physical work, especially in workers doing repetitive overhead tasks under load.

Traumatic causes of rotator cuff tendon tear include a fall, shoulder dislocation, violent pull or sudden traction injury, direct trauma to the shoulder, vehicle accident, grabbing a rail to prevent falling, and lifting heavy objects or catching a falling object⁴.

Rotator cuff tears are also more common with increasing age, diabetes and abdominal obesity⁵.

Workers experiencing a rotator cuff tear may complain of a dull deep ache in the shoulder, and/or weakness or difficulty when reaching behind their back or washing their hair. They may not be able to sleep on their affected side due to pain.

Here are some strategies, tools and resources to support workers get back to work:

• Ensure a sustainable graduated return to work by developing suitable duties in collaboration with the worker and the worker’s treating health professionals. This includes their physiotherapist or exercise physiologist and treating medical specialist and insurer.
  • Seek advice on how much the injured worker can lift and whether they can they lift at chest height or above head height.
  • Cleaners may need to focus on light duties and cleaning at low levels when they first return to work.
  • Warehouse workers may need to be placed in an area where items weigh less than five kilograms.
  • Construction workers will initially need to avoid overhead work under load and climbing ladders.
  • Gardeners should initially avoid using brush cutters and hedge trimmers.
  • Office workers, after a workstation assessment, may need to use their mouse on the uninjured side and/or use a roller bar mouse to avoid forward reaching.
  • Work with the insurer to promote early and safe return to work and discussions around the long-term health benefits of returning to work.
• For manual workers, you will need to consider the weights of items lifted, height at which items are lifted and how repetitive the task is.
• Review the task that caused the initial injury with your work group to find ways to eliminate or minimise the hazard, using the PErforM assessment tool for hazardous manual tasks.
• Check in regularly with the injured worker to determine how their strengthening program is going and what their physiotherapist or exercise physiologist is recommending. You can monitor improvement by getting the worker to complete the Shoulder Pain and Disability Index (SPADI) questionnaire.

Article written by Dr Ki Douglas, Consultant Occupational Physician