Why is my shoulder still stiff 3 months after rotator cuff surgery?

Shoulder stiffness at three months following rotator cuff repair is very common and, in most cases, expected. Understanding why it occurs, however, requires looking at several contributing factors that frequently overlap in the post-surgical period.

The most prevalent cause is post-surgical adhesive capsulitis, in which scar tissue forms within the joint capsule and progressively restricts motion. This is the leading driver of post-operative stiffness and occurs as a recognized complication in 4 to 20 percent of rotator cuff repairs. Alongside capsular scarring, the nervous system often engages in protective guarding — reflexively limiting range of motion to shield the healing repair from potentially damaging loads. The mandatory sling period compounds this by allowing the capsule to tighten and surrounding musculature to shorten through disuse. Ongoing tissue healing also plays a role, since immature repair tissue is inherently less pliable than mature, remodeled tendon. Rehabilitation pacing matters as well: mobilization that was either delayed or introduced too aggressively can both contribute to persistent stiffness. Finally, repair tension is a relevant variable — larger tears require tighter repairs, and that mechanical constraint temporarily limits motion regardless of how well rehabilitation proceeds.

The immediate clinical priority is a surgical follow-up visit, ideally within one week, to confirm healing status and rule out re-tear or early infection. This provides the medical clearance necessary before advancing rehabilitation. Concurrently, a formal range-of-motion assessment should be performed to measure passive versus active motion in all planes and to determine whether a capsular pattern is present. The classic capsular pattern of adhesive capsulitis restricts external rotation most, followed by abduction, then internal rotation. Identifying this pattern guides treatment selection.

Once surgical clearance is obtained, structured physiotherapy is the central intervention. Capsular stretching combined with joint mobilization at grades I through III has strong evidence supporting its use in this setting and should be pursued over a 2 to 12 week period with the goal of progressive range-of-motion restoration. Heat applied before stretching sessions improves tissue extensibility and enhances the effectiveness of subsequent mobilization. Pendulum exercises and passive range-of-motion work performed daily provide gravity-assisted capsular lengthening between formal therapy sessions. As glenohumeral motion improves, a scapular stabilization program addresses the compensatory movement patterns — particularly early scapular elevation — that develop when the glenohumeral joint is restricted. This phase typically becomes the focus between weeks 4 and 12.

If capsular contracture is confirmed and range of motion fails to improve meaningfully by week 16, hydrodilatation is a reasonable next step. This procedure expands the capsule by injecting fluid under pressure and carries moderate supporting evidence.

Several clinical details would sharpen the assessment considerably. The original tear size and repair technique — single-row versus double-row fixation — influence how conservatively the early rehabilitation was structured and how quickly motion can be safely advanced. The specific post-operative protocol followed, including the week at which passive motion was initiated and when active-assisted motion began, helps identify whether a rehabilitation gap contributed to the current stiffness. Current pain levels at rest and with movement, the pattern of stiffness across the day, and whether the restriction is improving, plateauing, or worsening all inform prognosis and urgency.

One point worth emphasizing on timeline: full range-of-motion recovery after rotator cuff repair commonly takes 6 to 12 months. Stiffness at three months is within the expected recovery window, but it should be actively and measurably improving with proper rehabilitation. If stiffness is worsening rather than improving, or if it is accompanied by fever, redness, warmth around the joint, new neurological symptoms such as numbness or tingling, or sudden loss of strength, the surgeon should be contacted promptly, as these findings would warrant more urgent evaluation.

Persistent stiffness at three months following rotator cuff repair is one of the most common and frustrating complications of the procedure, and it is rarely explained by the repaired tissue alone. The underlying biomechanics are layered and worth understanding in detail.

The glenohumeral joint operates on a fundamental arthrokinematic principle: for the humeral head to elevate smoothly, it must simultaneously glide inferiorly and posteriorly within the glenoid fossa — the classic roll-glide mechanism. After rotator cuff surgery, several forces conspire to disrupt this relationship. Surgical scarring and capsular fibrosis cause the inferior glenohumeral ligament complex and posterior capsule to thicken in response to immobilization and surgical trauma, mechanically blocking the inferior glide required for elevation. Simultaneously, the repaired cuff muscles — most commonly the supraspinatus, sometimes the infraspinatus — are neurologically inhibited by pain and swelling, leaving the deltoid as the dominant elevator without adequate cuff-driven humeral head depression. The result is superior migration of the humeral head, impingement against the coracoacromial arch, and a mechanical block to further motion. Posterior capsule contracture compounds this problem in a way that is critically underappreciated: a tight posterior capsule forces the humeral head anteriorly and superiorly during internal rotation and cross-body movements, further disrupting the joint's mechanical axis.

The shoulder does not operate in isolation, and three months of guarded, restricted movement creates a cascade of compensatory dysfunction throughout the kinetic chain. The scapula begins to compensate through excessive anterior tilting and protraction, which reduces the subacromial space further and alters the length-tension relationship of the rotator cuff — a pattern called scapular dyskinesis. Ipsilateral cervical side-bending and thoracic rotation become restricted as the body protects the shoulder, loading the cervical facets and potentially generating secondary neck pain. The opposite shoulder, hip, and even the ipsilateral elbow begin absorbing forces the restricted shoulder can no longer manage. Chronic shoulder guarding also elevates the ipsilateral first rib, restricting diaphragmatic excursion and altering breathing mechanics.

The dysfunctional movement patterns that emerge from this picture are predictable. Excessive upper trapezius recruitment substitutes for true glenohumeral elevation, producing the characteristic shrug sign. Ipsilateral trunk lean allows apparent arm elevation through lumbar side-bending rather than true shoulder range of motion. Loss of serratus anterior and lower trapezius activation creates scapular instability, visible as winging or anterior tilt. Inability to reach behind the back — loss of internal rotation — is the hallmark presentation of posterior capsule contracture.

At three months post-repair, the typical trajectory is a transition from the early protective phase into active rehabilitation. Persistent stiffness at this stage, however, suggests that joint mobility work needs to be revisited before strengthening is progressed. The specific protocol must always be confirmed with the operating surgeon, because repair complexity directly dictates tissue healing timelines.

The first priority — roughly the initial one to three weeks of a structured mobility restoration program — is restoring the roll-glide mechanism before loading the joint. The sleeper stretch addresses posterior capsule extensibility directly: lying on the affected shoulder with the arm at 90 degrees of forward flexion and the elbow bent to 90 degrees, the opposite hand gently presses the forearm toward the floor into internal rotation, held for 30 seconds, three repetitions, twice daily. The cross-body horizontal adduction stretch targets the same posterior capsule and the infraspinatus by bringing the affected arm across the chest and using the opposite hand to pull the elbow gently toward the opposite shoulder, again 30 seconds, three repetitions, twice daily. Inferior glide mobilization — ideally performed by a physiotherapist, though a self-mobilization version using a towel roll in the axilla with gentle downward traction through the arm, held 10 seconds for 10 repetitions once daily — restores the critical inferior glide needed for elevation. Codman's pendulum exercises, performed by leaning forward over a table and allowing the arm to hang freely through small circles and forward-backward and side-to-side swings of 20 repetitions each direction, three times daily, use gravity to create gentle joint distraction while neurologically inhibiting pain and restoring synovial fluid distribution. Thoracic extension mobilization over a foam roller placed horizontally across the mid-thoracic spine at T4–T8, performing 10 repetitions at each spinal level while moving the roller superiorly, once daily, restores the thoracic extension that is critical for scapular retraction and shoulder elevation.

Once meaningful passive range of motion has been recovered — targeting at least 140 degrees of elevation, 40 degrees of external rotation, and internal rotation reaching the L3 vertebral level — the focus shifts to retraining the force couples that create dynamic stability, typically over weeks three through six. Scapular retraction and depression, sometimes called shoulder packing, involves drawing the shoulder blade down and back without shrugging, held five seconds for 15 repetitions across three sets twice daily, reactivating the lower trapezius and suppressing upper trapezius dominance. Wall slides with forearms on the wall, sliding the arms upward while maintaining scapular contact with the ribcage, three sets of 12 repetitions once daily, activate the serratus anterior and can be progressed to fully extended arms and then to a resistance band. Sidelying external rotation — lying on the unaffected side with the elbow bent to 90 degrees and a small towel under the elbow, rotating the forearm upward against gravity for three sets of 15 repetitions once daily — can be progressed to 0.5 kg of resistance once three sets of 15 feel easy without a compensatory shrug. Prone Y-T-W exercises, performed in the Y position with arms overhead, T position with arms out to the sides, and W position with elbows bent and thumbs up, three sets of 10 each position once daily, target the lower and mid-trapezius — the scapular stabilizers most inhibited following surgery.

The final phase, spanning roughly weeks six through twelve, integrates the entire kinetic chain. Rhythmic stabilization with the arm supported at 90 degrees of elevation, during which a therapist or partner applies gentle perturbations in multiple directions for 30 seconds per position across three positions three times weekly, restores proprioceptive acuity and co-contraction patterns. Diagonal PNF patterns, particularly the D2 flexion pattern — beginning with the arm across the body, palm down, and sweeping up and out to overhead with the palm forward — for three sets of 10 repetitions three times weekly, integrate the entire upper extremity kinetic chain in functional diagonal movements.

Progression through these phases should be driven by objective criteria, not time alone. The transition from the first phase to the second requires passive forward flexion of at least 140 degrees, passive external rotation of at least 40 degrees at the side, internal rotation reaching at least the L3–L4 vertebral level, pendulums performed pain-free, and no significant night pain. The transition from the second phase to the third requires active forward flexion of at least 160 degrees with symmetric scapular rhythm and no shrug sign, external rotation strength of at least 70 percent of the contralateral side as measured with a handheld dynamometer, scapular retraction and depression maintained during all phase-two exercises, and no pain with resisted external rotation. Return to full activity requires bilateral shoulder strength symmetry of at least 90 percent, full pain-free range of motion in all planes, negative functional movement screen shoulder clearing tests, and sport-specific or task-specific movements performed without compensation.

Persistent stiffness at three months also warrants investigation for adhesive capsulitis, which can develop as a complication of rotator cuff surgery. Reassessment should be sought promptly if there is progressive loss of range of motion despite consistent rehabilitation, severe end-range pain in all directions rather than just with elevation, loss of external rotation with the arm at the side — the hallmark sign of frozen shoulder — or significant night pain disrupting sleep. In these cases, the surgeon may consider a hydrodilatation procedure or manipulation under anesthesia before continuing conservative rehabilitation.

Shoulder stiffness at three months is biomechanically explained by a combination of posterior capsule contracture, inferior glenohumeral ligament fibrosis, rotator cuff inhibition, and secondary scapular dyskinesis. All of these are addressable with targeted, progressive intervention. The sequence matters: arthrokinematic mobility must be restored first, followed by rebuilding the neuromuscular force couples that create dynamic stability, and finally integrating the entire kinetic chain. Stiffness at this stage is common, but it is not inevitable, and with the right approach, full functional recovery remains very achievable.

Persistent stiffness three months after rotator cuff repair is one of the most common complaints at this stage of recovery. It is almost always explainable, and more importantly, addressable. Understanding what is actually happening in the shoulder is the necessary first step.

Stiffness at three months post-repair is rarely just about scar tissue, though that is part of the story. The deeper issue is a cascade of neuromuscular events that began the moment the first incision was made. The primary culprit is arthrogenic muscle inhibition. When the shoulder joint experiences trauma — whether from injury or surgery — the nervous system reflexively inhibits the surrounding musculature as a protective mechanism. The rotator cuff muscles (supraspinatus, infraspinatus, teres minor, and subscapularis) and the scapular stabilizers (serratus anterior, lower trapezius, and rhomboids) are all operating at a neurological deficit at this stage. This is not weakness in the traditional sense — the muscles have not forgotten how to contract — but the nervous system is actively suppressing full motor unit recruitment to protect the healing tissue.

The inhibition pattern typically follows a predictable distribution. The supraspinatus is severely inhibited, especially in the first 90° of elevation, making it the primary stiffness driver. The infraspinatus and teres minor show reduced external rotation torque, contributing to the locked feeling in rotation. The serratus anterior is often profoundly inhibited, causing scapular dyskinesis that mechanically limits glenohumeral motion. The lower trapezius is weakened, allowing the scapula to anteriorly tilt and further compress the subacromial space.

Simultaneously, the posterior capsule has likely developed adaptive shortening from weeks of immobilization and guarded positioning. This shifts the humeral head anteriorly and superiorly in the glenoid, mechanically blocking internal rotation and cross-body motion. Disuse atrophy compounds the problem further. Research shows measurable Type II muscle fiber atrophy begins within 72 hours of immobilization. At three months, 20–35% of rotator cuff cross-sectional area may have been lost depending on the immobilization protocol. The brain is, in effect, trying to protect a structurally compromised and neurologically confused shoulder.

At three months post-repair, most standard protocols are transitioning from passive and active-assisted range of motion into active range of motion and early strengthening, assuming surgical clearance has been given. The stiffness present at this stage signals that mobility and neuromuscular re-education need to be addressed simultaneously before any aggressive loading begins.

One critical caveat applies throughout: the specific repair type matters enormously. A small single-tendon repair has a very different timeline than a large or massive tear repair. If a large repair was performed, the surgeon may intentionally be maintaining a conservative approach. The current phase should always be confirmed with the surgical team before advancing.

The following protocol targets weeks 10 through 16 and addresses posterior capsule mobilization, scapular neuromuscular re-education, and early rotator cuff activation in sequence.

Posterior capsule shortening is likely contributing significantly to the stiffness and should be addressed first. The sleeper stretch is performed lying on the surgical side with the elbow bent to 90°. The opposite hand gently presses the forearm toward the table into internal rotation. The hold is 30 seconds for 3 repetitions, twice daily. The essential form cue is keeping the shoulder blade pinned to the table rather than allowing it to roll forward — this isolates the posterior capsule stretch rather than stressing the repair. The cross-body stretch is performed standing or seated, using the opposite arm to draw the surgical arm across the chest at shoulder height. Hold 30 seconds for 3 repetitions, twice daily, stopping at the first point of resistance without forcing end range.

Before loading the rotator cuff, scapular control must be restored. A dyskinetic scapula undermines every subsequent exercise. The scapular clock is performed seated, with isolated scapular movements — retraction, depression, protraction, elevation — carried out in a controlled pattern: 2 sets of 10 full cycles, once daily. This re-establishes the motor pattern for scapular stabilizers without loading the cuff. Wall slides are performed standing facing a wall with forearms resting on the surface, slowly sliding the arms upward while maintaining scapular depression (shoulder blades away from the ears): 3 sets of 10 repetitions, once daily. This activates the serratus anterior and lower trapezius in a gravity-reduced position. The prone Y-T-W is performed lying face down. The Y position places arms overhead at 30° from midline; the T position extends arms straight out to the sides; the W position bends the elbows into external rotation. Each position is held for 3 seconds: 2 sets of 8 per position, every other day, with no added weight initially — arm weight alone is sufficient. This exercise is among the most evidence-supported for lower trapezius and posterior cuff re-education.

For early rotator cuff activation, side-lying external rotation is performed lying on the non-surgical side with the elbow bent to 90° and a small towel roll under the elbow. The forearm rotates upward through available range: 3 sets of 15 repetitions, once daily, starting with no weight. Progression to 0.5 kg is appropriate when 3 sets of 15 can be completed with smooth, controlled motion and no compensatory trunk rotation. This is the primary re-educator for the infraspinatus and teres minor. Side-lying internal rotation uses the same position in the opposite direction: 3 sets of 15, once daily, targeting the subscapularis — often the most neglected muscle in post-repair rehabilitation. Isometric shoulder flexion, abduction, and external rotation are performed standing with the elbow at 90°, pressing the hand against a wall in each direction: hold 5 seconds, 10 repetitions per direction, twice daily. Isometrics are the safest entry point for cuff loading because they generate tension without joint movement, minimizing stress on the repair while countering arthrogenic inhibition.

Load progression is where the most common errors in post-surgical rehabilitation occur — either advancing too quickly and risking re-tear, or advancing too slowly and perpetuating inhibition and atrophy. Objective measures should drive progression, not the calendar alone.

Resistance training should begin with bodyweight or a maximum of 0.5 kg for rotator cuff exercises. Load should increase by no more than 10% per week, and only when morning stiffness is not increasing, resting pain remains at or below 2/10 on the visual analog scale, full range of motion from the previous session is maintained, and no night pain follows exercise. If increased pain or stiffness appears the day after a session, load should be reduced by 50% and held at that level for one additional week before attempting progression again. At four to five months post-repair, assuming a standard repair, the transition to isotonic strengthening with elastic resistance bands is appropriate, progressing toward dumbbell exercises in the 1–3 kg range for rotator cuff work.

Stiffness resolution and return to function should be measured against specific objective benchmarks. For range of motion, compared to the non-surgical side, the targets are: forward flexion at or above 160° or within 10° of the opposite side; external rotation at the side at or above 60° or within 10° of the opposite side; internal rotation with the hand reaching the T8–T10 spinal level; and abduction at or above 150°. Strength benchmarks, typically assessed at four to six months, are: external rotation strength at or above 70% of the non-surgical side by handheld dynamometry; internal rotation strength at or above 80%; abduction strength at or above 70%; and an external-to-internal rotation ratio at or above 65%. Functional benchmarks for return to normal activities include the ability to reach overhead without compensatory trunk lean, reach behind the back to the T8 level, carry 4–5 kg at the side without pain, perform 10 repetitions of shoulder press at 50% bodyweight without pain, and sleep on the surgical side without waking from pain.

Stiffness at three months is the product of arthrogenic inhibition, posterior capsule contracture, scapular dyskinesis, and disuse atrophy — all working together to restrict shoulder motion. This is not a sign that something went wrong with the surgery. It is a sign that the nervous system did exactly what it was designed to do: protect healing tissue. The task now is to systematically demonstrate to the nervous system that it is safe to release that protection.

Consistency with the mobility work twice daily, combined with progressive neuromuscular re-education, should produce measurable improvements in range of motion within 3–4 weeks and meaningful strength gains by weeks 16–20. The specific details of the repair — tear size, tendon involved, and fixation method — will modify this protocol significantly, which is why confirmation and supervision from the surgical team and a physical therapist who specializes in shoulder rehabilitation remain essential throughout this process.

Stiffness at 3 months after rotator cuff surgery is completely normal and expected. Rotator cuff repairs involve reattaching torn tissue to bone, and the healing timeline is genuinely long — most surgeons consider the tissue biologically immature until 4 to 6 months post-op. The body is likely doing exactly what it should be doing. That said, the experience of persistent stiffness — the frustration, the uncertainty, the fear — has a very real psychological dimension that can either accelerate or slow recovery.

The question "why is my shoulder still stiff" carries important psychological signals worth unpacking. The word "still" reflects an expectation of being further along by now. That gap between expectation and reality is one of the most psychologically challenging aspects of orthopedic recovery.

Several psychological patterns are common at this stage. Catastrophizing — interpreting persistent stiffness as evidence that something went wrong, that the surgery failed, or that permanent damage occurred — is extremely common and genuinely harmful to recovery outcomes. Thoughts like "it should be better by now, what if it never gets better?" fall into this category. Fear-avoidance behavior is equally common: unconsciously protecting the shoulder by limiting movement, which paradoxically increases stiffness. The brain learns to associate shoulder movement with threat and begins restricting range of motion as a protective response. Hypervigilance to sensation is another pattern — after surgery, the nervous system becomes sensitized, and monitoring every twinge, ache, and restriction with intense focus amplifies both pain perception and stiffness awareness. Finally, motivation erosion is predictable at this stage. Three months is a long time to be restricted, uncomfortable, and dependent. Fatigue, frustration, and low mood are not signs of weakness; they are predictable neurological responses to prolonged physical limitation.

Here is a fundamental principle that changes how people recover: stiffness and discomfort at 3 months post-rotator cuff surgery does not mean harm is occurring. In fact, the opposite is often true — appropriate movement through stiffness is required for healing. The nervous system cannot yet distinguish between "this movement is dangerous" and "this movement is uncomfortable because tissue is remodeling." It defaults to protection. The task, with guidance from the surgical and physical therapy team, is to gently teach it the difference.

Several pain psychology principles apply directly here. Pain in the 0 to 3 out of 10 range during prescribed exercises is acceptable and expected — it reflects tissue being challenged, not damaged. Stiffness that improves during a session is a positive signal, indicating the nervous system is learning safety. A temporary flare-up after activity that returns to baseline within 24 hours is a normal tissue response, not re-injury. Avoiding movement to avoid discomfort creates a cycle that extends stiffness for months beyond what is necessary.

If fear-avoidance is present — and at 3 months it almost always is to some degree — a structured graded exposure approach helps the nervous system gradually accept movement as safe. This progresses across five phases. In the first one to two weeks, the goal is to reconnect with the shoulder without fear, using gentle pendulum swings and supported passive range of motion. The psychological focus is on noticing sensation without labeling it as dangerous, and the progression criterion is completing exercises with a confidence level of at least 5 out of 10. In weeks two to three, the focus shifts to active assisted movement — pulley-assisted elevation and wall slides — with the aim of beginning to trust one's own muscle activation. The sensation of stretch is reframed as tissue lengthening and healing rather than something tearing, and progression requires consistent 0 to 3 out of 10 pain during activity returning to baseline within 2 hours. Weeks three to four introduce active range of motion — active elevation and external rotation within prescribed limits — using visualization before each session to mentally rehearse completing the movement smoothly and successfully. Progression requires completing the full prescribed range without bracing, guarding, or breath-holding. Weeks four to six focus on functional integration: reaching for objects at shoulder height and performing light daily tasks, while tracking confidence levels on a 0 to 10 scale in a journal. Objective data of this kind directly counters the subjective feeling that nothing is improving, and progression requires a confidence level of at least 7 out of 10 for functional tasks with minimal anticipatory anxiety. From week six onward, the goal is load and confidence building using light resistance band work as prescribed by the physical therapist. Incremental wins should be acknowledged explicitly, as the nervous system responds to positive reinforcement. Progression is marked by consistent engagement without protective guarding and stable or improving mood and motivation.

Several practical tools help manage the hard moments. When fear arises during movement, a useful reframe is: "This is healing tissue responding to appropriate challenge. Discomfort here is information, not danger. I can move through this safely." A specific breathing technique supports feared movements: inhale for 4 counts before initiating the movement, then exhale slowly for 6 counts during the movement. This activates the parasympathetic nervous system and directly reduces the threat response that creates protective muscle guarding — which is itself a major contributor to stiffness. A brief visualization practice of 2 minutes before each session — eyes closed, imagining the shoulder moving through its full range smoothly and comfortably — is not wishful thinking. Motor imagery activates the same neural pathways as physical movement and has documented effects on recovery outcomes. Progress journaling is also valuable: rating both shoulder confidence and mood on a 0 to 10 scale each day for two weeks reveals an upward trend that is difficult to perceive day-to-day. Objective data is a powerful antidote to catastrophizing.

Stiffness at 3 months is not a sign of failure. It is a sign of being in the middle of a genuinely long process. The psychological work of recovery is as real as the physical work, and addressing it directly is one of the most evidence-based things a patient can do to improve outcomes. How one thinks about the shoulder, and how much one trusts it, will shape how it heals.

Shoulder stiffness following rotator cuff repair is a common and expected complication affecting a substantial proportion of patients. Emerging evidence, however, suggests it may not be purely detrimental. An editorial commentary by Murrell (2024, PMID 38460767) proposes a meaningful paradigm shift: moderate stiffness in the early post-operative period may actually enhance repair integrity by limiting excessive motion during the critical healing phase. This challenges the historical view of stiffness as an unambiguous complication and raises the possibility that selective, controlled stiffness may serve a protective function.

That said, the clinical challenge lies in distinguishing protective stiffness from pathological stiffness that perpetuates functional limitation. Edwards and colleagues (2017, PMID 28704624) conducted a systematic review of electromyography studies in normal shoulders to guide post-operative rehabilitation progression after rotator cuff repair. Their findings indicate that EMG-guided rehabilitation can inform safe loading parameters and help clinicians balance protection of the repair against the need for progressive mobilization. The central concern is that under-mobilization perpetuates stiffness, while over-loading risks re-tear — and the evidence does not yet provide clear thresholds for when one risk outweighs the other. A narrative review by Papalia and colleagues (2012, PMID 22334282) confirms that post-operative stiffness remains a frequent complication with substantial negative impact on functional outcomes and patient morbidity, though it offers limited detail on specific prevention or treatment protocols.

Several important evidence gaps limit clinical certainty in this area. The available studies do not provide consensus on when stiffness persisting at 3 months should prompt escalation to advanced interventions such as hydrodilatation or manipulation under anesthesia. Murrell's commentary suggests some stiffness is protective but does not quantify safe range-of-motion thresholds. Edwards and colleagues advocate EMG-guided progression but do not specify whether accelerated or conservative post-operative protocols are superior for preventing pathological stiffness while preserving repair integrity. None of the studies stratify outcomes by tear size, repair technique (single versus double row), or patient age — factors that likely influence both the stiffness trajectory and management decisions. Alignment with AAOS, AOSSM, or APTA guidelines regarding optimal mobilization timing and stiffness thresholds for intervention was not verified in this search. Additionally, the Papalia review predates current understanding of capsular biology and inflammatory cascades, and more recent mechanistic studies may inform prevention strategies not captured here.