Acromial stress fractures occur in about 1–3% of patients after rotator cuff repair, and the highest risk is within the first 18 months as the shoulder adapts to new loading forces. That’s why I limit lifting to 15 pounds on the operative arm for the first year—it gives the acromion time to strengthen and regain bone density under controlled stress. The good news is that these fractures rarely happen without warning. Most patients develop a stress reaction first, which shows up as new aching pain on top of the shoulder, often triggered by increasing activity too soon. If we catch it early, we can intervene and prevent a full fracture using tools like vitamin D supplementation, bone-building medications such as Fosamax, and bone stimulators to help reinforce the bone before it breaks. Early communication and smart recovery progressions are key to avoiding this complication.
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