Each November, the Great American Smokeout serves as a powerful reminder that quitting tobacco - and now vaping - is about more than just protecting your lungs. Nicotine use affects nearly every system in the body, including how well you heal after injury or surgery. For athletes recovering from shoulder surgery, smoking or vaping can slow tissue repair, weaken tendons, and increase the risk of complications. Understanding how nicotine interferes with recovery after surgery is the first step toward stronger, safer results - and a better return to play.
How Smoking Affects Shoulder Healing
Shoulder surgeries, whether for rotator cuff repair, labral tears, or shoulder instability, depend on the body’s ability to heal soft tissue and bone. Nicotine, carbon monoxide, and other chemicals found in tobacco products reduce oxygen delivery to healing tissues. When oxygen levels drop, tendons and muscles take longer to repair, and surgical outcomes are less predictable.
In fact, studies have shown that smokers have higher rates of tendon re-tears and slower functional recovery following shoulder surgery.1 This isn’t just about wound healing; it’s about how well your shoulder regains strength, stability, and motion, all factors crucial for returning to sport.
Increased Risk of Postoperative Complications
Smoking impacts every phase of recovery, from the operating room to physical therapy.
Nicotine causes blood vessels to constrict, which limits blood flow to the shoulder and surrounding tissues. This can lead to delayed incision healing, infections, and even higher rates of anesthesia-related complications.
A Journal of Shoulder and Elbow Surgery analysis reported that smokers faced up to two to three times higher risk of surgical complications, including infections and wound-healing issues, compared to non-smokers.2 These complications often result in longer rehabilitation times and reduced shoulder performance long after surgery.
The Athletic Cost of Smoking
For athletes, the cost of smoking goes beyond surgery. It directly impacts endurance, performance, and muscle recovery. Nicotine reduces oxygen utilization, making training sessions feel harder and recovery slower. Even after a successful shoulder procedure, athletes who continue to smoke often notice persistent weakness or stiffness that limits their athletic potential.
Quitting, on the other hand, can dramatically improve outcomes. Within just weeks of stopping, circulation begins to normalize, tissue oxygenation improves, and the risk of infection starts to decline. By the time of surgery or during rehabilitation, the benefits become even more significant.
Timing Matters: When to Quit Before Surgery
Surgeons generally recommend quitting smoking at least four to six weeks before shoulder surgery and avoiding tobacco for a similar period afterward. This window gives the body time to clear nicotine and carbon monoxide, improving oxygen supply to healing tissues.
Even short-term cessation makes a difference. Research suggests that athletes who quit a few weeks before surgery heal more efficiently and regain strength faster than those who continue to smoke.
A Stronger Shoulder Starts with Smarter Choices
Whether you’re preparing for rotator cuff repair, shoulder instability surgery, or arthroscopic treatment, your recovery depends as much on your habits as your surgical care. Quitting smoking is one of the most effective ways to enhance healing, protect your investment in surgery, and return to your sport stronger.
If you’re considering shoulder surgery or want expert guidance on optimizing your recovery, schedule a consultation with Dr. Shah to discuss personalized surgical and rehabilitation options that support your long-term performance.
AUTHOR: Anup Shah, MD, MBA, FAAOS is a board-certified, fellowship-trained Sports Medicine Orthopedic surgeon specializing in Knee and Shoulder Surgery in Phoenix, Arizona at Banner Health. Dr. Shah uses a patient-centric and evidence-based approach to help his patients achieve their desired goals.
