What to Expect After Reverse Shoulder Replacement

The reverse shoulder replacement procedure has restored function and relieved pain for many individuals dealing with complex shoulder conditions, including cuff tear arthropathy and complex fractures. However, the journey does not end when the surgery is complete. Many patients wonder what to expect after reverse shoulder replacement. In this post, we’ll explore the recovery process, helping you prepare for the weeks and months ahead.

Key Takeaways

• Expect to wear a sling for 2 weeks with a reverse total shoulder replacement and for an anatomic total shoulder replacement 6 weeks. This protects the surgical site and allows soft tissues to heal properly.

• A structured physical therapy program, starting with passive range of motion, often begins soon after surgery. 

• Many patients regain functional use of their arm for daily activities within three to six months. Full strength and endurance may take up to a year or longer.

Understanding the Reverse Shoulder Replacement

Before we discuss the recovery, it helps to understand the procedure itself. A conventional anatomic total shoulder replacement mimics the natural anatomy: a ball is placed on the end of the humerus (arm bone), and a socket is placed on the glenoid (shoulder blade). The reverse procedure, as the name suggests, reverses this setup.

The surgeon places the ball component on the shoulder blade and the socket component on the humerus. This unique configuration changes the shoulder’s biomechanics. It allows the large deltoid muscle, which covers the shoulder, to take over the function of the damaged rotator cuff muscles. This innovative design may be particularly effective for patients with cuff tear arthropathy, where both the rotator cuff is torn and the joint is arthritic.

The Immediate Post-Operative Period

Pain Management

Immediately post-surgery, your surgical team will prioritize your comfort. You will likely receive a combination of pain relief methods. These often include a nerve block, which numbs the shoulder and arm for the first 12 to 24 hours. Once the nerve block wears off, you may transition to oral pain medication. It is important to take your medication as prescribed. 

Hospital Stay and Initial Mobility

While some patients can return home the same day, others stay in the hospital for one night. Before discharge, you will learn how to manage your sling, which keeps your arm in a protected position, preventing accidental movements that could damage the healing tissues. Patients typically wear the sling full-time, even while sleeping, for the first two to six weeks depending on the type of replacement. Timelines and instructions may vary between patients.

Incision Care

The surgical incision will be covered with a dressing. Your medical team will provide specific instructions on how to care for the wound. Generally, you must keep the incision clean and dry. You should avoid submerging the incision in water, such as in a bathtub or pool, until your surgeon confirms it has healed.

Phase 1: The Protection Phase

This initial phase is all about protecting the surgical repair and allowing the tissues to heal. The primary focus is on rest and passive motion.

Physical therapy usually begins soon after surgery. In this phase, your therapist, a machine, or a caretaker moves your arm for you. This is called passive range of motion. You must not use your own muscles to lift or move the arm. The goal of PROM is to gently maintain the flexibility of the joint without stressing the healing components.

Phase 2: The Active Motion Phase

While timelines vary, at around six weeks, your surgeon may clear you to begin the next phase of rehabilitation. The focus shifts away from passive movement. You will start using your own muscles to move your arm. This is called active range of motion. The physical therapist will guide you through exercises to improve your range of motion and coordination. You may begin to work on lifting your arm away from your side and forward.

Your therapist may introduce very light strengthening exercises. These typically involve isometric exercises, where you contract the muscle without moving the joint, and resistance bands. The goal is to wake up the deltoid muscle and start building the strength it needs to power your arm.

As your motion improves, you can gradually resume more daily activities. You may be able to dress yourself more easily. Driving is typically permitted once patients are out of the sling and demonstrate sufficient control and reaction time, often after around 6-8 weeks. Always confirm with your surgeon.

Phase 3: The Strengthening Phase

By around three months, you may notice improvements in your strength and function. This phase is dedicated to maximizing your strength and endurance.

The physical therapy program may become more intensive. You may progress to using light weights and more challenging resistance exercises. The focus remains on strengthening the deltoid and the muscles around the shoulder blade.

Your therapist may incorporate functional training exercises. These mimic the movements you need for work, hobbies, or sports. The goal is to translate the strength you have gained in the clinic into practical, everyday function. You will work on reaching, grasping, and carrying light objects.

Beyond Six Months: Full Recovery and Long-Term Outlook

While significant recovery occurs in the first six months, the final results of your surgery can continue to develop for up to a year or longer.

Long-Term Activity Guidelines

To ensure the longevity of your new joint, your surgeon may recommend permanent activity modifications.

• Avoid Heavy Lifting: Many patients are advised to avoid lifting objects over 10 to 15 pounds with the operated arm.

• Avoid High-Impact Activities: Activities that involve repetitive, forceful impact, such as chopping wood or certain contact sports, are generally discouraged.

• Listen to Your Body: Persistent pain is a signal that you may be overstressing the joint.

Summary

Reverse shoulder replacement may offer meaningful pain relief and improved function for individuals with complex shoulder conditions, especially when the rotator cuff is no longer able to support the joint. Early on, expect to wear a sling, manage post-operative discomfort, and begin gentle, passive motion under guidance. As healing progresses, patients gradually transition to active movement and strengthening, with many returning to everyday activities within three to six months. Full strength, endurance, and confidence in the shoulder may continue to develop for up to a year or longer.

Long-term, many patients maintain good function by following activity guidelines, avoiding heavy lifting or high-impact activities, and staying consistent with their home exercise program. With realistic expectations and a strong partnership with your care team, many patients achieve meaningful improvements in comfort and mobility.

Frequently Asked Questions

When can I start driving again?

You can typically resume driving once you are no longer wearing the sling and have regained sufficient control and reaction time in your operated arm. This usually occurs around six to eight weeks post-surgery, but it can vary. Always consult your surgeon for final clearance.

Can I sleep on my side after the surgery?

In the early weeks, plan to sleep on your back or in a semi-reclined position. Many patients find a recliner or propping themselves up with pillows in bed to be the most comfortable. Sleeping on the operated side is typically discouraged for the first six to twelve weeks to protect the implant and the healing tissues. Your surgeon will advise you when it is safe to gradually transition back to sleeping on your non-operated side.

What activities should I avoid permanently?

To protect your new joint and ensure its longevity, you may be advised to avoid activities that place excessive stress on the shoulder. This includes heavy, repetitive lifting (typically over 10-15 pounds) and high-impact sports. An experienced shoulder surgeon can provide a detailed list of permanent restrictions tailored to your specific implant and lifestyle.