After shoulder replacement surgery, most people wear a sling for about 6 weeks and go back to light daily tasks over the first 6 to 12 weeks. Recovery usually continues for 6 to 12 months, often longer for strength. Total and reverse replacements carry different precautions in the first weeks, so it helps to know which one you had. Your surgeon’s protocol comes first, and timings vary with the type of replacement and with each surgeon.
Pain from the worn joint often eases within weeks. Movement and strength take much longer.
Key takeaways
- Sling: typically about 6 weeks for both total and reverse replacements.
- Overall recovery: often 6 to 12 months, sometimes longer for strength and endurance.
- Total replacement: relies on a working rotator cuff; early precautions protect a front tendon (subscapularis) that is cut and repaired.
- Reverse replacement: relies on the deltoid muscle; early precautions limit positions that can push the ball out of the socket.
- Protocol: your surgeon’s protocol comes first; timings vary with the type of replacement and with each surgeon.
Total and reverse: the two types
Total shoulder replacement (anatomic)
The worn ball at the top of the arm bone is replaced with a metal ball, and the socket is lined with a plastic cup. The joint keeps its natural shape. It is usually chosen for arthritis when the rotator cuff is working. The surgeon usually detaches a tendon at the front of the shoulder (subscapularis) to reach the joint and repairs it at the end.
Reverse shoulder replacement
The parts are swapped. A metal ball is attached to the socket side, and a cup is attached to the top of the arm bone. The deltoid, the large muscle over the shoulder, then does most of the lifting. It is usually chosen when the rotator cuff is badly torn or not working, and for some complex fractures.
How their precautions differ
Every surgeon sets their own rules. These are common patterns.
- After a total replacement: turning the arm outward and pushing the arm back behind you are usually limited for about 6 weeks, to protect the subscapularis repair.
- After a reverse replacement: the combination of reaching behind your back, with the arm turned inward and pulled back, is usually avoided for about 6 to 12 weeks. That position, used to tuck in a shirt, can push the ball out of the cup (dislocation). Pushing up from a chair or bed with that arm is also usually avoided.
- Both: no lifting heavier than a cup and no taking your body weight through the arm until your surgeon allows it.
Where are you right now?
- First 2 weeks: sling, sleep and wound care. Start with weeks 0 to 2 and the night pain answer.
- Weeks 2 to 6: gentle, protected movement. See weeks 2 to 6 and the precautions above.
- 6 to 12 weeks: out of the sling and using the arm more. See weeks 6 to 12 and “If it isn’t going to plan”.
- 3 months on: strength and longer days. See months 3 onward and the “When can I…” table.
Week by week, then month by month
- Weeks 0 to 2: Most people stay in the hospital for 1 to 2 nights. The sling stays on except for washing, dressing and your exercises. Your physical therapist (PT) shows you supported movements and elbow, wrist and hand exercises.
- Weeks 2 to 6: Stitches or clips are usually removed around 10 to 14 days. Assisted movement builds slowly within your precautions. Night pain and swelling usually ease.
- Weeks 6 to 12: The sling usually comes off around week 6. Active movement starts. Light use at waist and chest height, such as eating and typing, becomes easier.
- Months 3 to 6: Light strengthening builds. Reaching to a shelf at head height often becomes possible.
- Months 6 to 12: Strength and endurance keep improving. Gains continue slowly for up to a year or more. Overhead reach often stays less than before arthritis set in, especially after a reverse replacement.
Is this normal?
- Night pain: Common in the first 4 to 8 weeks. Sleeping propped up with a pillow under the forearm often helps.
- Swelling and bruising: Bruising can spread down to the elbow and even the forearm in the first 2 weeks. It usually fades within 3 weeks.
- Stiffness: Expected while the arm is protected, easing as movement progresses.
- Clicking: Painless clicking is common with a new joint. A painful clunk with a sudden change in how the arm moves needs checking the same day.
- Numbness near the scar: A numb patch beside the scar is common and often shrinks over months.
- Low mood: Common with broken sleep. If it lasts more than a couple of weeks, tell your doctor.
If it isn’t going to plan
It is week 12. You still use your other hand to lift a mug to the shelf, and getting a coat on remains a two-person job. The thought in your head is: “The pain is better, so why can’t I lift my arm?”
The belief that tends to fail here is that the new joint does the work. It does not. After a total replacement, the rotator cuff still moves the joint. After a reverse, the deltoid does most of the lifting. Both need months of graded strengthening, and progress often slows if exercises stop once pain eases.
If movement has stalled for 3 to 4 weeks, pain is rising after week 6, or the arm feels weaker instead of stronger, get assessed by your PT or surgeon. Questions worth asking:
- Is my range where you would expect for my type of replacement?
- Which precautions still apply to me now?
- Do I need an X-ray or other check?
- What should I be able to do in 4 weeks?
When can I…
| Activity | Typical range |
|---|---|
| Shower | Usually within the first week with a waterproof dressing, arm by your side; no soaking until the wound has healed |
| Sleep in bed | Propped up for 4 to 6 weeks is common; lying on the operated side often waits 3 months or more |
| Drive | Not in the sling; often 6 to 8 weeks or later, once you can control the wheel safely |
| Desk work | Often 3 to 6 weeks, one-handed at first |
| Lift | Light items close to the body from about 6 to 12 weeks; a common long-term limit is about 10 to 25 pounds (about 4.5 to 11 kg), set by your surgeon |
| Reach overhead | Light reaching often from 3 to 6 months; often less range than before arthritis, especially after a reverse |
| Manual work or sport | Light activities often from 4 to 6 months; heavy manual work is often not advised; ask your surgeon about any sport |
Your surgeon’s protocol comes first. Timings vary with the type of replacement and with each surgeon.
A shoulder replacement takes away the worn joint; the muscles around it still have to learn to move it.
Call your local emergency number or go to the emergency department if
- Sudden breathlessness or chest pain: especially with a racing heart.
- A cold, pale or blue hand: on the operated side.
- The shoulder suddenly changes shape: with severe pain and the arm unable to move, which can mean the joint has come out of place.
See a doctor today if
- Wound redness or discharge: spreading redness, warmth, pus, a bad smell or the wound opening.
- Fever: 100.4°F (38°C) or higher, or shaking chills, at any time after surgery, including months later.
- Calf swelling or pain: in one leg.
- Numbness or weakness spreading: in the arm or hand, or getting worse after the nerve block has worn off.
- Uncontrolled pain: pain the medicines you were given are not controlling.
Get it checked soon if
- New pain months after surgery: after a period of steady improvement.
- A new clunk or catching feeling: that changes how the arm moves.
- Movement stalled for 3 to 4 weeks: despite doing your exercises.
More on this area: surgery recovery guides.
Know which replacement you have, follow its precautions, and measure recovery over months.
Written by Louise Yow, Neck & Shoulder Physio.