Tips for recovery and rehabilitation after shoulder replacement surgery

After you have shoulder replacement surgery, rehabilitation is important for a successful recovery. Whether you have a partial shoulder replacement, an anatomic total shoulder replacement or a reverse total shoulder replacement, the procedure is just the first step in eliminating pain and returning to daily life. The recovery process is the next important phase to ensure your new shoulder joint heals properly and you avoid complications.

“It is important to understand that the initial weeks after surgery are meant to allow for soft tissue healing and for bone growth into the implant,” said Dr. Jacob Triplet, an orthopedic surgeon specializing in shoulder and elbow surgery at IU Health.

While the shoulder pain you’ve had for years may improve after surgery, recovery can be challenging. Unlike hip or knee replacement surgeries, which require you to get moving right after surgery, a shoulder replacement is often immobilized in a sling for four to six weeks. This affects driving, especially if your dominant hand is in the sling.

“Hand dominance is a big factor in the recovery process. For a right-handed person who has surgery on that side, wearing a sling affects their quality of life in the short term,” said Ryan Taylor, Physical Therapist and Outpatient Rehab Manager for the IU Health South Central Region, including IU Health Orthopedics & Sports Medicine in Bloomington. “You’ll rely on people to help you with things like putting on your shoes and getting dressed. This is temporary, but something to think about before surgery.”

As you plan for the things you need after shoulder surgery, arrange for friends or family members to help you with transportation, home care and meal prep. Try wearing your arm in a shoulder sling before surgery to understand the limitations you’ll have later. Be sure to talk with your doctor about what to expect after surgery so you are prepared for the limitations.

“Have some questions prepared to ask your doctor about how long you’ll be in a sling, how long until you can go back to driving, working, cutting grass, doing laundry, and getting back to daily living,” Ryan said.

Recovery Timeline

Progress after shoulder replacement surgery is different for everyone, but you can expect:

• Days 1-4: Pain and swelling that tapers off
• Weeks 1-2: Gentle therapy exercises begin
• Weeks 2-6: Sling use followed by light activities, like lifting a cup of coffee or making a sandwich
• Weeks 8-12: Return to normal function
• Forever: 30-pound weightlifting restriction for patients who undergo total shoulder replacement

Pain Management

On the day of your surgery, you will receive a preoperative interscalene nerve block (anesthesia) that lasts 24 to 72 hours. You will need to have pain medications ready for your return home. Surgeons often prescribe scheduled acetaminophen (Tylenol) and an “as-needed” narcotic pain medication. Discuss any concerns you may have about taking narcotic pain medications with your doctor.

“Patients who take Tylenol on a routine schedule after surgery tend to need less narcotic pain medication,” Dr. Triplet said.

“Applying ice to your shoulder can be helpful during those first couple of weeks,” Ryan said. “It is also important to stay consistent with your exercises. Stiffness can lead to pain, and gentle movements prescribed by your therapist can help reduce this stiffness.”

Another way to improve recovery and pain is by getting enough sleep, which allows the body to heal. While sleep can be challenging during the first few weeks, it will improve.

Rehabilitative Exercises

You may wonder when to start physical therapy after shoulder replacement surgery. A few days after your procedure, therapy begins with very small movements in the hand, wrist and elbow that focus on range of motion. You begin with “passive” exercises in which you or the therapist moves your arm for you. Eventually, you will move on to more active movements like shoulder shrugs, elbow raises, and weights. Not all patients will require physical therapy after shoulder replacement.

“Your therapist will give you an at-home exercise program that we update at every visit to continue your progress,” Ryan said. “The shoulder replacement rehab timeline looks different for everyone. For instance, a 40-year-old with a physical job has a different routine than an elderly man who’s retired.”

As you prepare for shoulder replacement surgery, doctors say one of the best things to keep in mind for the recovery process is that it will take time and patience.

“Understand shoulder replacement is a slower process than other joint replacement surgeries. Proper recovery and adhering to the postoperative instructions should hopefully lead to excellent pain relief and function,” Dr. Triplet said.