Recovery guide
After shoulder replacement
Dr. Ramirez’s recovery instructions after anatomic or reverse shoulder replacement.
These instructions summarize the Shoulder Replacement Patient Guide. They apply to most anatomic and reverse replacements. Fracture surgery, revision surgery, tendon transfer, or another open reconstruction may require a different plan; your discharge instructions and directions from Dr. Ramirez always take priority.
ImportantDo not start antibiotics on your own if you suspect an infection. Call the office first because antibiotics taken before cultures can make a shoulder infection harder to diagnose and treat.
Pain control and sleep
- Use Extra-Strength Tylenol 1000 mg every 6 hours on schedule without exceeding 3,000 mg in 24 hours or double-dosing combination medicines
- Use an anti-inflammatory only if Dr. Ramirez prescribes it and your kidney, stomach, and heart history allow
- Ice 15–20 minutes at a time, 4–5 times daily for the first 72 hours and then as needed
- Use narcotic medicine only for breakthrough pain; aim to stop within 2 weeks and no later than 1 month
- Sleep propped up for 2–4 weeks, support the elbow with pillows, and keep the sling on while sleeping
Sling and first 6-week precautions
Wear the sling whenever you are up and about and while sleeping. Typical duration is about 2 weeks after a reverse replacement and about 4 weeks after an anatomic replacement. For 6 weeks, do not actively raise the arm, reach behind your back, reach overhead or across your body, push up from a chair or bed, lift more than a coffee cup, or let the elbow drift behind your body.
Wound care
Leave the bandage and gauze in place through day 4. Remove them on day 5 and call the office for any drainage. If the wound is dry, shower without scrubbing or soaking it, pat it dry, and apply a fresh dressing. Do not use lotion or ointment. Do not soak for at least 4 weeks and until the incision is fully healed. The first postoperative visit should occur 10–14 days after surgery.
Weeks 0–6
Start the exercises taught before surgery on postoperative day 1 for 10–15 minutes, 3–4 times daily. Perform frequent elbow, wrist, and hand motion, scapular squeezes, permitted pendulums, and directed passive elevation to about 120° and external rotation to about 30°. Therapy usually begins around weeks 2–3; many patients can complete a home program. Continue all first-6-week precautions.
Weeks 6–12 and months 3–12
Active shoulder motion begins as directed during weeks 6–12 with a gradual return to light daily activities. Avoid heavy lifting and repetitive overhead work. Progressive strengthening begins during months 3–12. Most patients return to normal activity around 3 months and continue improving for a full year. Long-term lifting limits differ between anatomic and reverse replacements.
Driving and work
Drive only when you are off narcotic medicine, out of the sling, and feel safe. Most patients resume at 2–3 weeks; first test in an empty parking lot or quiet street. Desk or one-handed work may be possible within 2 weeks. Light-duty restrictions may continue through weeks 10–16, with return to full duty generally expected during weeks 16–24. Heavy laborers after reverse replacement may have permanent lifting restrictions.
Call promptly for
- Fever above 101°F or chills
- Increasing redness, warmth, swelling, or cloudy or foul-smelling drainage
- A sudden unexplained increase in pain or pain not relieved by medication
- Persistent hand numbness or tingling 24–48 hours after the block wears off
- Significant hand or forearm swelling
- A pop or sudden change in shoulder shape or motion
- Go to the emergency room for chest pain, shortness of breath, calf pain with swelling, or sudden severe arm swelling
PIA Shoulder MD