March 26, 2021

What to expect after shoulder replacement surgery

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A look at shoulder replacement surgery post-op pain control, recovery time and activity restrictions.

If you’re considering shoulder replacement surgery, you may be wondering what the days immediately following shoulder surgery recovery will entail, what the limits on your activity will be and how you can expect to feel. And you may be curious how the weeks and months following your procedure will unfold in terms of recovery. To provide a snapshot and timeline, we talked to John Kuhn, M.D., chief of shoulder surgery at Vanderbilt Orthopaedics.

“Shoulder replacements are not as big as knee or hip replacement surgeries,” Kuhn said. “It’s an operation that can be done very effectively as an outpatient because there’s a lot of different ways to control post-operative pain.”

Pain control

For pain control after shoulder replacement surgery, Kuhn said Vanderbilt uses what’s called an interscalene catheter. “The anesthesiologist places a small catheter next to the neck,” he explained. “The catheter tip is close to the nerves that make the shoulder have feeling and function. And that catheter is hooked up to a bag full of Novocaine with a pump. And it pumps Novocaine into that region for four or five days.”

After those four or five days, a patient may need some pain medication. But usually after 10 to 14 days, patients no longer require pain relief. “Typically what we’ll see,” Kuhn said, “is patients will come back after about a week after the operation and see me in the office and they’ll tell me that their arthritis pain is already gone and their surgery pain is getting better every day.”

Initial activity restrictions

To replace the shoulder joint, your surgeon must detach (and later repair) a muscle called the subscapularis. “The implant is solid from day one,” Kuhn explained. “A patient could do a push-up on it when they come out of the operating room if they wanted to, but we have to protect that muscle.”

After shoulder replacement surgery, you will likely wear a sling for about six weeks. “We recommend keeping the hand in front of the body,” Kuhn said. “That will protect the muscle. If the hand is rotated out or up high or reaching behind the back, those positions would put stress on that muscle that’s trying to heal.”

Kuhn said you can drive as long as you’re off narcotic pain medications. But there are a few caveats. “Patients can operate power steering,” he said. “But we don’t want them to reach across their body and get the seatbelt or shift gears or change the radio — anything that would have them reaching out.”

In general, you can move your elbow, wrist, and hand, which aids in completing some everyday functional activities. “Patients can feed themselves, they could brush their teeth, and they could reach down in front of themselves,” Kuhn said. “But the key is the hand should stand in front of the body.”

You don’t need to prep your home in any special way pre-surgery. However, having a few ready-to-heat meals on hand is a good idea. “You’d be able to make a sandwich after about a week and chop vegetables after about a week,” he said. “You just couldn’t lift that heavy pot of soup up off the stove.”

You can return to desk work after about two weeks. “But to do any kind of heavy labor or pushing or pulling or sports activities,” Kuhn said, “that’s more like three to four months.”

Physical therapy

In the three to four months after shoulder surgery, you’ll be undergoing a progressive program of physical therapy to recondition the shoulder muscles. “Typically by six or eight weeks,” Kuhn said, “patients will have fairly normal motion. And then we get rid of the sling, and we start to work on strengthening.” Once physical therapy is complete, Kuhn said people continue to make gains in shoulder strength and endurance over the next nine months.

If you have shoulder pain or a shoulder injury, the specialists in the Vanderbilt Shoulder Care Program can help you find relief. They provide a range of treatments, from physical therapy to total shoulder replacement.

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Jed Kuhn, M.D.

Jed Kuhn, M.D., is the Kenneth D. Schermerhorn Professor of Orthopaedics and director of Sports Medicine and Shoulder Surgery at Vanderbilt University Medical Center.