Reverse Shoulder Surgery: Post-Operative Restrictions, Recovery, and Long-Term Care

What Are the Restrictions After Reverse Shoulder Surgery?

Reverse shoulder arthroplasty (RSA) involves specific and crucial post-operative restrictions designed to protect the surgically altered joint, facilitate healing, and prevent complications like dislocation or implant failure. Adherence to these guidelines is paramount for optimal recovery and long-term success.

Understanding Reverse Shoulder Arthroplasty (RSA)

Reverse shoulder arthroplasty is a highly specialized surgical procedure, distinct from traditional shoulder replacement. In RSA, the ball and socket components of the shoulder joint are reversed: a "ball" is affixed to the shoulder blade (scapula), and a "socket" is attached to the upper arm bone (humerus). This alteration fundamentally changes the biomechanics of the shoulder, shifting the primary responsibility for arm elevation from the damaged rotator cuff to the deltoid muscle. This makes RSA a viable option for individuals with severe rotator cuff tears that are irreparable (rotator cuff tear arthropathy), failed conventional shoulder replacements, or complex fractures.

The Critical Post-Operative Period: Initial Restrictions (0-6 Weeks)

The initial phase post-surgery is the most critical for protecting the delicate surgical repair and allowing soft tissue healing. Strict adherence to these restrictions is non-negotiable.

• Immobilization:
  • A shoulder sling will be worn continuously, often for 4-6 weeks, sometimes longer, depending on surgeon protocol and individual healing. The sling helps to support the arm, reduce stress on the joint, and prevent unintended movements.
  • It is typically removed only for specific prescribed exercises or hygiene, under careful guidance.
• Range of Motion (ROM) Restrictions:
  • No Active Movement: Generally, no active elevation, external rotation, or internal rotation of the surgical arm is permitted during this phase. All movements are typically passive, performed by a therapist or the non-surgical hand, within prescribed limits.
  • Avoid "Dislocation Positions": The most critical restriction is to avoid the combined movement of adduction (bringing the arm across the body), internal rotation, and extension (reaching behind the back). This specific position places significant stress on the implant and is the most common cause of dislocation in RSA.
  • No Hyperextension: Reaching backward excessively is prohibited.
  • Limited External Rotation: Often restricted to 0-20 degrees or as specified by the surgeon.
• Weight-Bearing and Lifting Restrictions:
  • Absolutely no lifting of objects, even light ones, with the surgical arm. This includes pushing up from a chair using the arm.
  • The arm should not bear any weight.
• Activity Restrictions:
  • No Driving: Driving is strictly prohibited due to the inability to react quickly and safely.
  • Avoid Pushing, Pulling, or Reaching: These movements can stress the healing joint.
  • No Strenuous Activity: This includes any activities that could put the shoulder at risk, such as gardening, cleaning, or opening heavy doors.
• Sleeping Positions:
  • Sleeping on the surgical side is forbidden. Many surgeons recommend sleeping on the back, often in a semi-reclined position (e.g., in a recliner or propped up with pillows) to prevent accidental movements and promote comfort.

Gradual Progression: Intermediate Restrictions (6-12+ Weeks)

As healing progresses, the restrictions are gradually eased under the guidance of a physical therapist and surgeon. This phase focuses on restoring controlled motion and beginning gentle strengthening.

• Transition to Active-Assisted and Active ROM:
  • Your physical therapist will guide you through exercises to regain active range of motion, carefully avoiding previous "danger zones."
  • Emphasis remains on controlled movements and avoiding sudden, uncontrolled motions.
• Gradual Increase in Weight-Bearing/Lifting:
  • Light lifting (e.g., a cup of water) may be introduced, with strict limits on weight (often no more than 1-2 pounds initially).
  • The therapist will specify when and how much weight can be handled.
• Introduction of Gentle Strengthening:
  • Isometric exercises (muscle contractions without joint movement) may be introduced first, followed by light resistance exercises.
  • All strengthening must be pain-free and closely monitored.
• Resumption of Driving:
  • May be permitted once sufficient pain control, range of motion, and reaction time are regained, and only with surgeon approval.

Long-Term Considerations and Lifelong Precautions

While significant recovery occurs within the first year, certain lifelong precautions are often recommended to protect the reverse shoulder replacement and ensure its longevity.

• Avoidance of High-Impact Activities: Contact sports (e.g., football, rugby), activities with a high risk of falls, or those involving repetitive overhead impact (e.g., certain racquet sports) are generally discouraged.
• Weight Lifting Limits:
  • Heavy overhead lifting is often permanently restricted. The specific weight limit will vary by individual and surgeon, but it's typically advised to avoid lifting more than 10-15 pounds overhead.
  • Repetitive heavy lifting, even at lower angles, may also be limited.
• Extreme Ranges of Motion:
  • Continued caution with the combined movement of adduction, internal rotation, and extension (reaching behind the back, especially across the body) to prevent dislocation.
  • Extreme external rotation may also be limited.
• Awareness and Protection: Always listen to your body, avoid movements that cause pain, and be mindful of protecting the joint in daily activities.

The Role of Rehabilitation

Adherence to a structured, individualized physical therapy program is crucial for navigating these restrictions and achieving the best possible outcome after reverse shoulder surgery. Your physical therapist will:

• Guide you safely through each phase of recovery.
• Educate you on proper body mechanics and activity modifications.
• Prescribe specific exercises to restore range of motion and strength within safe limits.
• Monitor your progress and adjust the program as needed.

Potential Complications to Be Aware Of

While RSA is generally successful, understanding potential complications can help in early detection:

• Dislocation: The most common complication, often due to violating the specific movement restrictions.
• Infection: A serious complication requiring immediate medical attention.
• Fracture: Around the implant during or after surgery.
• Nerve Injury: Though rare, can occur during surgery.
• Loosening of Components: Over time, the implanted components can loosen.
• Deltoid Dysfunction: As the deltoid is crucial for RSA function, injury or dysfunction of this muscle can impair outcomes.

Navigating Life with a Reverse Shoulder Arthroplasty

Living with a reverse shoulder arthroplasty requires a commitment to protecting your new joint. By understanding and respecting the prescribed restrictions, engaging diligently in your rehabilitation, and maintaining open communication with your surgical and therapy teams, you can significantly improve your quality of life and ensure the long-term success of your shoulder replacement. Always consult your surgeon or physical therapist before attempting new activities or if you have concerns about your restrictions.