Shoulder Replacement: Understanding Permanent Restrictions and Lifelong Care

What can you never do after shoulder replacement?

While a shoulder replacement can significantly improve pain and function, there are specific, lifelong restrictions on activities and movements designed to protect the artificial joint from damage, wear, and dislocation, ensuring its longevity.

Understanding Shoulder Replacement (Arthroplasty)

Shoulder replacement surgery, or shoulder arthroplasty, involves replacing damaged parts of the glenohumeral joint with prosthetic components. This procedure is typically performed to alleviate severe pain and restore function in individuals suffering from conditions like osteoarthritis, rheumatoid arthritis, or severe fractures. There are two main types:

• Total Shoulder Arthroplasty (TSA): Replaces both the humeral head (ball) and the glenoid socket.
• Reverse Total Shoulder Arthroplasty (rTSA): Reverses the ball-and-socket configuration, placing the ball on the scapula and the socket on the humerus. This type is often used when the rotator cuff is severely damaged, as it relies more on the deltoid muscle for movement.

While these surgeries offer remarkable relief, the artificial nature of the joint necessitates permanent modifications to activity to prevent complications.

Permanent Restrictions: What You Can Never Do (or Do With Extreme Caution)

The term "never" implies a strict, lifelong avoidance of certain actions that pose a high risk to the integrity and longevity of the prosthetic joint. These restrictions are crucial for preventing implant loosening, wear, dislocation, and periprosthetic fractures.

• Avoid Heavy Lifting: This is perhaps the most critical and universal restriction. While specific weight limits vary by surgeon, implant type, and individual recovery, a general guideline often prohibits lifting anything heavier than 10-15 pounds (approximately a gallon of milk) with the operated arm.
  • Why: Excessive loads place undue stress on the implant-bone interface, accelerating wear of the polyethylene components, and increasing the risk of the implant loosening from the bone over time. It can also lead to fatigue fractures of the bone surrounding the implant.
• No High-Impact Activities or Contact Sports: Activities that involve sudden jolts, impacts, or direct blows to the shoulder are strictly prohibited.
  • Examples: Football, rugby, martial arts, boxing, competitive volleyball (spiking), basketball (aggressive play), skiing (with risk of falls), or even activities involving repetitive jumping where the shoulder absorbs significant force.
  • Why: High-impact forces can cause acute dislocation, fracture of the prosthetic components or surrounding bone, and accelerate wear.
• Steer Clear of Repetitive Overhead Activities (Especially with Resistance): While some overhead movement is restored, repetitive or forceful activities above shoulder height are generally discouraged.
  • Examples: Painting ceilings, throwing a baseball (especially with force), chopping wood, certain swimming strokes (e.g., freestyle with forceful pulls).
  • Why: These movements place high shear and compressive forces on the joint, contributing to accelerated wear and potential loosening, particularly in TSA. For rTSA, while overhead motion is improved, extreme or forceful ranges can still pose a dislocation risk.
• Avoid Extreme Ranges of Motion, Especially with Combined Movements: Specific movements that push the joint to its end range, particularly when combined with rotation, can lead to dislocation. This is especially pertinent for rTSA.
  • Examples (rTSA specific): Reaching behind the back (internal rotation and extension), or reaching across the body while the arm is extended (adduction and internal rotation) can sometimes be restricted depending on the implant and surgical approach. End-range external rotation with abduction can be risky for TSA. Your surgeon and physical therapist will provide precise instructions.
  • Why: The altered biomechanics of the prosthetic joint, especially in rTSA, can create positions of instability where the ball can dislodge from the socket.
• Prevent Falls on the Operated Arm: While not an activity, actively preventing falls is a lifelong necessity.
  • Why: A fall directly onto the operated shoulder or an outstretched arm can result in a catastrophic periprosthetic fracture (a fracture around the implant), dislocation, or damage to the implant itself, often requiring complex revision surgery.

Why These Restrictions Are Critical

These permanent restrictions are not arbitrary; they are grounded in the biomechanics of the artificial joint and the long-term goal of implant survival:

• Implant Longevity: Prosthetic joints are subject to wear and tear, similar to natural joints. Excessive stress accelerates this process, leading to implant loosening or the need for revision surgery.
• Dislocation Risk: Unlike a natural joint with ligaments and a strong capsule, a prosthetic joint relies more on surrounding musculature for stability. Certain positions can put the artificial components at risk of dislocating.
• Periprosthetic Fracture: The bone around the implant can be weakened or stressed by the surgery. High forces can cause fractures around the prosthetic components.
• Soft Tissue Integrity: While the joint is replaced, the surrounding muscles (like the deltoid in rTSA) and tendons are vital for function. Overstressing these can lead to injury or failure, compromising the overall outcome.

The Importance of Lifelong Adherence and Rehabilitation

Adhering to these permanent restrictions is as vital as the initial surgery and immediate post-operative rehabilitation. Your physical therapist will guide you through a progressive rehabilitation program designed to restore strength, range of motion, and function within safe limits. This program will teach you how to move safely and efficiently, incorporating strategies to protect your new joint.

• Listen to Your Body: Pain is a warning sign. Do not push through pain, especially in the operated shoulder.
• Modify Activities: Instead of eliminating beloved activities entirely, learn how to modify them to be shoulder-friendly. For example, use lighter weights, change grip, or alter technique.
• Consult Your Healthcare Team: Regular follow-ups with your orthopedic surgeon are crucial to monitor the implant's status. If you have any doubts about an activity or experience new pain, consult your surgeon or physical therapist immediately.

Living with a shoulder replacement requires a conscious effort to respect the limitations of the artificial joint. By understanding and adhering to these "never" rules, you can significantly enhance the lifespan of your shoulder replacement and enjoy a higher quality of life with reduced pain and improved function for many years.