Setting Realistic Expectations Prior to Shoulder Replacement Surgery

So…you’ve made the decision to have shoulder replacement surgery... now what?

Your surgeon and their staff realize that this is a big decision and you may be apprehensive and confused; this is normal. In this article, I’ll discuss some common questions I hear from my patients, and ways I try to help them understand what’s to come and set proper expectations for surgery and recovery.

It can be strange to think about having a replacement shoulder that’s not what nature gave you, but your new replacement shoulder is designed to help reduce your current pain and give you better function. What many patients don’t realize, is how important their active participation is in getting good results. Also, it’s important to understand that you’ve likely had worsening function and pain for some time. So, it can take time and work to get the results you are hoping for.

Before surgery, there are many things you can do to prepare for your recovery. One example is to strengthen your shoulder and motion as much as possible as it can pay dividends after surgery. Just remember to follow your doctor’s recommendations because they will know the specifics of your condition. Also, discuss the possible risks and complications associated with shoulder replacement surgery with your doctor. You can also read more about some potential risks and complications here.

1. Strength and range of motion exercises. If you’re able, try strengthening your shoulder and working through your range of motion. Obviously, in some cases, pain and other factors may not allow this, but if your surgeon agrees and suggests physical therapy or exercises prior to surgery, your active participation in following instructions can help with recovery.

2. Determine limitations to daily activities. It can be helpful to practice going about your day-to-day activities while wearing a sling to see where you may need help during recovery. If you can figure out some of challenging activities before surgery, it may help relieve stress during recovery. It also takes some of the surprise out of what you can and cannot do post-surgery, while wearing a sling.

3. Clothes. Try to find easy-to-wear clothes for after surgery. The best options are oversized, button-down shirts. Try dressing and undressing while wearing a sling to determine what clothing items will be easiest to maneuver post-surgery.

4. Pain control. Discuss pain control with your doctor. There are multiple options to help you reduce pain, including cold therapy, anti-inflammatory and nerve medications, and anesthetic techniques such as long-lasting nerve blocks and medications placed into the joint during surgery. Occasionally, narcotic medications are needed but doctors are trying to reduce their use due to possibilities of complications and addictions. Talk to your doctor about what they plan to use for pain control in your specific case, so you are prepared in advance.

5. Post-operative instructions. Remember to follow the doctor’s recommendations before and after surgery, as there are reasons for these guidelines. The success of your surgery is greatly dependent on how well you follow your doctor’s instructions.

Another area in which many patients experience anxiety in not knowing what to expect is in regard to what happens immediately following your shoulder replacement. This can vary from surgeon to surgeon and from patient to patient. There isn’t really a one-size-fits-all when it comes to what to expect after your surgery; however, here are a few of the common points you might expect:

• Cautiously mobile. It’s usually important for patients to be up and about right away after surgery. This is good for your overall health, can aid in recovery, and can help reduce surgical pain. The worst thing a patient can do is to be immobile and in fact, immobility can lead to other medical conditions.
• Protect your new shoulder. Your shoulder is different… it’s new to your body. If you’re told to wear a sling, your doctor has determined that it may help with your comfort as well as protect your new joint.
• Exercises and physical therapy. Your doctor will likely get you started with exercises or therapy post-surgery. It’s important to follow any precautions or instructions given. Moving safely will often help decrease your pain and swelling faster. Doing regular exercises or therapy are the best way to see faster improvement. Not doing your exercises can result in decreased function and mobility.
• Outpatient vs. inpatient. Many factors are taken into consideration to determine whether or not you’re a candidate for outpatient shoulder surgery or if you’ll be kept overnight in the hospital. These factors involve, but are not limited to, your health and needs immediately following surgery. Often times, patients prefer not to be in the hospital. Sometimes your insurance will have parameters allowing, or not allowing this, too. Regardless, be sure to follow your instructions for mobility, medications and precautions when you get home.

As I tell all my patients, this is like the fable of the tortoise and the hare… slow and steady wins the race. Here are a few other thoughts regarding your return home after surgery:

• If you feel good, great! But don’t overdo it! You’ve had surgery, your muscles and bones have been repaired, and the surgical incisions need time to heal.
• If your doctor and/or therapist tells you to avoid certain motions – listen to them! Limiting certain motions is important because some muscles can take weeks, even months, to heal completely. If this healing is disrupted, it can lead to poorer results and in rare cases, the need to re-operate.
• Some of your muscles haven’t moved in certain ways in years and can take time to regain flexibility and strength. This can often take weeks and in some cases months. It’s another reason to be mindful of avoiding certain motions (as instructed by your doctor) and that exercises should be done slow and steady.
• It’s important to do your exercises as directed by your surgeon and/or therapist. A good guide is if you are doing something in a slow and steady fashion and it’s comfortable, you are probably fine. If an exercise starts to hurt, it’s best not to force it. Talk to your doctor or physical therapist about what you’re experiencing.
• In some cases, like reverse shoulder replacements, where there might be missing or repaired rotator cuff muscles, your remaining muscles are trying to make up for the lost muscle and will need time to build up strength to work with your new joint and “learn a new job”. 

• Your muscles are “working double duty” and may be a little sore. They may not be able to build up to the level of strength like you may have had in your youth. For these and other reasons, you surgeon may limit your lifting allowances in the early weeks, especially overhead. Some of these limitations may be even permanent. Talk to your surgeon about what activity restrictions you will have and for how long, and whether any restrictions will be permanent.

Obviously, everyone is different, but driving is usually restricted until you are both comfortable and safe. This is important in case an emergency were to occur while you were driving, and you were unable to react appropriately. Some insurers may have guidelines too, so it’s important to check with your auto insurance company to see if they have limits. Travel is usually fine as soon as you feel up to it and your doctor is happy with your healing. You may want to wear your sling while traveling so that others are careful around you. 

Everyone’s needs and demands are different. If you’re at a desk, and not lifting weight, you could be back in a matter of a week or two. If your job requires travel and heavy physical activity, return to normal work could take months. Your surgeon may even tell you to avoid certain activities permanently.

Patients wishing to return to sports may have specific guidelines that will depend on the sport and the patient. Many patients successfully go back to golf, tennis, etc. However, your body will usually need time to get back strength and flexibility and some sports may not be appropriate to start for 3 to 6 months after surgery. Be aware that your shoulder’s performance and results can often improve for up to a full year after surgery.

Remember you, your shoulder, and your muscles have been through a lot together. If you expect to be perfect, you might be disappointed even though your team is trying to get you as close to perfect as possible. However, if you do your part, your surgeon is going to help you improve your quality of life and your return to activities. It’s important to discuss your goals with your surgeon so they can help you set realistic expectations for time required and amount of improvement. Ultimately, what makes you happy is also what makes your doctor happy. Helping a patient with debilitating pain and loss of activity return to a better quality of life is a win-win for everyone!