When to get a shoulder replacement?

@wells53 As someone who has had at least 15 shopulder injections, some are much more helpful than others....Some I have had almost no pain releif from, and others have lasted 7 months pain free. Same PM doctor but he still injects in different places every time, but always puts some right in the joint itself.

So my point is, perhaps try again.

I am finally going ahead with a shoulder replacement at the end of the month after moderate pain for a few years, cortisone and hyaluronic injections, pt and strength training. I have been told that recovery runs a wide spectrum but that I will be told not to lift more than an empty teacup for 6-8 weeks. I’m 65 and also active. Pickleball, surf, swim, and train one way or another daily. I am seriously concerned about the length of downtime I’m looking at. I can’t seem to get a straight answer from the doc. I had a rotator cuff repair about 10 yrs ago in my dominant shoulder and I did not have full range of motion in that shoulder for nearly a year!! I had adhesive capsulitis after about 8 weeks of motion on that side which will not be an issue on this one. Fingers crossed. I’m much less worried about pain as it wasn’t bad except during PT (started at 8 weeks when it froze up) and nowadays they send us home with a nerve block port for 3-5 days post surgery. I don’t recall the pain being excruciating even back then when it was opiates only. I wish I could reassure you but would gladly communicate ongoing as I enter the post surgery phase of this. Good luck.

Hi!!!
I had shoulder replacement a few yrs ago, at age 65.

It was the best decision I have ever made. I had a lot of pain prior to surgery. I know everyone is different, but l only took pain medication for two days. Immediately after surgery, I had range of motion that I hadn't had before...l could even put my contacts in by myself.

Here's hoping your decision is best for you. Surgery was best for me.

Be blessed,
Susan

Hi Jules,

I just had an anatomical TSR. I'm a very fit, 70 year old male, in the gym everyday. Because it was anatomical, the subscapularis (one of the rotator cuff muscles) is released and then reattached after the replacement. It takes time for that to heal. You'll definitely feel it when rotating your arm inward in rehab. The first two weeks I just rested, some arm "hanging" called Codman exercise, and then a continuous passive motion machine for two weeks, and then real PT started.

I still had what I consider a quick recovery. I do mostly cardio, and was able to get back on the spin bike in 5 weeks, but without putting pressure on the handlebar with my operated arm. It's 9 weeks now, and I can gently rest my hand on the handlebar.

Resistance and strength training come after ROM and flexibility is restored. If I did play racket sports. I'd be very cautious about getting back into that and follow Dr's guidance closely.

If your RC is already damaged, you'll need a reverse TSR. Initial recovery is a little quicker, but I think there are permanent limitations on how far you can raise your hand to play racquet sports, for example.

But if you're in the kind of pain I was in, you'll feel much better within days of the surgery. Don't get me wrong, the first few days are painful, and you have to sleep propped up and on your back.

I'm a veteran of joint replacements - both knees, right hip, and now left shoulder. Couldn't be happier with the results.

All the best to you!

Joe

My husband is 66 years old & had rotator cuff surgery November 2024. The surgeon told him it would be 6 - 12 months for an 85% recovery. He's actually in worse pain than prior to surgery and not able to get full movement without assistance from his other hand/arm. After 4 months PT the therapist told him they couldn't do anything more for him and his amount of pain was not normal & to get a second opinion. They gave him recommendations of who to see. Six months post-surgery my husband asked his surgeon for another MRI (this time w/contrast) and they found two more tears & osteoarthritis that were not detected on the initial MRI. He called the new surgeon in September & was told he had to wait the full year post-surgery, so he's scheduled for the second opinion the beginning of December. In all our research through Mayo Clinic & Cleveland Clinic, the comments from PT and various posts we've read here, it sounds like my husband should have had a reverse shoulder replacement and not a rotor cuff repair. It's so disappointing for him to have come out of surgery worse than prior to it. As you can imagine, he's very hesitant about having another surgery, but living the rest of his life with this pain and limited abilities is not something he looks forward to either. At this point I believe he's wanting to know what options he has going forward. Julesolo I wish you well.

@heyjoe415

In regard to what you said -
"If your RC is already damaged, you'll need a reverse TSR. Initial recovery is a little quicker, but I think there are permanent limitations on how far you can raise your hand to play racquet sports, for example."

In my case, I luckily have no racket use limitations on how far I can raise my arm/hand after my reverse TSR. As I see it, the problem is that without those frontal rotator cuff muscles, you lose the ability for a fast, hard snap to the ball that you need for upper level play. I'm sure I could still play, but it would be at a much slower, non-competitive gentle pace. What I don't know, is whether with dedicated muscle development of the other surrounding groups, you perhaps compensate and adjust your stroke.

I had a total rt shoulder replacement this morning. Am 70 yo fit female. Had been dealing with not being able to tuck my shirts in the back of my pants, not being able to wash windows, wash the car, or sleep on my right side, without pain of about a "six". Am very rt handed. didn't have any rotator cuff issues. Damage to my rt shoulder joint happened when I was 58; walking a 110lb dog on a leash when he took off after a squirrel, got to the end of the leash and nearly yanked my arm out of the socket? The aftermath pain of that incident got better, after 5-6 years and exercising. Then, arthritis began in the joint and a bone spur developed which caused the most atrocious loud click, snap ratcheting in that joint when lifting my arm! That ratcheting click, snap didn't hurt at all BUT the sound could be heard by everyone within 12' of me! The doc said he was amazed by the noise; but it was pretty fun to demonstrate to people....

So today was surgery will try to keep ya'll posted. Was outpt, took 1.5 hrs, I researched what hardware I wanted, etc, doc very good.

Thank you for the correction ddsack! This will be good news for people needing a rTSR, but concerned about recovery and limitations. Based on your experience, those limits are very small, if any.

I'm very happy for you that you can still play racket sports with a rTSR! I'm betting you were fannatical about your rehab, and are overall in very good health. Good for you.

As far as your point of not being able to generate a sharp, forward snap since rTSR - that's probably because the anterior RC muscle, the subscapularis, is torn or otherwise weakened, and it's left alone during rTSR. You describe internal rotation of the shoulder, and that's the domain of the subsapularis. (In my anatomical TSR, the subscapularis is intact, released to allow access to the shoulder joint, and then stitched back onto the scapula and clavicle. This made my initial recovery a few weeks longer, as time has to pass to allow healing to begin.)

I would ask a trainer if there is a way to compensate for that lack of snap with a racket. The deltoids take over for the RC after a rTSR, holding the joint together. I'm just not sure if the loss of some inward rotation is permanent, or if there are exercises to address.

Anyway, thanks so much for your reply, and congratulations on your recovery. 70% of all TSRs are reverse. The guys my age who need it seem afraid. Honestly, I don't get it. I will share your story though of what is possible if a patient has will and determination, as you clearly do.

(Side note: I do have one permanent restriction in the gym after the aTSR. I cannot do tricep dips, where I'm lowering and raising my body weight, usually with weight assistance. My PT says this requires my elbows to be well behind my back, and a no no now that I have the new shoulder. Other than that, I'm at 2 months post-op and back in the gym everyday. I have to slowly increase the weight Ilift, but recovery is very doable.)

Great work my friend!

Joe

@slarson14

Best of luck on your surgery, please do keep us updated on your recovery. I think we all like to hear step by step recovery results, positive or negative so we can glean something to apply to our own hopes or problems.

Day 1 post op:

1) Wearing a sling 24/7.
2) Applying icepacks 3-4 times a day. Went online before surgery and found really functional and nice reusable icepacks: by Comfytemp. Two icepacks that fit nicely into a well designed shoulder "holster type" soft bag with adjustable straps. Highly recommend, icing this way really helps. The packs are also microwaveable, but using the packs frozen feels really good.
3) Pain isn't terrible unless I move certain ways. Brachial plexus nerve block lasted from when it was injected at 7am before surgery yesterday until 7pm last night. worst part of the nerve block was the numbness/tingling in hand and zero muscle control; my whole right arm was like an elephant trunk, and very heavy; only way to move it was by using my left arm. Once yesterday, without realizing how "dead" my right arm was, I bent over to pick up a dropped hairbrush. As I bent over my dead arm slid completely out of my sling and my fingertips hit the floor!! Didn't hurt as nerve block was doing its job but am now a bit concerned that could have messed up the newly installed joint hardware? We shall see in 10 days at F/Up appt X-rays.
4) Tried to sleep, in bed; no way; then went to recliner. I tend to be a back sleeper, sleep was pretty much nil either way. Doubled up on my oxycontin which did allow me to doze off an on for an hour or two 3;30am to 5;30am...one tab simply does not relieve pain enough.
5) Pain is there, but manageable, am not a whiner and understand it is what it is and will get better.
6) Swelling was pretty significant first 18 hrs; has gone away by about 80% today.

Also before I had surgery I found these super soft very stretchy Tshirts that have snaps all over, to make putting on and taking off easy. Amazon again. I got 2 short sleeve and 2 sleeveless. The softness allows me to wear them braless...as wearing a bra just isn't going to be possible, along with this sling.