This is the question I am asked most often, even before the date of the operation. The honest answer comes in three stages.
The first three or four days are the most intense. The nerve block given during the anaesthetic covers the first few hours, then the painkillers take over. This is the period when you should take your medication at fixed times, without waiting until it hurts, because pain that has already settled in is harder to catch up with than pain that has been prevented.
Between the second and the sixth week, the background pain drops clearly. Night pain, the pain that kept you awake before the operation, is often the first to go. That is the sign patients remember most, and it is also the one that reassures them best.
After that, it is common to still have pain on exertion and occasional night waking for two to three months. These are not complications, this is a shoulder adapting again.
These timescales apply to most operations. A rotator cuff repair is more painful in the first days than a shoulder replacement, because a tendon has just been reattached under tension onto the bone.
Ice is your best ally: twenty minutes several times a day, never directly on the skin. It works on both pain and swelling, and many patients use it far less than they should.
Take the painkillers you have been prescribed according to the schedule given to you on discharge, without skipping doses in the first days. You will reduce them naturally afterwards.
Move your elbow, wrist and fingers from day one, even if the shoulder itself is not moving much yet. That is what prevents the rest of the arm from stiffening up and stops the hand from swelling.
And arrange some help for the first days, especially if you live alone. It is not the pain that gets in the way most, it is everything that normally needs two hands.
The size depends on the operation. Keyhole surgery leaves two to four incisions of less than a centimetre. A shoulder replacement leaves a vertical scar of around eight centimetres on the front of the shoulder, inside a natural skin crease.
Dressings are changed according to the protocol given to you on discharge, usually by a nurse at home. The scar must stay clean and dry, and it must not be allowed to get wet before you are told it can.
Once the wound has healed, gently massaging the scar with a moisturizing cream softens the tissue and stops it sticking down. You should also protect it from the sun for a year, otherwise it will darken permanently.
A scar that turns red, swells, becomes hot or leaks fluid is not a normal scar. If that happens, call me straight away.
It takes almost everyone by surprise and nobody mentions it beforehand. General tiredness, sometimes marked, is normal in the two to three weeks that follow the operation.
The explanation is simple: the anaesthetic, the painkillers, nights broken up by discomfort, and the work your body is doing to heal. It has nothing to do with whether the operation went well.
It lifts on its own once your nights are whole again and the painkillers are reduced. If it lasts beyond a month or comes with a fever, tell me about it.
Sleep is the hard part of the first month, more so than daytime pain.
The position that works best is half sitting up, with your back propped on two pillows and a cushion under the elbow on the operated side so the arm does not drop backwards during the night. Many patients sleep better in an armchair than in a bed for the first few nights, and that is not a failure.
Sleeping on the operated side becomes possible again gradually, usually between six weeks and three months depending on the operation. Do not force it, your shoulder will tell you.
This is a very practical question, rarely raised in consultation, and yet it is one of the first difficulties once you are home.
The basic rule fits in one sentence: always put the sleeve on the operated side first, and take it off last. The good arm does the work.
Before the operation, get in loose clothes that open at the front: shirts, cardigans, zip-up jackets. A T-shirt one or two sizes too big goes on without trouble, whereas a narrow-necked jumper or a fitted top becomes an ordeal.
For women, a bra that fastens at the front is by far the simplest option after shoulder surgery, or failing that a soft non-wired bralette that you step into and pull up. Fastening at the back, which means reaching a hand behind you, is the most uncomfortable movement of the first weeks.
Think about the small details too: slip-on shoes, elasticated trousers, an electric toothbrush, a pump-action soap. It is these little things, prepared in advance, that make the first month comfortable.
It depends entirely on the operation, and the difference is sometimes striking.
After a reverse shoulder replacement fitted without detaching the muscles, there is no immobilization and driving resumes immediately.
After a rotator cuff repair, you have to wait until you can hold the wheel with both hands and manoeuvre without pain or apprehension, which depends on the side operated on and on the car.
In every case, the test is not the calendar but safety: if you cannot parallel park or swerve in an emergency, you cannot drive. Start with a short trip in daylight.
How long you are off does not depend only on the operation, it depends above all on your job and on what your hands and arms actually do all day.
A desk job can be resumed far earlier than heavy work or a job that means working with the arms above shoulder height. Work involving travel and carrying loads means waiting until rehabilitation is finished.
We set that date together in consultation, and I will support you with occupational health if adjusted duties or a phased return are needed. Going back too early to an unsuitable job always costs you in the end.
Rehabilitation starts early, usually within the week that follows the operation, and it follows a written protocol that I give you on discharge.
It always goes through the same stages: passive movement first, to keep the shoulder supple without loading the repair, then assisted active movement, then active movement, and finally strengthening.
The rhythm is three sessions a week, and the total length depends on the operation, in the order of three to four months for a shoulder replacement.
The exercises you do on your own count as much as the sessions. A few minutes several times a day do more for your shoulder than one intense session now and then.
These markers are indicative and I adjust them for each patient, but they give you the order of magnitude.
After a shoulder replacement fitted without detaching the muscles: day surgery or one night in hospital, no immobilization, the arm used from the next day for simple tasks, driving straight away, three physiotherapy sessions a week, and three to four months of rehabilitation in total.
After a rotator cuff repair: home the same day or the next, the tendon protected while it heals onto the bone, which takes around three months, movement often back at about three months and strength continuing to improve for up to a year.
After treatment for a calcific deposit: recovery is generally simpler, with pain that settles quickly once the acute episode is over.
After surgery for instability or dislocation: what needs protecting is the repair or the bone block, and going back to contact sport is the last milestone of all.
After a release for frozen shoulder: the priority is not to lose the movement gained in theatre, so rehabilitation starts immediately and intensively.
Yes, in most cases. At three months it is common to still have pain at the end of the day, discomfort after an unusual effort, or the occasional night waking. An operated shoulder takes longer than people imagine to forget the operation.
What should raise concern is not the pain itself, it is the way it changes. Pain that was easing and then picks up again, pain that comes back after several weeks of improvement, or weakness that sets in all deserve an examination and often an X-ray.
Pain along the biceps, at the front of the arm, is common after rotator cuff surgery and usually improves with rehabilitation.
It is a term that worries people, often read on forums, and it deserves a calm explanation.
Complex regional pain syndrome, once known as reflex sympathetic dystrophy, is an excessive reaction of the body after an injury or an operation. It combines disproportionate pain, stiffness, and sometimes changes in the skin, the temperature or the sweating of the limb.
It is rare, it is nobody's fault and it is not the consequence of a failed operation. It can be treated, with gentle rehabilitation, proper pain management and sometimes specific medication. The important thing is to recognize it early, so do not wait before reporting pain that resembles nothing you were told to expect.
These signs are not part of a normal recovery and justify contacting me without delay: a fever, a scar that is red, hot, swollen or leaking, pain that clearly increases instead of easing, a painful calf or unusual breathlessness, an arm or hand that swells and turns bluish, loss of sensation or of movement that appears later on.
When in doubt, call. A worry cleared up in two minutes is worth more than a problem found too late.
The first three or four days are the most intense, then the background pain drops clearly between the second and the sixth week. Night pain is often the first to go. Pain on exertion and intermittent night waking can last two to three months.
Yes, in most cases. What should raise concern is not the pain but the way it changes: pain that picks up again after several weeks of improvement, or weakness that sets in, deserves an examination and often an X-ray.
It depends on the operation. After a shoulder replacement fitted without detaching the muscles, there is no immobilization and rehabilitation lasts three to four months. After a rotator cuff repair, the tendon takes around three months to heal onto the bone and strength keeps improving for up to a year.
After a shoulder replacement fitted without immobilization, immediately. After a rotator cuff repair, once you can hold the wheel with both hands and manoeuvre without pain. The test is not the calendar but whether you could swerve in an emergency.
Always put the sleeve on the operated side on first and take it off last. Choose loose clothes that open at the front and oversized T-shirts. For women, a bra that fastens at the front or a soft non-wired bralette avoids the most uncomfortable movement of all.
Yes, it is common for two to three weeks. The anaesthetic, the painkillers, broken nights and the work of healing all explain this fatigue. It lifts once your nights are whole again. Beyond a month, or with a fever, you should be seen.
Half sitting up, with your back propped on two pillows and a cushion under the elbow on the operated side. Sleeping in an armchair for the first few nights is common and perfectly normal. Sleeping on the operated side comes back between six weeks and three months.
It depends above all on your job. A desk job can be resumed far earlier than heavy work or work with the arms above shoulder height. We set the date in consultation, with adjusted duties or a phased return if needed.
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