A reverse shoulder replacement, or reverse shoulder arthroplasty (RSA), fundamentally changes the mechanics of the shoulder joint to restore function, particularly when the rotator cuff is irreparably damaged. Unlike a traditional replacement, the ball component is fixed onto the shoulder blade (glenoid), and the socket component is placed on the upper arm bone (humerus). This reversal repositions the center of rotation, allowing the large deltoid muscle to take over the lifting and movement previously performed by the damaged rotator cuff. This new mechanical configuration provides stability and improved arm elevation but introduces a unique set of strict, lifelong precautions necessary to protect the implant.
Immediate Post-Operative Movement Restrictions
The initial recovery phase, typically lasting four to six weeks, involves highly restrictive limitations designed to allow the surrounding tissues to heal and the implant to settle. During this period, the arm will be secured in a sling day and night, only to be removed for specific, gentle exercises as directed by the surgeon or therapist. This mandatory immobilization protects any soft tissue repairs, such as the subscapularis tendon, which may have been involved in the procedure.
The distinction between passive and active motion is central to this phase, with all active movement (AROM) strictly prohibited. AROM involves using the shoulder muscles to lift or move the arm, which places direct, unhealed stress on the joint components. Patients must not actively raise, reach, push, or pull anything with the operated arm, including pushing off a chair or bed. Movement is limited to passive range of motion (PROM), where the non-operated arm or a therapist assists in gently moving the arm within a safe zone.
Daily tasks must be executed using only the non-operated arm, including dressing, bathing, and basic hygiene. While the hand, wrist, and elbow should be moved frequently, the shoulder itself must remain protected. Patients often find it more comfortable to sleep in a reclined or semi-upright position, such as in a recliner or bed propped up with pillows. This position helps maintain protection and avoids unintended movements during sleep. Driving is also prohibited during this initial period, as a sudden reaction or the need to steer aggressively would violate these restrictions.
High-Risk Movements That Cause Instability
Long after the initial healing period, specific motions remain permanently restricted because they place the implant in a “position of jeopardy” for dislocation. The RSA design medializes the center of rotation, making the joint inherently less stable in certain combinations of movement. This instability risk is higher compared to traditional shoulder replacement.
The most dangerous combination of movements is known as the dislocation position: combining shoulder adduction (across the body), internal rotation (twisting inward), and extension (moving backward). These movements can cause the humeral component to lever out of the glenoid component, particularly if the subscapularis tendon was compromised or repaired. Practical examples of this high-risk motion include reaching directly behind the back to tuck in a shirt, scratch one’s back, or perform personal hygiene.
The inability to perform deep internal rotation, especially when combined with reaching behind the back, is a predictable and permanent limitation after RSA. Surgeons advise against pushing the arm into this position because it risks contact between the implant and the bone (scapular notching) or, more acutely, dislocation. Avoiding these specific movements is a lifelong necessity to prevent mechanical failure.
Permanent Weight and Load Limitations
A significant permanent change after a reverse shoulder replacement is the lifelong restriction on lifting, pushing, and carrying heavy loads with the operated arm. This limitation prevents excessive stress on the new joint, which can lead to loosening of the implant components from the bone over time (aseptic loosening). The new joint is not designed to withstand the same high forces as a natural, healthy shoulder.
The maximum lifting limit is typically between 10 and 25 pounds, though many surgeons advise the lower end (10 to 15 pounds) for regular, repetitive use. This restriction applies not only to static lifting, such as carrying a heavy suitcase or groceries, but also to dynamic force application. Activities involving pushing, like opening a heavy door, or pulling, such as yanking weeds, must be done with caution or avoided entirely.
Patients must also avoid heavy overhead work, as lifting objects above chest level significantly increases the strain on the shoulder’s new mechanical configuration and surrounding tissues. Ignoring these permanent weight limitations accelerates the wear of the polyethylene liners and increases the likelihood of needing a revision surgery.
Lifestyle Activities That Must Be Modified
The permanent mechanical and load restrictions translate into necessary modifications for many daily and recreational activities. High-impact or contact sports must generally be avoided entirely due to the risk of a hard fall or direct impact, which could severely damage or dislocate the implant. Activities involving repetitive, forceful overhead motions are also discouraged.
Sports to Avoid
- Football
- Wrestling
- Downhill skiing
- Professional painting of ceilings
- Throwing a baseball
- Certain types of manual labor
Even common recreational pursuits require alteration. While low-impact activities like walking, cycling, and gentle swimming are encouraged, sports like golf or tennis must be approached cautiously. Modifications, such as using lighter equipment, avoiding aggressive swings, or focusing on doubles play, help protect the joint from excessive rotational or impact forces.
Driving is permanently affected for some, particularly with manual transmission vehicles, where the forceful and rotational movements required for shifting can be challenging. Patients are advised to wait until they have the full confidence and reflex speed to safely operate a vehicle. Those with a history of instability may need to permanently avoid aggressive use of the arm while driving. Ultimately, the long-term success depends on accepting these restrictions and adapting daily life to the new biomechanical reality of the shoulder.