week 4 · last reviewed 2026-06-08
Shoulder replacement recovery: week 4
Clinical procedure: Total shoulder replacement.
Typical, evidence-anchored estimate only. It is not medical advice, not a prediction for your body, and not a substitute for your surgeon or clinician.
what's typical at week 4
typical pain · week 4
Around week 4, the typical pain band sits at 1.6/10 (range 0.5–3.6). This is a soft, interpolated read: this exact week wasn't measured, so the band is bridged between the nearest measured points. Treat it as a rough guide, not a target to hit.
weeks 2–6
Weeks 2-6 · in the sling, restricted motion
The sling stays on through this entire phase in most protocols. Passive ROM under physiotherapist supervision typically begins by week 4-6 (active-assisted ROM is the gate). The 6-week measured pain in the cohort is a median of 11/100 (1.1/10) — mostly stiffness and post-activity soreness rather than rest pain.
Some sling-weaning starts at week 4 in anatomic TSA protocols; reverse TSA generally holds the sling through week 6 with the option to wear it longer if the tissue quality was concerning.
documented at this week
This week
Sling weeks — hand and elbow stay free
The sling is worn continuously for the first 4-6 weeks (generally 4 with an isolated reverse replacement, up to 6 with a tendon transfer or subscapularis repair). Elbow, wrist, and hand keep moving.
This week
Assisted motion starts; sling weans
Around weeks 4-6, active-assisted range of motion begins and the sling weans gradually during the day over about two weeks.
What's typical
Median pain ~1/10 from week 6
In a 755-patient cohort (77% reverse, 23% anatomic), median pain falls to about 1.1/10 at six weeks and 1.0 at three months — with a real spread (some still at 3/10), all on the published curve.
milestones around now
- wk 5 ·Active-assisted range of motion / sling weaning starts (About 4-6 weeks; sling weaned during the day over ~2 weeks)
- wk 6 ·Sling discontinued / sleep without sling (About 6 weeks; reverse TSA may extend with poor tissue quality or tendon transfer)
- wk 9 ·Return to light activity / household & light work (About 9-12 weeks; no lifting heavier than ~10 lb until strengthening; manual labor much later)
sources
What this page is built from
- Variations in 1-year trajectories of pain and capability after shoulder arthroplasty (n=755) prospective cohort · reliability 8.5/10
- Trajectory of recovery after the Big 3 shoulder surgeries (anatomic vs reverse VAS 3/6/12mo) prospective cohort · reliability 7.5/10
- MGH rehabilitation protocol for total shoulder arthroplasty and hemiarthroplasty clinical protocol · reliability 7/10
Track your own week-by-week so a flare doesn't erase the months behind it.
Start a recovery logThis is a typical, evidence-anchored reading of shoulder replacement recovery at week 4 — not medical advice, not a prediction for your body, and not a substitute for your surgeon or clinician.