Week 3 and my whole hand is puffy with a bruise that has crept down to my wrist. Is that the operation draining or is something wrong?

Second shoulder, the reverse this time, done just under three weeks ago, and I thought I knew the drill from the first one. The shoulder itself is behaving. Wound is dry, pain is a dull ache and a lot better than week one, the block wearing off was no drama this time because I knew it was coming.

What I did NOT get with the total is this. About day four a bruise appeared on the inside of my upper arm, which fine, they cut you open. But it has kept MOVING. It went to the elbow, then the forearm, and this morning there is a yellowy green stain right down at the wrist, nowhere near where anyone touched me. And the hand is puffy. Not agony, but the fingers feel like sausages first thing, my wedding ring is tight, and making a fist is an effort. Wife thinks I should ring someone. I think I am being soft but I genuinely did not have any of this the first time round and the difference is bothering me.

So. Is a bruise travelling down the arm a thing after a shoulder replacement or is that blood going somewhere it should not? Is the hand swelling just from the sling? Am I meant to be moving the hand and elbow more than I am, because I have basically been treating the whole arm as off limits. And what would actually be the sign that it IS something wrong, because I would rather know the line than guess at it.

Ha, the travelling bruise. Mine went from the armpit to the elbow over about a week and my daughter photographed it every day like a weather map. Reverse as well. It went through the full purple, green, yellow palette and was gone by about week four. The first physio I saw was completely unbothered by it and said it drains downhill because the arm hangs down, which once she said it seemed obvious.

From the fracture and partial side, and I had this worse than most because the broken bone bleeds into the arm on top of what the surgery does. My hand swelled up properly, could not get my watch on for a fortnight. The bit that helped me, and I only got told it at the first physio appointment which felt late, was that the fingers, wrist and elbow are NOT part of what the sling is protecting. I had been holding the whole arm rigid like it was made of glass. Once I was opening and closing the hand, wiggling the fingers and letting the elbow straighten out of the sling a few times a day, the puffiness went down over about a week. Rested it up on a cushion in the evenings too. But that was what my physio told me for my arm, so worth putting the question to yours rather than copying me.

Short version first: a bruise that tracks down the arm and a puffy hand in the first few weeks are both very common after a shoulder replacement, and on their own they are not a sign that anything has gone wrong. The reason you did not get it with the total and did with the reverse is mostly luck and plumbing, not a warning. Every shoulder bleeds a bit into the tissues after surgery, the arm then hangs in a sling for weeks, and gravity carries that bruising downhill through the loose tissue on the inside of the arm, so it shows up at the elbow, then the forearm, then the wrist, days after the operation and nowhere near the cut. It fades through exactly the colours Derek describes over roughly 2 to 3 weeks. Mine reached the elbow and stopped; some people's reach the fingers.

The hand swelling is the same story. In a sling the hand sits low and still, the muscles that normally pump fluid back up the arm are not working, and so the fingers puff up, worst first thing in the morning. What surgeons and physios generally ask for, and this is the bit you have got the wrong way round, is that the hand, wrist and elbow keep moving from day one: opening and closing the fist, bending the wrist, straightening the elbow out of the sling a few times a day, and resting the hand up rather than dangling. The sling protects the shoulder repair, not the whole limb. How that fits into the first weeks is set out in the week by week recovery. Your own protocol is the one that counts though, because a reverse can have its own rules about how far the arm comes out of the sling, so check with your physio what they want rather than take it from me.

Now the line you asked for, because it matters more than the reassurance. The ordinary version is a bruise that is fading and a hand that is puffy but soft, moves, and is better once you have been up and moving. The not ordinary version is any of these: a whole arm that is hot, tight, red or painfully swollen rather than just puffy at the hand; a deep ache in the arm that is getting worse rather than better; fingers that are going numb, tingling, cold or pale; a fever, or a wound that starts to weep or redden; or pain in the shoulder that is climbing day on day rather than easing. Any of those is a same day call to your surgical team, not a forum question. Blood clots are rarer after shoulder surgery than after hip or knee, but they are not impossible, which is why the hot, tight, whole-arm swelling gets named specifically. And because yours is a reverse, one more thing that is nothing to do with bruising but belongs in the same conversation: a sudden clunk or give in the shoulder with the arm no longer lifting is a different problem entirely, and dislocation after a shoulder replacement explains what that looks like so you would recognise it. From what you have written, you are describing the ordinary version. Your wife is not wrong to want it looked at, and a quick photo to the physio or a call to the ward is a perfectly reasonable middle road.

Wedding ring. Take it off now while you still can, or have it taken off. Mine had to be cut off on the ward after my reverse because I left it too long and the finger swelled round it. Small thing, felt like a big thing at the time.

Update for the next person who searches this at 6am. Rang the ward, described it, they were not remotely concerned and said exactly what Douglas said about gravity. Physio then showed me the fist and elbow routine at my appointment and told me off, kindly, for treating the whole arm like it was in plaster. Ten days on the bruise is a faint yellow smudge at the wrist and the hand is nearly normal in the mornings. Ring came off with soap and a bit of thread, just about, and reverse-at-68 you were right, another week and it would have been the cutters.