Shoulder Pain After Shoulder Surgery: What to Expect and How to Manage It

Shoulder surgery can be a crucial step to restoring function, reducing pain, and improving one’s quality of life. As a surgeon, my job is to focus on minimising the impact that a shoulder operation has on healthy tissue so that your recovery is as quick as possible.

However, it’s common to experience post-operative shoulder pain, which can raise concerns and questions among patients. In this article, we will address the following concerns: how much pain you can expect, the duration of the pain, methods to alleviate it, and general advice for optimal recovery.

For a better understanding of the rehabilitation process, refer to this blog article.

How much pain is there after shoulder surgery?

The amount of pain one experiences after shoulder surgery can vary significantly based on factors such as:

• Type of Surgery: Some procedures, like total shoulder replacements or rotator cuff repairs, might be more invasive than others, leading to more post-operative pain.
• Individual Pain Threshold: Every individual perceives pain differently. What might be moderate pain for one person can be severe for another.
• Surgical Technique: Minimally invasive surgeries, such as arthroscopies, typically result in less post-operative pain compared to traditional open surgeries.
• Pre-existing Conditions: Conditions like arthritis or chronic shoulder issues might amplify post-surgical pain.
• Smoking: Chronic cigarette smoking has been associated with higher intensity post-operative pain.

While it’s challenging to give a definitive answer that applies to everyone, it’s common for patients to experience moderate to severe pain in the immediate days following the surgery. Pain should, however, gradually decrease over time.

How long does post-surgical shoulder pain last?

Just as the intensity of pain can vary, so too can its duration. However, a general timeline is:

• First 48 hours: This is typically the most painful period as the anaesthesia wears off and the surgical trauma settles in.
• First Week: Pain starts to decrease but is still present, especially when moving the shoulder or when not using pain medications.
• 2-6 Weeks: Gradual reduction in pain levels. Usually it is easier to perform physical therapy and mobilisation of the shoulder ( if allowed by the surgeon) during this period.
• Beyond 6 Weeks: For many, pain has significantly decreased by this time. However, it’s not uncommon for some discomfort or mild pain to persist, especially after physical activity or therapy sessions.
• 3-4 months: Whilst the shoulder and associated pain will continue to improve up to 1 year following surgery, the significant improvement usually occurs by 3-4 months following surgery.

Remember, everyone heals differently. Some might experience minimal pain after the first couple of weeks, while others might take a couple of months for substantial relief.

How can post-surgical shoulder pain be eased?

1. Medications: Your surgeon will likely prescribe pain relievers for the initial post-operative period. It’s essential to take them as directed and communicate any side effects ( see below). In South Australia, analgesics can be prescribed for 2 weeks following surgery, thereafter it is a requirement to use scriptcheck to monitor use. Thus because of the risk of side effects and the latter, it is often better to involve your general practitioner in the prescribing of longer term medications if required, as the GP is aware of your other medications and potential cross-reactions.
2. Cold Packs: Applying cold packs can reduce inflammation and numb the area, providing relief. Ensure you don’t apply ice directly to the skin; use a cloth as a barrier, and only apply for 20 minutes at a time.
3. Physical Therapy: Engaging in prescribed physical therapy ( when appropriate) can help mobilise the shoulder, reduce stiffness, and speed up the healing process.
4. Rest and Elevation: Especially during the first few days, ensure you rest adequately and keep the shoulder elevated to reduce swelling.
5. Wear Your Sling: If your surgeon recommends a sling, wear it as directed. It can help reduce movement of the surgical area, providing pain relief. Dr Nimon recommends wearing your clothes normally, and the sling over the top so as to reduce perspiration that occurs from skin contact and the risk of eczema or candida infection (thrush).
6. Avoid Strain: Refrain from heavy lifting or strenuous activities until cleared by your doctor.
7. Stay Hydrated and Eat Healthily: Proper nutrition and hydration can support the healing process.
8. Reclining Chair:Often sitting/ sleeping in a reclining style chair can help the pain which seems worse when lying flat.

 

General Advice

• Follow Post-Operative Instructions: Adhere to all post-operative instructions provided by your surgeon or healthcare team.
• Communicate: If pain is worsening, or if there are signs of infection, reach out to your healthcare provider immediately. Dr Nimon prides himself on being alsways available for any concerns. If an issue or question arises, contact us ASAP on (08) 8376 9988 to speak to Dr Nimon. After hours, a message will come through to jhis phone, so he can ring you back. 
• Be Patient and Positive: Recovery is a journey, and staying positive can mentally help in dealing with post-surgical pain.
• Set Realistic Expectations: Understand that surgery aims to correct a problem, but the path to complete recovery may be longer for some than for others.

In conclusion, shoulder pain after surgery, though expected, can be managed effectively with the right interventions and mindset. As always, the key lies in understanding the process, following medical advice, and being proactive in addressing concerns. Your shoulder is on its way to better function and mobility; give it the care and patience it needs!

When to Contact Your Surgeon after Shoulder Surgery

Post-operative shoulder pain is expected, but how do you distinguish between normal healing discomfort and potential complications? Knowing when to reach out to your surgeon is crucial for a safe and effective recovery. This expanded section will detail specific concerns that necessitate prompt communication with your surgeon.

1. Excessive or Worsening Pain

While pain after surgery is common, any pain that suddenly intensifies or doesn’t improve with prescribed pain medications is a cause for concern. If the pain:

• Becomes unbearable or distinctly different from the initial post-op discomfort.
• Shows no signs of improvement despite following post-operative care instructions.
• Is not alleviated or is worsened with prescribed medications.

It’s essential to consult your surgeon to rule out complications.

2. Swelling or Redness

Some swelling is expected after surgery. However, if you notice:

• A sudden increase in swelling that doesn’t improve with elevation or cold packs.
• Swelling that extends beyond the surgical site.
• Persistent redness or a warm feeling around the incision.

These could be signs of an infection or a post-operative complication and warrant immediate medical attention.

3. Drainage from the Surgical Site

A small amount of clear or slightly blood-tinged fluid might ooze from the incision in the first few days. But if you observe:

• Pus or any foul-smelling drainage.
• Continuous or heavy bleeding.

It’s essential to reach out to your surgeon as this might indicate an infection or issues with wound healing.

4. Fever or Chills

While a low-grade fever can be a typical response following surgery, a persistent or high fever (over 101°F or 38.3°C) is concerning. Fever, especially when accompanied by chills, could be a sign of an infection.

5. Unexpected Change in Skin Colour

If you notice:

• Bruising or discolouration that extends far from the surgical site, is not uncommon, and can worsen initially, but if it continues to increase, it is worth checking with your surgeon.
• Pale, blue, or gray skin around the operated area.

These could be indicative of infection and should be addressed immediately.

6. Decreased Mobility or Numbness

While some stiffness and restricted movement are anticipated after shoulder surgery, sudden or significant decreases in mobility can indicate infection and loss of  sensation in the arm, fingers, or hand could indicate nerve issues and should be reported.

7. Breathing Difficulties or Chest Pain

Though not directly related to the shoulder, complications like blood clots can manifest as breathing difficulties or chest pain. If you experience either of these symptoms post-surgery, seek medical attention immediately.

8. Allergic Reactions

Symptoms like hives, rashes, itching, difficulty breathing, or swelling around the eyes and lips can indicate an allergic reaction, possibly to medications administered during or after surgery.

General Advice

Always prioritise your instincts and well-being. If something doesn’t feel right or if you’re concerned about a symptom, even if it’s not on this list, it’s better to reach out to your surgeon or medical professional for clarity. It’s essential to ensure that your recovery process is on track and free from preventable complications.

Remember, early detection and intervention can make a significant difference in outcomes.

Complications from the Use of Analgesics after Shoulder Surgery

The use of analgesics, or pain-relievers, after shoulder surgery is commonly prescribed to manage post-operative pain. While these medications can be highly effective, it’s crucial to be aware of potential complications and side effects. Let’s delve into some of the potential issues associated with analgesic use post-shoulder surgery:

1. Gastrointestinal Complications

• Ulcers and Gastritis: Non-steroidal anti-inflammatory drugs (NSAIDs), often prescribed for pain and inflammation, can cause or exacerbate stomach ulcers or gastritis, especially when taken for extended periods or on an empty stomach.
• Constipation: Opioid analgesics frequently cause constipation. It’s crucial to monitor bowel movements and consider stool softeners or increased fibre intake if using opioids.
• Nausea and Vomiting: Some analgesics can irritate the stomach lining, leading to nausea or vomiting.

2. Cardiovascular Issues

Certain NSAIDs have been associated with an increased risk of heart attack or stroke, especially when used in higher doses or for prolonged periods.

3. Dependency and Addiction

Opioid-based analgesics carry a risk of dependency and addiction. While they might be prescribed for intense post-surgical pain, it’s essential to use them under strict medical guidance and only for as long as necessary.

4. Central Nervous System Effects

• Drowsiness and Dizziness: Opioid analgesics, in particular, can cause drowsiness or dizziness, making activities like driving or operating heavy machinery dangerous.
• Mood Changes: Some individuals might experience mood swings, depression, or even euphoria with analgesic use.
• Respiratory Depression: High doses of opioids can depress the respiratory system, leading to shallow or infrequent breathing. This is a severe side effect and requires immediate medical attention.

5. Allergic Reactions

Though rare, some individuals might be allergic to specific analgesics. Symptoms can range from mild rashes to severe reactions like anaphylaxis, which is life-threatening and demands emergency medical care.

6. Drug Interactions

Analgesics can interact with other medications, either reducing their effectiveness or leading to harmful side effects. Always ensure that your medical provider is aware of all medications and supplements you’re taking.