Shoulder Pain and Stiffness Following Surgery
If you have surgery for a shoulder condition, you must be prepared for some degree of pain or discomfort, reduced motion and reduced function for a period following your operation.
In general, operations can be divided into two types:
Decompression operations
Bone or soft tissue is trimmed with the aim of decompressing tendons, and no structures are repaired or reconstructed during surgery. This means there are no repaired structures to pull apart, and in this case, you can rehabilitate within the limits of comfort. A sling is available for comfort, but you should stop using it as soon as possible and use your shoulder within the limits of comfort. Operations such as subacromial decompression, acromioplasty, lateral clavicle excision, decompression of the suprascapular nerve, shoulder debridement – fall into this category of operation.
Repair or reconstructive operations
These procedures involve tissue repair or the reconstruction of bones, tendons or ligaments. You will need to wear a sling post surgery, and limit what you do with your shoulder for a designated period to allow the tissues to heal. We will guide you as to how long to wear the sling and how restrictive your shoulder movement should be. It is important to follow our guidance as the aim of the operation is to allow the structures in your shoulder to repair. If you overuse your shoulder or don’t follow instructions, there is a greater risk your tissue will not heal, and the results of your surgery will not be optimal. We aim for the best possible long-term result. If this means you suffer a short-term inconvenience, try to remember that you have to live with, and use, your shoulder for the rest of your life.
Happy and Unhappy Shoulder
Why does a patient’s shoulder get stiff and sore following surgery? This seems like a silly question, but it is worth thinking about why particular symptoms occur in the weeks and months after surgery. When you have an operation, the body interprets it as an injury and mounts a healing response. The level of healing response depends upon some factors, including how injured your shoulder was prior to surgery, what and how large your operation was, and the biology of your healing response, which varies between people and at different times for individuals. If your healing response is large, you will tend to be quite sore and stiff, and recovery will take longer. Conversely, if your healing response is limited, you will feel more comfortable and recover your function and motion more quickly.
Everyone requires a healing response to varying degrees, but for some operations, it is less vital than others. Decompressive operations are less invasive, and the healing response is reasonably small. Because recovery time is quicker, we need relatively little healing for this type of operation.
Repairs or reconstructive operations where tissues are healing, the healing response is vital, and a large healing response, despite a slower initial recovery, leads to a better long-term outcome.
To recap:
For decompressive operations; you can use your shoulder as much as it will let you within the limits of comfort. For repair or reconstructive operations; the long-term outcome is likely to be better if you remain stiff and sore for longer.
If you are relatively comfortable and seem to be recovering quickly, we should consider slowing down your rehabilitation to compensate for the potential lower healing rate. Feeling comfortable and regaining motion may be a nicer experience for you, it does not mean you can use your shoulder more or undertake heavier tasks. It actually means the reverse because the use of your shoulder is coming back faster than expected for this type of operation and you risk pulling the repair apart.
Patients who are comfy and recovering quickly after repair operations tend, in the longer term, to do less well than the patients who were initially more uncomfortable and stiffer. The latter group of patients tend to do better as their repairs are more likely to heal properly. If you are in the comfy patient group, you can reduce the risk of a negative long-term outcome by not overusing your shoulder early, and not undertaking heavy tasks for at least six months.