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Pain After Arthroscopic Shoulder Surgery

Contact Orthobethesda For Orthopedic Treatment For Your Shoulder Ailment Or Injury

Pain after arthroscopic shoulder surgery – causes and management

If youre experiencing pain in your shoulder, its time to schedule an appointment at OrthoBethesda. Our doctors will determine the cause of your pain and develop a personalized treatment plan. At our patient-centric orthopedic care center, our entire staff has dedicated their skills to providing you with individualized care, from evaluation to diagnosis to treatment to recovery.

How Much Therapy Should I Have After Surgery

Your surgeon can answer this since they are the ones who know how much work had to be done to repair the tendons. The doctors can prescribe therapy based on the work done during the operation. If more than one tendon had to be repaired or if the tendon tear is a big tear, the surgeon may recommend that the therapy progress slower to allow more time for healing on the other hand, if the tear is small, they may allow a little more motion earlier than usual after the surgery.

Number Of Measurements And Time Points

The total number of pain recordings within the first seven PODs was extracted from 45 studies two studies did not report the total number of recordings . The mean number of recordings within the first postoperative week was 6.3 .

The distribution of recordings during the first seven PODs could be extracted from 45 studies . The majority of pain recordings were made on POD1, totaling 60% of cumulated number of recordings within the first postoperative week, equivalent to a mean of 5.1 recordings. The number of pain recordings decreased from POD2 to POD6 with a small increase in POD7. The time points in POD1 were specified in 32 of the included studies and represented 28 different time points . The most frequently used time points were: post-anaesthesia care unit, 1, 2, 4, 6, 8, 12, and 24 hours postoperatively.

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How Do I Know If The Tendon Repair Has Torn Again

It is not easy to tell if the rotator cuff tendon repair has failed or not. The symptoms of pain or loss of strength are common after rotator cuff surgery while the tendons are healing, and minor setback are to be expected. We do not recommend a magnetic resonance scan or other studies when these setbacks occur for several reasons. The first reason is that magnetic resonance imaging after a surgical repair of the rotator cuff does not have the same accuracy in determining whether tendons are torn. If an MRI is performed, we recommend that it be performed with dye in the affected shoulder with a needle under x-ray or CAT scan guidance by a radiologist. This test is called an arthrogram-MRI and may be positive if the tendon has not had enough time to heal or if parts of the tendon have not healed to bone. As a result, within three months after a rotator cuff repair, it is common for the dye to leak through the tendon since it has not completely healed. After this period of time, the degree of tear in the tendons can be determined best with this study.

What To Expect Following Arthroscopic Shoulder Surgery

Arthroscopic Shoulder Surgery

Your arm will be in a sling after surgery to immobilize it. Its normal to feel tired for several days and its best to take it easy. You may notice that your shoulder is swollen and may feel numb. This is perfectly normal and will resolve over the course of a few days.

The time it takes to recover depends on your specific shoulder problem, but most people need at least six weeks to recover. Generally, you will need to limit your activity until you restore the strength and mobility of your shoulder. Your surgeon will provide specific instructions on what activities to avoid during your recovery.

At home, its important to rest and get adequate sleep to aid recovery. Rehabilitation starts once your shoulder has healed enough to endure strengthening exercises. In most cases, this phase begins eight to 12 weeks after your surgery.

You can expect these common stages of recovery:

  • Immobilization: During the first several weeks a sling will help immobilize your shoulder so that it can heal.
  • Passive exercise: A physical therapist or machine assists you with passive exercise. This involves gentle going through gentle movements without effort.
  • Active exercise: Once ready, you can expect to engage inactive exercise to begin strengthening your shoulder. As you go through the rehabilitation process you will increase your range of motion, strength, and endurance.

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What Is Arthroscopic Rotator Cuff Surgery

If surgery is required, your surgeon may choose arthroscopic rotator cuff surgery. This technique allows your surgeon to evaluate and repair the tear using a few very small incisions instead of one large incision.

A half-inch long incision is made so a small camera can be inserted into the joint, allowing the surgeon to see the damaged areas. Additional incisions are made to accommodate surgical tools that are used to repair the damage. Plastic screws and sutures may also be utilized to repair the tear.

Shoulder Surgery Recovery Timeline

Your arm will be placed in a sling to keep it immobilized during the healing process, which takes approximately four to six weeks. This can make some daily activities difficult, but you must wear your sling as instructed by your surgeon. Keeping your shoulder immobilized is a key part of making sure you heal correctly and avoid future stiffness, pain, or failed shoulder surgery syndrome.During the four to six weeks that you are wearing the sling, youll likely also be working with a physical therapist, who will have you do different exercises and movements to build strength and flexibility in your arm.

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Arrange For Help With Chores

Whether you have family or friends living with you or you live alone and need to make special arrangements, be sure someone is on hand to help with tasks like getting groceries, walking the dog, and house cleaning. You also wont be able to drive for a time following surgery, so arrange for transportation to your appointments.

Know The Stages Of Rehabilitation After Shoulder Surgery

Shoulder Arthroscopy Surgery

Your physical therapist will guide you through these rehabilitation stages.

  • Immobilization: Uses a sling to stabilize your shoulder for several weeks as your joint heals.
  • Passive exercise: Relies on assistance and support of your physical therapist or a specific machine to move your arm gently starting a few weeks after surgery.
  • Active exercise: Moves your shoulder and arm by using your muscles beginning up to three months following your surgery.

As you continue progressing through rehabilitation, weightlifting exercises and gentle stretches can help you with your range of motion and gaining endurance. Performing some of these exercises in a pool eases the impact on your shoulder.

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Are There Any Potential Complications

Any surgery comes with the risk of complications. While these are rare, it is essential you become an informed patient before deciding to undergo surgery. The potential complications of shoulder arthroscopy include the following.

  • Infection: Your surgeon will take every precaution to prevent surgical site infection, but bacteria are always present in our environments. Signs of postoperative infection include redness, pain, swelling and drainage at the site of the surgical incision. Infections like these typically need treatment with a long course of antibiotics. While you should be aware of this complication, only 0.16 to 1.9 percent of arthroscopic surgery patients experience deep infection postoperatively.
  • Stiff shoulder: A stiff shoulder is one of the more common complications of rotator cuff surgery, with one study finding 20 percent of patients experiencing postoperative stiffness. While this stiffness may be unpleasant, the study found it typically resolved with six to 12 months after the surgery.
  • Lack of improvement: Arthroscopic rotator cuff surgery has a high success rate, but it is not 100 percent. Lack of improvement is not a true complication, but the result can be disappointing for patients. It is possible patients will find they do not regain full motion, strength and function in the shoulder.
  • Retears: While arthroscopic rotator cuff surgery can be successful, there is a risk of retearing the injured tendon. The risk of this is higher with larger tendon tears.

Acute Postoperative Pain After Arthroscopic Rotator Cuff Surgery: A Review Of Methods Of Pain Assessment

Jacob Korsbæk Rasmussen1, Lone Nikolajsen2 and Karen Toftdahl Bjørnholdt3*

1Aarhus University, Vennelyst Boulevard 4, Aarhus, Denmark 2Department of Anesthesiology and Intensive Care, Aarhus University Hospital, Research, C319, Palle Juul Jensens Boulevard 99, Aarhus, Denmark 3Department of Orthopedic Surgery, Horsens Regional Hospital, Sundvej 30, Horsens, Denmark

Accepted: 10 August 2018

Abstract

Introduction: Pain can be severe during the first days after arthroscopic surgery, and acute pain is an important outcome in clinical trials of surgical technique or anaesthetic strategy. A standardized, validated method of assessing acute postoperative pain would improve the quality of clinical studies, and facilitate systematic reviews and meta-analyses. A step on the way towards this standard is to investigate the methods most commonly used in recent literature.

Methods: PubMed and CINAHL databases were searched, including studies of arthroscopic rotator cuff surgery with a primary pain-related outcome during the first postoperative week, published in English from 2012 to 2017.

Discussion: This review describes the currently most common methods of assessing acute postoperative pain in clinical trials of arthroscopic shoulder surgery involving rotator cuff repair, and the large variety of methods applied. Based on this study and international guidelines, several recommendations on how to measure and report postoperative pain outcomes in future trials are proposed.

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What Is The Surgery Like

The surgery is done using arthroscopic techniques. Instead of a large incision I use 3-5 small incisions. Through 1 incision I insert the arthroscope that lets me look inside your shoulder. The other incisions are used to insert special instruments that allow the removal of scar tissue and bone. I then insert small suture anchors into the shoulder. There are sutures attached to the eyelets of the anchors. We use special instruments to weave the sutures through the torn labrum. The anchors are inside the bone and you cannot feel them. They do not have to be removed. The anchors will not set off airport sensors. It is also safe to have a MRI. When you arrive at Texas Orthopedic Hospital a nurse will have you sign the Operative Permit. The name of the operation I will be doing is Shoulder arthroscopy, labral repair. If you need additional procedures for your shoulder, these will be added to the permit.

Shoulder Pain After Surgery

Arthroscopic Rotator Cuff Repair

At Barkman & Smith Physical Therapy in Bedford, Irving, and Alliance Forth Worth, TX, we see many patients with shoulder pain. With some rest and physical therapy, patients often recover and go back to their normal daily activities. Sometimes, we help patients prepare for shoulder surgery and then assist in the healing process afterward. If you have recently had an operation, you may experience shoulder pain after surgery.

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Plan And Prepare Meals

Its great if you live with someone who can do the cooking, but most of our patients find it helps to plan meals ahead of time. If its feasible, cook extra meals in the weeks before your surgery and freeze them. Otherwise, dont hesitate to purchase frozen, packaged foods.

Think in terms of foods you can easily pop into the microwave or oven without a lot of preparation. You may not be able to open cans or jars, or clean and cut fresh foods, with one hand.

Are Any Other Options Available

While I believe that surgery is the best course of action, there are other available treatments including no treatment, just living with the condition physical therapy exercises medication or injections. Any of these treatment options may be successful in your situation, and some of these you may have already tried. In my experience they will not work reliably. Of course, we can arrange for any or all of these options if you desire.

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Why All The Questions About Your Health

Although the operation involves your shoulder, your entire body will react to the anesthesia and surgery. Your general medical condition is obviously important. Before surgery you must see the anesthesiologist. They will go over your medical condition and request any tests or consultations with other physicians if necessary.

Sleeping After Shoulder Surgery

Arthroscopic shoulder surgery post 2 weeks and pain symptoms leading to surgery

It can be a challenge trying to find a comfortable sleep position after shoulder surgery. Here are some rotator cuff surgery recovery sleeping tips your doctor will likely have you follow:

  • Sleep on the opposite side, since initially, you wont be able to put pressure or weight directly on the affected shoulder. You can also use pillows for propping yourself up into a more upright position.
  • Lie flat to sleep, as your pain and discomfort begin to decline.
  • Add some pillows behind your back to help keep you from rolling back on the affected shoulder. You can also use wedge-shaped pillows, or you can stuff something underneath your mattress to make it tilt slightly, which will make it harder for you to turn over.
  • Switch sides with your partner to help keep you sleeping on your unaffected shoulder, depending on your sleeping habits and the side you usually sleep on.
  • If you live alone, try putting your bed up against a wall to keep you from turning toward the wall side.
  • Elevate your shoulder by placing pillows under it. Doing this will help with swelling and keep you from turning onto your shoulder.
  • Keep your affected arm in a sling to help keep your shoulder protected and prevent unnecessary movement.
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    Data Sources And Searches

    The databases PubMed and CINAHL were used to identify studies on shoulder surgery and postoperative pain. Subject-specific terms relating to any type of shoulder surgery were identified in the MeSH tree, PubMed, and in Headings, CINAHL. Any subject-specific terms unavailable in the indexed headings were searched as free text in title and abstract, such as subacromial decompression. All relevant MeSH terms/headings not exclusive to surgery or pathology of the shoulder, such as arthroscopy or bursitis, were combined with a shoulder-related MeSH term/heading. For MeSH terms introduced in 2012 or later, the previous MeSH term indexing was added to the search. To include articles with incomplete indexing processes in PubMed, a free text search in title and abstract was conducted for the last 2 years, using the subject-specific terms.

    How Do Shoulder Injuries Happen

    Four muscles form into tendons around each of your shoulder joints. These four muscles make up what is called the rotator cuff. A shoulder injury that requires surgery is often, but not always, a tear in one of these tendons. Some tears completely detach the tendon . Incomplete or partial tears leave part of the tendon intact.

    If you have a rotator cuff injury, it is probably from long-term repetitive motion. For example, baseball pitchers commonly suffer from shoulder injuries. Overusing your shoulder is the most common cause, but a sudden injury can tear a tendon, too. The chances of hurting your shoulder also increase as you get older anytime after you turn 40.

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    Managing Your Shoulder Surgery Sling

    Most patients will be sent home from key-hole surgery with a temporary shoulder sling . This sling is meant to support the arm overnight as it is usually floppy from the regional nerve block. The next morning when the arm comes back to life, if instructed by us, the collar and cuff should be removed and thrown away, and exercises and use of the shoulder, elbow, wrist, and hand should start straight away.

    If you have had some types of key-hole surgery such as arthroscopic rotator cuff repair, or arthroscopic shoulder stabilisation, or open surgery such a fracture fixation, you may be sent home from surgery with a more long-term shoulder surgery sling called a polysling. After the operation we will tell you how long the sling is to be worn for. If you need to purchase an adjustable polysling you can buy one online here.

    Polyslings can be confusing to adjust so please watch this video on how to adjust your shoulder sling:

    Comparison With Other Studies

    Left Shoulder Injuries with Arthroscopic Repair

    The number of many arthroscopic shoulder procedures are increasing, with patients opting for these types of operation despite limited evidence of effectiveness in some cases, and a lack of reliable data on serious adverse events and reoperation rates. Our findings are therefore overdue and important and will better inform patients, clinicians, and healthcare providers.

    The 90 day risks associated with the most commonly performed arthroscopic knee procedure were recently published using the same methods as this study. Recent trials on subacromial decompression shoulder surgery have led to new rapid recommendations and a reduction in the use of this procedure, but as the numbers of complications from arthroscopic interventions in trials tend to be small, obtaining reliable rates of adverse events for subacromial decompression and other arthroscopic shoulder procedures has been difficult. This means that attempts to provide estimates for serious adverse events after shoulder arthroscopy have been through systematic reviews. Trial data enabling an assessment of harms for rotator cuff repair have been insufficient, and two observational studies provided an estimate of serious adverse events after subacromial decompression surgery. Unlike with our study, none of these studies provided complications by procedure type. No additional studies were identified in our updated search following the published search strategies for the previous meta-analyses of harms.

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    How Much Does Rotator Cuff Surgery Cost

    The price of rotator cuff surgery will depend on several factors. Estimates range from $6,628 to $11,180, but talking to your insurance carrier is the best way to get an accurate estimate for you. The price of the surgery will hinge on variables such as your insurance coverage, your annual deductible, your coinsurance and your out-of-pocket maximum. The cost of the surgery will include the surgeon, anesthesia, imaging, lab tests and the hospital. You could receive separate bills for each of these services. When talking to your insurance company, it can be helpful to reference specific codes related to shoulder arthroscopy. Commonly used codes for arthroscopic rotator cuff repair include:

    • 29821: Shoulder arthroscopy

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