Shoulder bursitis involves the inflammation of a bursa, a small, fluid-filled sac that cushions the tendons and bones within the shoulder joint. When chronic inflammation persists despite conservative treatments like rest, medication, and physical therapy, a surgical procedure becomes an option to resolve the persistent pain. Modern protocols are designed to manage discomfort throughout the entire process, and this overview provides realistic expectations regarding the pain experience from the operating room through rehabilitation.
What Shoulder Bursitis Surgery Entails
The surgical treatment for chronic shoulder bursitis is typically a bursectomy, often performed alongside a subacromial decompression. This procedure is typically done arthroscopically, meaning the surgeon uses a tiny camera and specialized instruments inserted through a few small “keyhole” incisions to remove the irritated and inflamed subacromial bursa.
During the procedure, the surgeon may also remove a small amount of bone from the underside of the acromion, known as a subacromial decompression, to create more space for the tendons. This minimally invasive technique is preferred because it results in less trauma to surrounding muscle and tissue compared to older open surgical methods. Reduced tissue disruption translates into a quicker initial recovery and a lower overall level of post-operative pain.
Eliminating Pain During the Operation
Pain during the surgery itself is eliminated through a combination of general and regional anesthesia techniques. Most patients receive general anesthesia to ensure they are asleep throughout the procedure. This is supplemented with a regional nerve block, most commonly an interscalene block or a brachial plexus block.
The nerve block involves injecting a local anesthetic near the bundle of nerves in the neck that supply sensation to the entire arm and shoulder, blocking pain signals from the surgical site. The immediate benefit of this block is that patients wake up from general anesthesia with virtually no pain in the shoulder.
The numbing effect of the regional block is designed to last for several hours after the surgery is complete, often providing significant pain relief for the first 12 to 24 hours. This delayed onset of sensation is a deliberate strategy to prevent the immediate, intense pain spike that would otherwise follow the operation. This extended window allows patients to proactively begin taking oral pain medication before the numbness completely wears off.
Managing Acute Post-Surgical Discomfort
Once the effects of the nerve block fade, typically within the first day, patients transition into the acute post-surgical phase. It is realistic to expect pain during the first week following surgery. The pain management strategy during this phase is multimodal, combining different types of medication.
A structured regimen will include prescription pain medication, such as short-term opioids, which are reserved for breakthrough pain or the first few days of highest intensity. These are combined with scheduled doses of non-opioid options like non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. Taking these medications on a fixed schedule, rather than waiting for the pain to become severe, helps maintain a steady level of comfort.
Non-pharmacological methods are used for acute pain management. Cryotherapy, or continuous icing, reduces local swelling and inflammation at the surgical site, which helps to dampen pain signals. Patients are instructed on the correct use of a sling, which provides immobilization for the first few days to protect the repair and minimize movement that could trigger pain. Proper positioning, especially while sleeping, is also advised to prevent pressure on the operated shoulder.
The Role of Physical Therapy in Reducing Recovery Pain
Following the acute phase, the nature of discomfort shifts as physical therapy becomes the primary focus, typically beginning within the first week or two. The pain experienced during rehabilitation is distinct from the sharp, immediate pain of the surgical wound. This discomfort is primarily characterized by stiffness and a dull ache from movement.
The shoulder joint can quickly develop stiffness, known as “frozen shoulder,” if it is not moved, and this stiffness itself can become a source of chronic pain. Physical therapy involves gentle, controlled exercises to restore range of motion, which may feel uncomfortable or cause a temporary increase in soreness. This movement-related discomfort is a necessary part of preventing long-term functional loss.
Therapists employ techniques like manual therapy, gentle stretching, and passive range-of-motion exercises to gradually increase mobility. They also use modalities such as heat, ice, or electrical stimulation to help mitigate the soreness that follows an exercise session. Consistency in the rehabilitation program is what ultimately prevents the formation of restrictive scar tissue and leads to a successful, less painful recovery.