Shoulder surgery is a common procedure performed to address various conditions, from repairing rotator cuff tears to stabilizing the joint. While these surgeries aim to restore function and alleviate long-term discomfort, experiencing pain during the recovery period is an expected part of the healing process. Understanding the causes of post-operative shoulder pain, both anticipated and unexpected, can help manage expectations and guide recovery. Recognizing normal discomfort and identifying signs of complications is important for a smooth and effective rehabilitation.
Normal Post-Operative Discomfort
Immediately following shoulder surgery, some level of discomfort is a natural response to the surgical process. The surgical incision, along with the manipulation of muscles, tendons, and ligaments, causes direct tissue trauma. This trauma initiates the body’s healing cascade, which includes inflammation and swelling around the surgical site. These natural physiological responses contribute to the initial pain and stiffness.
Muscles surrounding the shoulder may develop spasms as a protective mechanism in response to the trauma and pain. This involuntary tightening further contributes to discomfort and can restrict movement. Nerves in the operated area might also undergo temporary irritation or stretching during the procedure or as a result of post-surgical swelling. This temporary nerve involvement can lead to transient discomfort in the arm or hand.
Pain is most noticeable in the first 48 hours as anesthesia diminishes. It gradually decreases over weeks and months, becoming more manageable with prescribed pain medication and physical therapy. Intensity varies by surgery and individual thresholds, but pain generally improves with healing.
Potential Complications Leading to Pain
While some pain is expected after shoulder surgery, persistent, worsening, or new pain can signal a complication. Infection at the surgical site is a serious concern, typically presenting with increasing pain, redness, swelling, warmth, fever, chills, or foul-smelling drainage. Though relatively rare (0.3% to 2.9% of shoulder surgeries), infections require prompt medical attention.
Hardware irritation or failure can cause pain if implants like screws, plates, or anchors used during surgery become loose, shift, or irritate tissues. A re-tear of repaired tendons or ligaments is a possibility, often resulting in significant pain and a noticeable loss of function. This complication can occur if too much stress is placed on the healing tissues too soon.
Adhesive capsulitis, or frozen shoulder, involves excessive scar tissue in the joint capsule, causing severe, worsening stiffness and pain. It limits range of motion and can take months to years to resolve. General excessive or poorly formed internal scar tissue can also restrict normal movement and cause pain by binding muscles and nerves.
Nerve damage, distinct from temporary irritation, can cause persistent numbness, tingling, weakness, or neuropathic pain (burning or electric shock). While most nerve issues are transient, some can persist. Referred pain from the neck or spine can become noticeable or exacerbated after shoulder surgery, sometimes mimicking shoulder problems. Improper or aggressive rehabilitation, or pushing the shoulder too soon, can also stress healing tissues, leading to new or worsening pain.
When to Contact Your Surgeon
Contact your surgical team if you experience a fever, chills, or persistent feelings of general unwellness. Increasing redness, swelling, or warmth around the incision site, especially if accompanied by foul-smelling drainage, also warrants immediate medical attention.
Report sudden, severe, or unbearable pain not relieved by prescribed medication, or pain distinctly different from initial discomfort. New or worsening numbness, tingling, or weakness in the arm or hand, or an inability to move the arm or sudden loss of movement, require prompt evaluation.
Other red flags include new popping, clicking, or grinding sounds with pain or instability. Any pain worsening over time instead of gradually improving also warrants contacting your medical team. Prompt communication ensures timely diagnosis and intervention.