Pain After Shoulder Surgery
Shoulder surgery as a cause of shoulder pain
- Doctors are saying that in surgery that failed to fix shoulder instability – it is not recommended to go to a second surgery to fix the first one because 36% of those surgeries fail too.1
- In another study, doctors say that one of the greatest risk factors for infection after shoulder replacement were history of a prior failed shoulder surgery. So replacing the shoulder in an attempt to fix the first shoulder surgery had high risk of infection.2
- Another study examined outcomes and complications in young patients undergoing revision reverse total shoulder arthroplasty (RTSA) for failed prior total shoulder arthroplasty or ball replacement and compared them with those of older patients undergoing the same procedure. While reverse total shoulder arthroplasty is effective in reducing pain and improving function after failed arthroplasty in young patients, complication rates are high and expectations should be managed appropriately. Subjective outcome scores are worse for older patients.3
What if this fails?
Doctors at the University of Washington sum up shoulder failure surgery as: “…surgery has failed when it does not achieve the expectations of the patient and the surgeon. Failure can result from stiffness, weakness, instability, pain or failure to heal as well as from complications such as infection or nerve injury
Every surgery has a risk of failure whether it is an operation for dislocation, rotator cuff tear, arthritis or fracture. Because fracture fixation, Bankart repairs, rotator cuff repairs, shoulder joint replacements and reverse total shoulders are performed commonly, a substantial number of patients have experienced these failures.”
We frequently see patients who have had surgery for shoulder pain, but are subsequently left with chronic pain after surgery. When you see what actually occurs during most surgeries, a legitimate question is, “how can they not still have pain?”
For instance, a surgery is called for after a traumatic injury in a motor vehicle accident where tendons, ligaments and/or bone are completely torn and broken. But most joint surgeries are performed for degenerative conditions that make the connective tissues such as tendons, ligaments and cartilage, weak and painful. We think, being regenerative injection specialists, that Prolotherapy is a better first choice to try to regenerate these damaged tissues. If it is viable to use simple techniques to speed the body’s own natural repair mechanisms why not do so instead of submitting oneself to surgical joint replacement, or what the orthopedists call “repair”? Prolotherapy is an injection treatment for lax, weak and injured connective tissues that gives the body the resources it needs to repair itself on its own.
Pain after shoulder surgery
Here is a case history of a patient who came to Caring Medical. The patient had extensive shoulder surgery. Seemingly, the surgeon tried to “fix” everything he thought was damaged enough to cause pain. The surgery went as planned, no complications, and the surgeon accomplished everything he set out to do. Two years following the surgery the patient came to our office, still in pain. How could this be? Let’s look exactly what was done.
The patient had an an arthroscopic procedur for:
- partial thickness rotator cuff tear, Type I (least severe),
- a labral tear,
- grade III to IV (nearly most or most severe) chondromalacia of glenohumeral joint and
- subacromial bursitis.
The labrum is a lip of cartilage that helps keep the end of the humerus in the shallow socket (glenoid). Chondromalacia is the degeneration of the cartilage inside the joint. Bursitis refers to the bursa, one of the fluid-filled sacks that provide cushioning in joints.
In the procedure the surgeon debrided the labral tear and the rotator cuff tear. Then, where the chondromalacia was most severe, he performed a chondroplasty. This consists of scraping the damaged cartilage which covers the surface of the bone in hopes of having healthy cartilage grow back. He scraped both the humeral head and the glenoid. He then performed a bursectomy, removing the inflamed bursa. This is fairly typical what we see in an arthroscopy report of the shoulder.
The patient expressed a desire to return to tennis as a key to surgery outcome,and surgery did not help him with this, and he was left with chronic pain. The patient went on to receive Prolotherapy treatment.
In regenerative injection techniques like Prolotherapy, Platelet Rich Plasma Therapy or Stem Cell Prolotherapy, the goal is always to preserve and regenerate these cushions and connective tissues rather than remove them. (See cartilage repair). It makes our job here at Caring Medical a little more difficult when treating a patient who has had an extensive procedure, but it is still possible to achieve healing after surgery.
1. De Giorgi S, Garofalo R, Tafuri S, Cesari E, Rose GD, Castagna A. Can arthroscopic revision surgery for shoulder instability be a fair option? Muscles Ligaments Tendons J. 2014 Jul 14;4(2):226-31. eCollection 2014.
2. Morris BJ, O’Connor DP, Torres D. Risk factors for periprosthetic infection after reverse shoulder arthroplasty. J Shoulder Elbow Surg. 2014 Aug 26. pii: S1058-2746(14)00281-X. doi: 10.1016/j.jse.2014.05.020. [Epub ahead of print]
3. Black EM, Roberts SM, Siegel E, Yannopoulos P, Higgins LD, Warner JJ. Reverse shoulder arthroplasty as salvage for failed prior arthroplasty in patients 65 years of age or younger. J Shoulder Elbow Surg. 2014 Jul;23(7):1036-42. doi: 10.1016/j.jse.2014.02.019.