Post-Surgery Shoulder Recovery: Limitations and Progress

Postoperative shoulder joint care

In December of last year, I was involved in a car accident, and the doctor diagnosed a complete rupture of the supraspinatus muscle in my right arm (with a gap of approximately 2 by 3 centimeters) and a biceps tear.
In January of this year, I underwent arthroscopic surgery for supraspinatus repair and biceps fixation (anchored to the humerus).

Post-surgery symptoms: After being discharged, I noticed muscle atrophy while showering, and the bone structure of my right shoulder joint appears smaller than that of my left shoulder.
When lying in bed, it feels like my right shoulder is positioned further away from the bed surface, and this condition has persisted.
On the first day post-surgery, my fingers became swollen and have not returned to normal; initially, it was just my index and middle fingers, but gradually the other three fingers have also started to swell, and now the swelling has extended to my wrist.
As of May, I can perform low-angle movements and can raise my arm forward and to the side.
Although the range of motion is limited, there has been gradual improvement.
However, I find it strange that I cannot touch my belly button with my palm, meaning my right hand lacks the ability to pull up my pants, cannot rest on my hips, and cannot place the back of my hand on my lower back.
I would like to know why I am unable to perform these low-angle movements.
Is it due to the biceps, or is it related to the greater tubercle of the humerus?

Yuan, 60~69 year old female. Ask Date: 2017/05/29

Dr. Shi Guozheng reply Orthopedics

Muscle weakness should be addressed by continuing rehabilitation to strengthen muscle power.

Reply Date: 2017/05/29

More Info

Post-surgery shoulder recovery can be a complex process, especially after significant injuries such as a torn supraspinatus tendon and biceps tear, as you have described. The surgery you underwent, which involved arthroscopic repair of the supraspinatus and fixation of the biceps tendon, is designed to restore function and alleviate pain. However, the recovery process can be lengthy and may come with various limitations and challenges.

Firstly, it is important to understand that muscle atrophy (shrinkage) can occur after surgery due to disuse. When a muscle is not used for an extended period, it can weaken and lose mass. This is particularly common in the shoulder area after surgery, where immobilization is often necessary to allow the surgical site to heal properly. The sensation of your right shoulder feeling different from your left, such as being "higher" or "further away" from the bed, may be due to muscle imbalances or atrophy, which can affect your posture and the way your shoulder sits in its socket.

The swelling in your fingers and hand can be attributed to several factors, including post-surgical inflammation, fluid retention, or even nerve compression. It is not uncommon for swelling to persist for weeks after surgery, especially if the arm has been immobilized. If the swelling does not improve or worsens, it would be advisable to consult your healthcare provider for further evaluation.

Regarding your ability to perform certain movements, such as bringing your palm to your belly button or placing your hand on your waist, this limitation can be multifactorial. It may involve the following:
1. Muscle Weakness: The biceps muscle plays a significant role in elbow flexion and shoulder stabilization. If the biceps tendon was torn and subsequently repaired, it may take time for the muscle to regain strength and function. Weakness in the biceps can limit your ability to perform movements that require lifting or reaching.

2. Range of Motion: After surgery, the range of motion in the shoulder may be restricted due to pain, swelling, or the healing process itself. The shoulder joint is complex, and full range of motion may take time to return, especially if there has been significant damage to the rotator cuff or surrounding structures.

3. Scar Tissue Formation: Post-surgical healing can lead to the formation of scar tissue, which may restrict movement. This is particularly true in the shoulder, where the rotator cuff and surrounding muscles and tendons can become stiff if not properly rehabilitated.

4. Pain and Discomfort: Pain can also limit your willingness to move your shoulder fully. If certain movements cause discomfort, you may subconsciously avoid them, which can further limit your range of motion.

To address these limitations, it is crucial to engage in a structured rehabilitation program under the guidance of a physical therapist. They can provide you with exercises tailored to your specific needs, focusing on gradually increasing strength, flexibility, and range of motion. This may include:
- Gentle Range of Motion Exercises: These can help to gradually restore movement without putting too much strain on the healing tissues.

- Strengthening Exercises: Once you have regained some range of motion, strengthening exercises for the shoulder and biceps will be essential to restore function.

- Functional Training: As you progress, your therapist can help you with exercises that mimic daily activities, which can help you regain the ability to perform tasks like pulling up your pants or reaching for objects.

In conclusion, while your recovery may feel slow and frustrating, it is important to be patient and consistent with your rehabilitation efforts. Regular follow-ups with your healthcare provider will also help monitor your progress and make necessary adjustments to your treatment plan. If you have concerns about your recovery or specific limitations, do not hesitate to discuss them with your healthcare team. They are there to support you on your journey to recovery.

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