Recovery After Removal of Proximal Humerus Screws: What to Expect

Removal of proximal humeral intramedullary nails?

Hello Doctor, due to a proximal humeral fracture, I had seven steel pins inserted for fixation.
After the bone healed, I can only raise my arm to about 150 degrees.
Later, during a check-up at the rehabilitation department, it was discovered that I have a tendon tear.
Since the pins loosened during the healing period, I plan to have them removed.
I would like to ask:
1.
After the removal of the pins, how long will it take to regain the ability to raise my arm to 150 degrees as before? Will I need further rehabilitation?
2.
After the surgery, will I be able to raise my arm to use a hairdryer or twist a towel?
3.
How long will the surgery take? Will the incision be painful?
4.
For the pin removal surgery, is it common for a resident physician to perform the procedure rather than the attending physician from the outpatient clinic?
5.
Will the removal of the pins cause any additional damage to the tendon?
Thank you.

Maruko, 40~49 year old female. Ask Date: 2022/01/08

Dr. Chen Yongxue reply Orthopedics

Hello, if the steel nail has loosened after a fracture, it usually indicates that the fracture has not healed properly.
Please be cautious regarding the information provided in the letter; if you are unable to lift your shoulder, it may be due to tendon rupture or joint stiffness.
Both of these conditions cannot be resolved simply by "removing the nail." Therefore, your concerns may be misguided.
Please consult an orthopedic outpatient clinic.
Thank you.
1.
After the removal of the steel nail, how long will it take to regain the ability to lift the arm to 150 degrees as before? Will rehabilitation be necessary?
2.
After the surgery, can I lift my arm to use a hairdryer or twist a towel?
3.
How long does the surgery typically take? Will the wound be very painful?
4.
For the steel nail removal surgery, is it generally performed by a resident physician rather than the attending physician from the outpatient clinic?
5.
Will the steel nail removal surgery potentially damage the tendon again?

Reply Date: 2022/01/08

More Info

Recovering after the removal of proximal humerus screws can be a significant concern, especially following a previous fracture and the complications that may arise from it. Here’s a comprehensive overview of what to expect during your recovery process, addressing your specific questions.

1. Recovery Timeline: After the removal of the screws, the recovery time can vary significantly depending on several factors, including the extent of the initial injury, the condition of the surrounding tissues, and your overall health. Generally, it may take several weeks to a few months to regain full range of motion and strength in your shoulder. If you were able to lift your arm to 150 degrees before the surgery, it is reasonable to expect that with proper rehabilitation, you can regain that range of motion. However, this will likely require a structured physical therapy program to address any stiffness or weakness that may have developed during your recovery from the fracture and the presence of the screws.

2. Post-Operative Activities: After the surgery, you may be advised to avoid certain activities for a period of time to allow for proper healing. Using a hairdryer or twisting a towel may be permissible, but it’s essential to listen to your body and avoid any movements that cause pain or discomfort. Your surgeon or physical therapist will provide specific guidelines on what activities are safe and when you can resume them.

3. Surgical Duration and Pain: The surgery to remove screws is typically a relatively quick procedure, often lasting about 30 minutes to an hour, depending on the complexity of the case. Post-operative pain can vary; however, many patients report that the pain is manageable and less intense than the pain experienced during the initial injury. Your healthcare provider will likely prescribe pain management strategies to help you through the recovery process.

4. Surgeon’s Role: In most cases, the surgery to remove screws is performed by the orthopedic surgeon who is familiar with your case. This could be your primary orthopedic surgeon or a colleague, depending on the specific arrangements at the medical facility. It’s always a good idea to clarify this with your healthcare provider before the procedure.

5. Risk to Tendons: There is always a risk of damaging surrounding tissues, including tendons, during any surgical procedure. However, experienced surgeons take great care to minimize this risk. If you have a history of tendon injury, such as a previous tear, your surgeon will likely take extra precautions. Discuss your concerns with your surgeon prior to the operation to understand the specific risks involved in your case.

In addition to these considerations, it’s crucial to follow your surgeon’s post-operative instructions closely. Engaging in physical therapy as recommended will be vital for your recovery. Physical therapists can help you regain strength and flexibility in your shoulder, which is essential for returning to your pre-injury activities.

Finally, maintaining a positive outlook and being patient with your recovery process is essential. Healing takes time, and while it may be frustrating, each step you take in rehabilitation will contribute to your overall recovery. If you have any concerns or experience unusual symptoms during your recovery, don’t hesitate to reach out to your healthcare provider for guidance.

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