Should You Undergo Surgery Again After Plate Removal for Pain Relief?

Is the pain after the removal of the metal plate from the car accident an indication of the need for another surgery?

On June 22, 2021, a car accident occurred in Daya, Taichung, and I was taken to a nearby hospital for treatment.
On June 23, a steel plate was implanted.
At that time, X-rays of my right shoulder and a CT scan of my head were performed (no MRI was done on the right shoulder).
After starting rehabilitation, the steel plate was removed in October 2022, about four months later, but I began to experience pain in my hand.
In December, an MRI revealed a partial tear of the triangular fibrocartilage in my left hand, a complete tear of the triangular fibrocartilage in my right hand, and a rupture of the scaphoid ligament.
I changed hospitals and underwent surgery, taking nearly a month off in between.
In January 2022, I started rehabilitation, but during this time, I began to experience pain in my shoulder and a feeling of instability, even when not moving.
An ultrasound showed signs of inflammation in the shoulder ligaments.
The rehabilitation doctor kept saying that my function was normal and that I could use it normally, but regarding my pain and shoulder instability, he only suggested strengthening through rehabilitation.
After changing hospitals, the new doctor indicated that my clavicle had grown at an angle and that there were bone spurs.
To address the root cause, he suggested that I would need to re-implant a steel plate to restore the original angle and suspected a tear in my rotator cuff, recommending an MRI for further evaluation.
I am confused about whether I should undergo surgery again.

Mr. Zhang, 20~29 year old female. Ask Date: 2022/02/16

Dr. Chen Yongxue reply Orthopedics

Hello, thank you for your hard work.
The healthcare professionals are doing their best to treat you.
However, the many complications regarding your right shoulder may indicate a rotator cuff tear, which is very important as it affects the functionality after future shoulder surgery.
Please complete the necessary examinations first.
Thank you.

Reply Date: 2022/02/16

More Info

Deciding whether to undergo surgery again after the removal of a plate for pain relief is a complex decision that requires careful consideration of multiple factors. Based on your description, it seems you have been experiencing persistent pain and instability in your shoulder after the initial surgery and subsequent plate removal. Here are some points to consider:
1. Understanding the Pain: The pain you are experiencing could be due to several factors. After the removal of the plate, it is not uncommon for patients to experience discomfort as the body adjusts. However, the presence of a broken triangular fibrocartilage complex (TFCC) and a ruptured ligament can significantly contribute to pain and instability. These injuries can lead to chronic pain if not addressed properly.

2. Assessment of Current Condition: It is crucial to have a thorough assessment of your current shoulder condition. An MRI can provide detailed images of soft tissues, including ligaments and cartilage, which may help in diagnosing any underlying issues that could be causing your pain. If your rotator cuff is indeed torn, this could explain the instability and pain you are experiencing.

3. Consultation with Specialists: Since you have already seen multiple doctors, it may be beneficial to seek a second opinion from an orthopedic surgeon who specializes in shoulder injuries. They can evaluate your imaging studies and physical examination findings to determine the best course of action. It is important to ensure that the surgeon you consult has experience with complex shoulder surgeries.

4. Surgical Options: If the assessment reveals significant structural issues, such as a misaligned clavicle or a torn rotator cuff, surgery may be warranted. The proposed surgery to reinsert a plate to correct the alignment of the clavicle could potentially alleviate pain and restore function. However, it is essential to weigh the risks and benefits of surgery, including the potential for complications and the recovery process.

5. Rehabilitation: Regardless of whether you choose to undergo surgery, rehabilitation will play a critical role in your recovery. A tailored physical therapy program can help strengthen the shoulder muscles, improve stability, and reduce pain. It is important to work closely with a physical therapist who understands your specific condition and can guide you through appropriate exercises.

6. Long-term Considerations: Consider the long-term implications of both surgical and non-surgical options. If surgery is performed, you may need a significant amount of time for recovery and rehabilitation. On the other hand, if you opt for conservative management, you may need to adjust your expectations regarding pain and function.

7. Personal Factors: Your personal circumstances, including your pain tolerance, lifestyle, and ability to engage in rehabilitation, should also influence your decision. If your pain significantly impacts your quality of life and daily activities, surgery may be a more favorable option.

In conclusion, the decision to undergo surgery again should be made after thorough discussions with your healthcare providers, considering all diagnostic findings and treatment options. It is essential to prioritize your overall well-being and quality of life in this decision-making process.

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