Post-Surgery Rib Pain: Seeking Relief and Rehabilitation Options

Postoperative Issues After Rib Surgery

Hello, doctor.
I had surgery to place a stent in my left chest rib, and it has been a year since the operation on June 30 of last year.
After the surgery, I did not undergo any rehabilitation and have not been active with my arm.
However, after receiving the second dose of the BNT vaccine in mid-February this year, I experienced abnormal pain in my arm, making it difficult to lift.
Therefore, I visited a rehabilitation specialist in May, who temporarily treated me for frozen shoulder.

Currently, I have daily chest pain, which is more intense near the surgical site.
I feel a foreign body sensation and tightness, which is noticeable when I breathe.
I informed the rehabilitation physician about this, but they only prescribed pain medication.
The surgery was not minimally invasive, resulting in a long scar, and touching the scar still causes pain.

Doctor, what should I do to alleviate this foreign body sensation and pain? I feel like life is unbearable due to the pain, which has led to insomnia every day.
I would appreciate your guidance on how to proceed.
Thank you, doctor.

Mi Mi, 40~49 year old female. Ask Date: 2022/07/09

Dr. Lin Ruixiang reply Rehabilitation

Hello, your condition is quite complex.
Regarding the localized pain in your wound, the first step is to rule out infection or loosening of the implant.
If infection or loosening of the implant is excluded, this pain, which is disproportionate to the extent of the injury, should first consider "Reflex Sympathetic Dystrophy" (RSD).
This condition often arises from abnormal sympathetic nerve reflexes following an injury.
Non-surgical treatment options include medication and physical therapy; however, due to the location of your injury, electrical stimulation devices cannot be applied.
Therefore, treatment can only be performed manually within a tolerable pain range, focusing on scar manipulation and desensitization therapy.
Surgical options may include nerve block procedures to interrupt the abnormal nerve reflexes.
It is important to note that this condition is more accurately referred to as "Complex Regional Pain Syndrome" (CRPS), and your symptoms resemble Type II, which pertains to the intercostal nerves.
The Hualien Hospital of the Ministry of Health and Welfare is concerned about your health.

Reply Date: 2022/07/09

More Info

Post-surgery rib pain, especially after a significant procedure like rib stabilization, can be quite challenging and distressing. It is not uncommon for patients to experience ongoing discomfort, tightness, and even a sensation of foreign objects in the area of the surgical site. Given your situation, it’s essential to approach this issue comprehensively.

Firstly, it’s important to understand that after rib surgery, especially if it was not minimally invasive, the healing process can take a considerable amount of time. The rib cage is a complex structure, and surgery can lead to scar tissue formation, which may contribute to ongoing pain and discomfort. The pain you are experiencing, particularly near the surgical site, could be due to several factors, including:
1. Scar Tissue Formation: After surgery, scar tissue can develop, which may adhere to surrounding tissues and cause discomfort or a sensation of tightness. This can also lead to restricted movement and pain when breathing deeply.

2. Nerve Sensitivity: Surgical procedures can sometimes irritate or damage nearby nerves, leading to chronic pain or abnormal sensations in the area. This could explain the "foreign body" sensation you are experiencing.

3. Muscle Weakness and Imbalance: If you have not engaged in rehabilitation or physical therapy post-surgery, the muscles around your rib cage may have weakened, leading to discomfort and pain during movement or even at rest.

4. Shoulder Issues: Given that you mentioned receiving treatment for "frozen shoulder" (50肩), it’s possible that the shoulder pain is interconnected with your rib pain. The shoulder and rib cage are closely linked, and issues in one area can affect the other.

Recommendations for Relief and Rehabilitation
1. Consult a Specialist: It would be beneficial to consult with a pain management specialist or a physical therapist who has experience with post-surgical rehabilitation. They can provide a tailored rehabilitation program that addresses both your rib pain and shoulder issues.

2. Physical Therapy: Engaging in a structured physical therapy program can help improve mobility, strengthen the muscles around the rib cage, and reduce pain. A therapist can guide you through exercises that promote healing and flexibility without exacerbating your pain.

3. Pain Management: Since you are currently on pain medication, discuss with your doctor the possibility of adjusting your pain management plan. This might include different medications, nerve blocks, or other interventions that could provide more effective relief.

4. Scar Tissue Treatment: Techniques such as myofascial release or scar tissue mobilization performed by a trained therapist may help reduce the tightness and discomfort associated with scar tissue.

5. Breathing Exercises: Incorporating gentle breathing exercises can help improve lung capacity and reduce tightness in the chest. This can also aid in managing pain during deep breaths.

6. Mind-Body Techniques: Consider exploring mind-body techniques such as mindfulness, meditation, or yoga. These practices can help manage pain perception and improve overall well-being.

7. Follow-Up Imaging: If your pain persists or worsens, it may be necessary to undergo follow-up imaging studies (like an MRI or CT scan) to assess the surgical site and ensure there are no complications such as hardware issues or other underlying problems.

8. Lifestyle Modifications: Pay attention to your daily activities and posture. Avoid movements that exacerbate your pain and consider ergonomic adjustments to your workspace or daily routines.

Conclusion
It’s crucial to address your pain holistically, considering both physical and psychological aspects. Chronic pain can significantly impact your quality of life, and it’s important to advocate for yourself in seeking the appropriate care. By working closely with healthcare professionals, you can develop a comprehensive plan to manage your pain and improve your overall function. Remember, recovery can be a gradual process, and it’s essential to be patient with yourself as you navigate this journey.

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