Rib Implant Issues: Pain and Mobility After Surgery

Rib cage support issues?

Hello, doctor.
I underwent titanium alloy rib stent surgery on my left chest on July 1st last year.
After the surgery, I experienced severe foreign body sensation in my left chest and tenderness in my left upper back.
In mid-February this year, I suddenly could not lift my arm high or bend backward.
I was diagnosed with frozen shoulder in the rehabilitation department.
After rehabilitation, I can lift my arm high, but I still experience pain when moving it backward.

Could this frozen shoulder be a result of the rib surgery? Is it normal for my chest to still hurt? When I lift my arm high and reach forward, I feel a grinding sensation at the surgical site and hear a clicking sound.
How should I address this? Currently, there is tightness from my chest to my arm, and rehabilitation has not been effective.
Pressing on my shoulder and upper back still causes pain.
Would manual therapy be appropriate? If X-rays show no abnormalities, does that mean the stent really does not need to be removed? I feel that the stent is causing the pain.
Thank you for your response, doctor.

Mi Mi, 40~49 year old female. Ask Date: 2022/07/21

Dr. Shen Boquan reply Orthopedics

Hello, the condition known as "frozen shoulder," or adhesive capsulitis, involves the adhesion of the internal tissues of the shoulder joint.
In about half of the patients, the exact cause remains unclear.
However, it typically arises from pain and reduced movement, and it will gradually resolve on its own, although this may take a significant amount of time, potentially up to two years.
Taking pain relievers and undergoing rehabilitation can help speed up recovery.
Regarding your rib fracture, if you have undergone reduction and plate fixation, and the fracture has healed but you still feel discomfort or a foreign body sensation, please consult your physician to evaluate whether the plate should be removed.
Wishing you good health, Shen Baiquan.

Reply Date: 2022/07/21

More Info

After undergoing rib implant surgery, it is not uncommon to experience a variety of symptoms, including pain, discomfort, and limited mobility. Your situation, particularly with the titanium rib implant, raises several important considerations regarding post-operative recovery and potential complications.

1. Understanding Pain and Discomfort: The sensation of a foreign body in the chest, along with localized pain in the back and shoulder, can be attributed to several factors. The surgical procedure itself can lead to inflammation and irritation of surrounding tissues, which may manifest as pain or discomfort. Additionally, the presence of the titanium implant can create a sensation of tightness or pressure, especially if the surrounding muscles and tissues are not healing properly.

2. Frozen Shoulder (Adhesive Capsulitis): The diagnosis of "frozen shoulder" or adhesive capsulitis, which you mentioned, is characterized by stiffness and pain in the shoulder joint. This condition can develop after surgery due to immobilization, inflammation, or trauma to the shoulder area. It is possible that the rib surgery may have contributed to the development of this condition, particularly if there was significant trauma to the shoulder during the procedure or if post-operative rehabilitation was inadequate.

3. Mobility Issues: The inability to raise your arm or perform certain movements can be frustrating. The "catching" sensation and noise you describe when moving your arm may indicate that the shoulder joint is not functioning optimally. This could be due to scar tissue formation, muscle tightness, or even issues related to the implant itself. It is essential to differentiate between shoulder-related issues and those directly related to the rib implant.

4. Management Strategies: Given that rehabilitation has not yielded the desired results, it may be beneficial to explore alternative therapies. Physical therapy focused on shoulder mobility and strength can be crucial. Techniques such as manual therapy, stretching, and strengthening exercises may help alleviate tightness and improve range of motion. If traditional physical therapy is not effective, consulting with a specialist in shoulder rehabilitation or considering modalities like acupuncture or chiropractic care might provide relief.

5. Imaging and Evaluation: If X-rays show no abnormalities, it suggests that the implant is in place and functioning as intended. However, if pain persists, further imaging studies such as MRI or CT scans may be warranted to assess soft tissue structures around the shoulder and rib area. This can help identify any underlying issues that may not be visible on X-ray.

6. When to Consider Implant Removal: The decision to remove the rib implant should be based on a thorough evaluation of your symptoms and their impact on your quality of life. If the implant is determined to be the source of significant pain and dysfunction, and conservative measures fail to provide relief, discussing the possibility of removal with your surgeon may be appropriate.

7. Communication with Your Healthcare Provider: It is crucial to maintain open communication with your healthcare team. Discuss your symptoms in detail, including the timeline of their onset and any changes in intensity. This information can help your physician tailor a treatment plan that addresses your specific needs.

In conclusion, while it is not uncommon to experience pain and mobility issues after rib implant surgery, it is essential to investigate the underlying causes thoroughly. A multidisciplinary approach involving physical therapy, potential imaging studies, and ongoing communication with your healthcare provider will be key to improving your symptoms and restoring function.

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