Post-Surgery Shoulder Issues: Pain and Stiffness

Issues After Right Shoulder Surgery

Hello, Doctor.
I fell in December last year and my clavicle was displaced.
I had surgery in May this year to insert a plate, and in October, I had a second surgery to remove the plate.
After the first surgery in May, I experienced the following issues, but I thought it was due to the plate until the plate was removed and the problems persisted.
Even after the stitches were taken out, I noticed something was wrong.
My right shoulder has been very stiff, almost like a shoulder brace is on it (the red area in the image).
At point A, I feel something is locked, and I often experience sharp pain or tingling whenever I move my right shoulder slightly.
I can feel that my right shoulder does not have the same normal sensation as my left shoulder.
The muscles in my right back and the area in front of my right chest (point B in the image) occasionally twitch (which did not happen before the surgery).
Could it be that during the surgery, the muscles, tendons, or bones were improperly connected or injured? X-rays seem to show no issues.
Would a CT scan or something else be necessary to identify the problem? If I need to make an appointment, which department should I consult? Thank you, Doctor.

Xuebu Laogong, 40~49 year old female. Ask Date: 2023/11/03

Dr. You Dianqi reply Orthopedics

Please return for an evaluation by your attending/surgeon.
Thank you.

Reply Date: 2023/11/03

More Info

Post-surgery shoulder issues, particularly after procedures involving the clavicle or shoulder joint, can be complex and multifaceted. Based on your description, it seems you are experiencing persistent stiffness, pain, and abnormal sensations in your right shoulder following two surgeries—one for plate insertion and another for plate removal. Let's break down your concerns and provide some insights into what might be happening and what steps you can take.

Understanding Your Symptoms
1. Stiffness and Pain: After shoulder surgery, it is common to experience stiffness and pain due to several factors, including inflammation, scar tissue formation, and muscle weakness. The sensation of your shoulder feeling "locked" or "hard" could be indicative of adhesive capsulitis (frozen shoulder), which is characterized by stiffness and pain in the shoulder joint. This condition can develop after surgery or injury, particularly if the shoulder has not been moved through its full range of motion during recovery.

2. Abnormal Sensations: The "jumping" or twitching sensations you describe in the right back and chest areas could be related to nerve irritation or muscle spasms. Surgery can sometimes affect the surrounding nerves, leading to sensations that were not present before the procedure. If the muscles or tendons were manipulated or if there was swelling, this could also contribute to abnormal sensations.

3. Imaging and Diagnosis: While X-rays are useful for identifying fractures or hardware placement, they may not provide detailed information about soft tissue injuries, nerve entrapments, or subtle changes in the joint. A CT scan or MRI may be more appropriate for assessing soft tissue structures, including muscles, tendons, and nerves. These imaging modalities can help identify issues such as rotator cuff tears, nerve impingement, or significant scar tissue formation.

Next Steps
1. Consult a Specialist: Given your ongoing symptoms, it would be advisable to consult with an orthopedic surgeon who specializes in shoulder injuries or a sports medicine physician. They can perform a thorough physical examination and review your surgical history to determine the best course of action.

2. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can help you regain range of motion, strengthen the shoulder muscles, and address any specific movement patterns that may be contributing to your symptoms. They can also provide modalities to manage pain and inflammation.

3. Pain Management: If pain persists, discussing pain management options with your healthcare provider is essential. This may include medications, injections, or alternative therapies such as acupuncture or massage therapy.

4. Monitoring Recovery: It’s crucial to monitor your recovery closely. If symptoms worsen or new symptoms develop, such as significant swelling, fever, or increased pain, seek medical attention promptly.

5. Surgical Consideration: If conservative management does not yield improvement, your physician may discuss the possibility of further surgical intervention to address any underlying issues, such as removing scar tissue or repairing damaged structures.

Conclusion
In summary, your symptoms following shoulder surgery warrant a comprehensive evaluation to determine the underlying causes. Persistent stiffness and pain can often be managed effectively with the right combination of physical therapy, pain management, and possibly further imaging studies. It’s important to communicate openly with your healthcare providers about your symptoms and concerns to ensure you receive the appropriate care. Your recovery is paramount, and with the right approach, you can work towards regaining full function and alleviating discomfort in your shoulder.

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