Post-Surgery Complications After Clavicle Fracture: What to Expect

Post-operative issues following clavicle fracture surgery?

Hello Dr.
Lee,
On July 9, I fell off my bike and fractured my left clavicle.
Although it was a comminuted fracture, the doctor recommended conservative treatment with a figure-eight strap for stabilization.
Aside from some inconvenience in movement, I experienced no discomfort or pain.
However, two months later, an X-ray showed no signs of healing.
Therefore, on September 15, I opted for surgery to implant a steel pin for fixation and to supplement with artificial bone.

The day after the surgery, I noticed that my left thumb was numb, and at times, the muscles in my left arm would twitch involuntarily, accompanied by severe pain similar to cramping.
However, when I lie down, aside from the thumb numbness, the pain in my arm gradually subsides.
This situation has been consistently occurring.
Additionally, the skin around my left shoulder has completely lost sensation over an area about the size of a fist.

Could you please explain what these symptoms might indicate? Did the surgery damage a nerve? What should I do? I didn't have these issues before the surgery, and I deeply regret having the operation.
I sincerely request your response.
Thank you!

Xiao Lin, 20~29 year old female. Ask Date: 2005/09/23

Dr. Li Wenlin reply Orthopedics

Hello,
In response to your question, it is reasonable to still feel some discomfort one week after surgery on September 15th.
This is because the procedure involves incising the skin, separating the fascia and muscles, and carefully detaching the scar tissue around the fracture site.
Although the incision may be small, there is a lot of work done beneath the surface.
Therefore, the surgery essentially involves reopening and rearranging the tissues, which understandably can lead to some swelling, bruising, and pain.
As the saying goes, "you've already gone through with it," so there is no point in regretting the surgery now.
Since surgery involves incisions, it is common to experience some damage to the superficial sensory nerves.
The complete lack of sensation in the skin near your left shoulder may be a result of this, but without a physical examination, it is difficult to confirm whether this is indeed the case or if there are other reasons involved.
The tingling sensation in your thumb is somewhat unusual and can be attributed to two common causes.
First, during general anesthesia, blood oxygen levels are monitored, often using a sensor placed on the thumb or other fingers, commonly referred to as a "pulse oximeter." If the sensor is too tight, it can cause temporary numbness, which is quite common.
The second cause requires a more detailed evaluation, as the dorsal side of the thumb is innervated by the radial nerve, while the palmar side is innervated by the median nerve.
In the case of a clavicle fracture surgery, unless it affects the brachial plexus (the upper roots of the radial and median nerves), thumb numbness should not occur.
Similarly, involuntary muscle twitching and cramping in the arm are also relatively uncommon after clavicle fracture surgery; these symptoms may be due to swelling from the surgery irritating the brachial plexus.
I recommend discussing these concerns with your attending physician during your follow-up appointment.
As for what you can do now, there are two main actions:
1.
Attend your scheduled follow-up appointments or come in earlier if you are feeling particularly anxious.
2.
Engage in both active and passive movements of the affected limb.
After clavicle fracture surgery, you can still move your fingers, wrists, and elbows.
It is important to make a fist, rotate your wrist, and flex and extend your elbow to help reduce swelling and promote blood circulation.
Wishing you a speedy recovery!

Reply Date: 2005/09/23

More Info

After a clavicle fracture, particularly a complex one that requires surgical intervention, patients can experience a range of complications and symptoms that may arise during the recovery process. In your case, it appears that you are experiencing several concerning symptoms following your surgery, including numbness in your thumb, involuntary muscle contractions, and a loss of sensation in a significant area of your shoulder.
These symptoms could potentially indicate nerve involvement, particularly if they began after your surgical procedure. The brachial plexus, a network of nerves that innervates the arm, can be affected during surgery on the shoulder or clavicle due to direct trauma, stretching, or compression. The fact that you are experiencing numbness and pain in your thumb and muscle spasms could suggest that the surgical procedure may have inadvertently impacted the nerves in that area.

Here are some possible explanations for your symptoms:
1. Nerve Injury: During surgery, there is a risk of damaging nearby nerves. The suprascapular nerve or the axillary nerve, which are responsible for sensation and motor function in the shoulder and arm, could have been affected. This could explain the numbness and muscle spasms you are experiencing.

2. Postoperative Swelling: After surgery, swelling can occur, which may compress nerves and lead to temporary symptoms like numbness or tingling. This is often a transient condition that improves as the swelling decreases.

3. Scar Tissue Formation: As you heal, scar tissue can form around the surgical site. If this scar tissue compresses nerves, it can lead to symptoms similar to what you are experiencing.

4. Referred Pain: Sometimes, pain in one area can be referred from another area due to nerve pathways. The pain you feel in your arm could be related to the healing process of your clavicle or surrounding structures.

Given that these symptoms were not present before your surgery, it is crucial to address them with your healthcare provider. Here are some steps you can take:
- Follow-Up Appointment: Schedule a follow-up appointment with your orthopedic surgeon or a neurologist. They can perform a thorough examination and may recommend imaging studies, such as an MRI or nerve conduction studies, to assess for any nerve damage or compression.

- Physical Therapy: Engaging in physical therapy may help improve your range of motion and strength while also addressing any nerve-related symptoms. A physical therapist can provide targeted exercises and modalities to help alleviate pain and improve function.

- Pain Management: Discuss pain management options with your doctor. They may recommend medications or therapies to help manage your symptoms effectively.

- Monitor Symptoms: Keep track of your symptoms, noting any changes or improvements. This information can be valuable for your healthcare provider in determining the best course of action.

In summary, while it is understandable to feel regret after experiencing complications following surgery, it is essential to focus on addressing your current symptoms. Early intervention can often lead to better outcomes, so do not hesitate to reach out to your healthcare provider for guidance and support. Your recovery journey may require patience and persistence, but with the right care, you can work towards regaining full function and alleviating your symptoms.

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