Persistent Shoulder Pain After Clavicle Fracture Surgery: What to Expect?

It has been almost three months since the surgery for a comminuted fracture of the left clavicle, and I am still experiencing significant pain?

Dear Dr.
Shi,
Hello! I underwent surgery on my left clavicle on September 1, where it was stabilized with a plate and screws.
I started rehabilitation at the hospital one month post-surgery, and it has now been two and a half months.
Why is there still significant pain near my shoulder joint that hasn't improved? At my two-month follow-up, an X-ray showed no displacement.
I have been diligent with my rehabilitation, but I experience discomfort whenever I raise my arm above 180 degrees.
My two fractured ribs have long since stopped hurting, so why is my shoulder joint still painful? The incision has healed, but I still experience occasional sharp pains four weeks later.
If this is a normal part of the healing process, I would feel reassured, but could it be due to short fragments of bone pulling or issues with the ligaments causing this pain? I am genuinely worried that this pain will persist indefinitely.
As I am about to return to school for work, I am concerned about how this will affect my job performance.
Could you please advise if the pain indicates a structural issue? For instance, is the plate too heavy or too long, or could there have been damage to the distal joint during surgery or other causes? Will the pain gradually improve? What should I do at this point? Should I consider taking traditional Chinese medicine for bone injuries? Will the recovery period after removing the plate in a year be just as long and painful? I am aware that I won't be able to take work injury leave after a year; what happens if I don't have the plate removed? The thought of general anesthesia makes me a bit anxious, so I sincerely appreciate your guidance on this matter!
Thank you very much!

lilas, 60~69 year old female. Ask Date: 2011/11/18

Dr. Shi Guozheng reply Orthopedics

After a clavicle fracture surgery, it is important to monitor the degree of bone healing.
If the bone has completely healed, there should be no pain, which typically occurs within three to six months.
Regarding shoulder mobility, if the bone screws are not impinging on the muscles or joints, movement is possible, and rehabilitation can be gradually initiated.
There is no need to take traditional Chinese medicine.
Once fully healed, the removal of the bone screws is not too difficult, and recovery is significantly faster than the initial surgery.

Reply Date: 2011/11/18

More Info

Dear Patient,
Thank you for reaching out with your concerns regarding the persistent shoulder pain following your clavicle fracture surgery. It's understandable to feel anxious about ongoing pain, especially when you are committed to your rehabilitation and eager to return to your normal activities.

Firstly, it is important to recognize that post-surgical pain can be multifactorial. After a clavicle fracture surgery, particularly when hardware such as plates and screws are used, it is not uncommon to experience discomfort or pain in the shoulder region. This pain can stem from several sources:
1. Soft Tissue Injury: During surgery, the surrounding muscles, tendons, and ligaments may be affected. This can lead to inflammation and pain, particularly if the rotator cuff or other stabilizing structures were impacted during the procedure.

2. Hardware Sensitivity: Some patients may experience discomfort due to the presence of surgical hardware. If the plate or screws are positioned in a way that irritates surrounding tissues, this could lead to persistent pain, especially with certain movements.

3. Rehabilitation Process: Engaging in physical therapy is crucial for recovery, but it can also lead to temporary discomfort as you work to regain strength and range of motion. If you are pushing your limits during rehabilitation, this could exacerbate pain.

4. Scar Tissue Formation: Post-surgical healing often involves the formation of scar tissue, which can restrict movement and cause pain. This is particularly relevant if you are experiencing difficulty lifting your arm above 180 degrees.

5. Underlying Conditions: Conditions such as adhesive capsulitis (frozen shoulder) can develop after shoulder surgery, leading to stiffness and pain. This condition often requires specific rehabilitation strategies to address.

Given that your X-ray showed no displacement and your wound has healed, it is reassuring that there are no immediate structural issues. However, if the pain persists or worsens, it may be prudent to consider further imaging, such as an MRI, to assess the soft tissues around the shoulder joint for any potential injuries that may not be visible on X-ray.

In terms of management, here are some recommendations:
- Continue Rehabilitation: Stick to your physical therapy regimen, but communicate with your therapist about your pain levels. They may need to adjust your exercises to avoid exacerbating your discomfort.

- Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage pain and inflammation. If your pain is severe, consult your physician about prescription options.

- Activity Modification: Avoid activities that provoke pain, especially overhead movements until you have a better understanding of the cause of your discomfort.

- Consider Alternative Therapies: Some patients find relief through acupuncture, massage therapy, or chiropractic care. Discuss these options with your healthcare provider to ensure they are appropriate for your situation.

- Follow-Up with Your Surgeon: If your pain does not improve or if you have concerns about the hardware, it is essential to follow up with your orthopedic surgeon. They can evaluate whether the hardware needs to be removed or if further intervention is necessary.

Regarding your concerns about the hardware removal and the recovery process, it is common for patients to experience a lengthy recovery period after such surgeries. The decision to remove hardware is typically based on the presence of ongoing pain or discomfort attributed to the hardware itself. If you choose not to have it removed, many patients live comfortably with the hardware in place, but it is essential to monitor for any changes in pain or function.

In conclusion, while it is normal to experience some pain following surgery, persistent or worsening pain should be evaluated further. Open communication with your healthcare team is vital to ensure that you receive the appropriate care and support during your recovery. Please do not hesitate to reach out for further assistance or clarification on your treatment options.

Best wishes for your recovery,
Doctor Q&A Teams

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