How to Determine if Surgical Hardware is Causing Pain After Clavicle Surgery?

How can one determine if the bone screws or plates on the left clavicle are impinging on the muscles or bones, and whether they are too short after surgery?

Dear Director Shih,
Thank you for your thoughtful response last time; I am very satisfied and extend my deepest gratitude to you! I am asking you again out of necessity, as it has been three and a half months since my surgery, and I am still in significant pain every day.
I started rehabilitation one month post-surgery, but the pain was so severe the day after that even the physical therapist mentioned there might be an issue.
They believe it does not feel like typical muscle soreness; simply stretching my arms to the sides causes pain.
I consulted two very busy senior physicians, but they only reviewed the frontal X-rays and said everything was fine.
However, with this level of pain every day, how can I return to work? How can I teach my lively ninth-grade students, especially since they are about to graduate? I am eager to return to my position.
Please clearly advise me on how to check if the metal plate or screws are impinging on my muscles or bones.
I have a comminuted fracture in the center of my clavicle; could the fragments be causing it to be too short? If it is too short, how can that be determined? I experience particular pain near the distal end close to the arm, and I often feel discomfort across my shoulder.
When the pain intensifies, I also experience pain in my left chest and left upper arm joint.

I believe the pain issue has not been identified, and continuing rehabilitation without addressing it is not a solution.
Since returning home from surgery, my pain has not improved, and it significantly affects my daily life.
Interestingly, my two fractured ribs stopped hurting after a month and a half.
If it is confirmed that something is impinging, it would be best to remove it sooner rather than later.

Director Shih, I kindly ask for your guidance on this matter.
Thank you for your immense kindness and support!

lilas, 60~69 year old female. Ask Date: 2011/12/12

Dr. Shi Guozheng reply Orthopedics

Typically, an X-ray examination can reveal any issues.
If a fracture has healed, depending on the situation, the bone screws can be removed early if they are impinging on the joint or muscle.
If the fracture has not healed, then further waiting is necessary, and another physician should be consulted for evaluation, which may be required.

Reply Date: 2011/12/12

More Info

After clavicle surgery, persistent pain can be a significant concern, especially when it interferes with daily activities and work. In your case, where you have undergone surgery for a comminuted fracture of the clavicle and are experiencing ongoing pain three and a half months post-operation, it is essential to consider several factors to determine whether the surgical hardware (such as plates or screws) may be contributing to your discomfort.

Understanding Post-Surgical Pain
1. Nature of Pain: It is crucial to differentiate between types of pain. Post-surgical pain can arise from various sources, including:
- Surgical Site Pain: This is often due to inflammation, healing tissues, or nerve irritation.

- Hardware-Related Pain: If the surgical hardware is improperly positioned or if it irritates surrounding tissues, it can lead to localized pain.

- Muscle Strain: Rehabilitation exercises can sometimes lead to muscle soreness, which may be misinterpreted as pain from the surgical site.

2. Symptoms to Monitor: You mentioned that the pain intensifies when you stretch your arms or engage in rehabilitation exercises. This could indicate that the hardware is affecting the surrounding muscles or nerves. Additionally, pain radiating to the chest and upper arm could suggest nerve involvement or referred pain from the shoulder area.

Diagnostic Steps
To determine if the hardware is causing your pain, consider the following steps:
1. Imaging Studies: While X-rays are commonly used to assess the position of surgical hardware, they may not always provide a complete picture. If you suspect that the hardware is causing issues, a more detailed imaging study, such as a CT scan or MRI, may be warranted. These modalities can provide better visualization of the hardware's relationship with surrounding tissues and help identify any complications such as:
- Hardware Migration: If the screws or plates have shifted from their original position.

- Bone Healing Issues: If there are signs of non-union or malunion of the fracture.

- Soft Tissue Impingement: If the hardware is pressing against muscles or nerves.

2. Physical Examination: A thorough physical examination by an orthopedic specialist can help assess the range of motion, strength, and specific areas of tenderness. This may provide clues about whether the pain is related to the hardware or other issues.

3. Consultation with a Specialist: If you have seen multiple doctors without satisfactory answers, consider seeking a second opinion from an orthopedic surgeon who specializes in shoulder and clavicle injuries. They may have more experience with similar cases and can offer insights into your specific situation.

Treatment Options
If it is determined that the hardware is indeed causing pain, several options may be considered:
1. Hardware Removal: If the pain is directly linked to the surgical hardware and conservative measures do not alleviate the discomfort, removal of the hardware may be necessary. This is typically considered if the hardware is causing significant pain or if it is impeding your recovery.

2. Physical Therapy: Continuing with physical therapy may still be beneficial, even if the pain persists. A skilled therapist can modify your rehabilitation program to focus on pain management and strengthening without exacerbating your symptoms.

3. Pain Management: In the interim, pain management strategies, including medications, ice therapy, and possibly nerve blocks, may help alleviate discomfort.

4. Activity Modification: It may be necessary to adjust your daily activities and work duties to prevent exacerbation of pain while you continue to heal.

Conclusion
Persistent pain after clavicle surgery can be frustrating and debilitating. It is essential to communicate openly with your healthcare providers about your symptoms and concerns. By pursuing further diagnostic evaluations and possibly consulting with a specialist, you can gain a clearer understanding of the cause of your pain and explore appropriate treatment options. Remember, your recovery is a process, and addressing these issues is a critical step toward regaining your quality of life and returning to your teaching responsibilities.

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