Managing Shoulder Pain After Surgery

Shoulder pain after surgery is a frequent concern, ranging from mild discomfort to persistent pain. The severity and duration of pain can vary and may manifest as stiffness, sharp aches, or restricted mobility, influenced by an individual’s overall health and the specific surgical procedure. Common causes include inflammation, scar tissue, and nerve irritation. 

Physicians often recommend medications to manage short-term pain. However, some surgical outcomes may lead to longer-lasting issues. For example, conditions such as a frozen shoulder, which can occur after prolonged immobilization, may persist for up to three years. Prolonged use of pain medications poses risks, such as dependency or adverse effects, including kidney dysfunction, heart attack, and stroke. 

Considering less-invasive alternatives that reduce surgery-related risks is important to long-term pain management. Physicians in the licensed Regenexx network utilize interventional orthobiologics to target the underlying causes of shoulder pain, aiming to minimize reliance on invasive surgeries.

Is Pain In The Shoulder After Surgery Common?

The shoulder is a complex joint connecting the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle). The joint is kept stable and mobile by the rotator cuff, a group of four muscles, and their tendons. This structure is essential for arm mobility and everyday activities, but its complexity makes the shoulder susceptible to injuries and chronic conditions.

Invasive procedures, such as rotator cuff repair or total shoulder replacement, are often performed to restore function. However, surgical intervention is associated with risks and lengthy rehabilitation periods.

After shoulder surgery, it is common to experience shoulder pain. However, it is important to distinguish between expected post-surgical pain, which typically eases as the shoulder heals, and persistent or chronic pain.

Post-surgical shoulder pain duration varies by surgery type. After undergoing shoulder surgery, the physician will provide an estimate for your specific case. This type of pain typically peaks in the first 48 hours and can last for days to weeks. Sometimes, post-surgical pain can persist for months or years.  A 2015 study on 538 patients found that 22% experienced persistent pain one to two years after shoulder replacement. 

After surgery, pain can be: 

• Acute: Acute pain is typically caused by tissue damage and inflammation during the healing process. It is temporary and should decrease as tissues heal. This type of pain is expected after surgery, and it is often manageable with medications and physical therapy.
• Chronic: Chronic pain persists beyond the normal healing time frame. According to the National Institute of Neurological Disorders and Stroke, pain is considered chronic when it lasts over three months. Unlike acute pain, chronic pain can stem from prolonged inflammation, nerve damage, or scar tissue complications. Chronic shoulder pain can interfere with daily life.

Causes Of Post-Surgical Shoulder Pain 

Short-lived post-surgical pain results from damage to shoulder tissues, including skin and nerves. Surgical incisions and procedures activate the body’s healing response, leading to inflammation and pain. Discomfort typically subsides as tissues begin the healing process.

However, post-surgical pain can sometimes last longer than the expected healing time frame. Causes include:

Post-Surgical Stiffness 

Post-surgical stiffness is a common complication arising from inflammation in the shoulder joint after arthroscopy or open surgery.

A 2023 systematic review found that stiffness can range from a temporary issue that improves with treatment after arthroscopic rotator cuff surgery to a more permanent loss of motion. This affects 3% to 23% of patients. It can lead to dissatisfaction with the surgical outcomes, even after successful rotator cuff repair.

Shoulder guarding, an involuntary response where muscles tense up to protect the joint, may also contribute to post-surgical stiffness. A 2018 study suggests that muscle guarding can contribute to frozen shoulder, which is a common complication of shoulder surgery.   

Symptoms include limited range of motion and a sensation of tightness. If untreated, stiffness can prolong rehabilitation.

Scar Tissue Formation

Scar tissue formation is a natural part of healing when the body repairs damaged tissues. In the shoulder, excessive scar tissue can limit movement and cause pain or stiffness. This occurs because scar tissue lacks the flexibility of normal tissue, binding structures important for mobility, like muscles and tendons. 

This condition, known as arthrofibrosis, may hinder recovery by restricting mobility. The thickened tissue may require medical management to restore joint function.

Lack Of Movement

Limited mobility or prolonged immobilization after surgery may cause adhesive capsulitis or a frozen shoulder. This condition develops when shoulder connective tissues become inflamed and thickened from disuse, leading to pain and restricted motion. A 2017 study found that a frozen shoulder is a severe complication of shoulder surgery that affects 11% of patients, regardless of the type of surgery performed. 

Symptoms include stiffness, difficulty with daily tasks, and increasing pain. Over time, lack of movement may lead to muscle loss, worsening joint function, and delaying recovery.

Infection 

Shoulder surgery infections are rare. They affect 0.3% to 1.9% of rotator cuff repair patients and up to 2.9% of those undergoing the more invasive shoulder replacement surgery.  However, this is a serious complication that requires prompt medical attention to prevent long-term damage.

Symptoms include:

• Redness, swelling, or warmth around the surgical site
• Fever or chills
• Persistent, localized pain or discharge from the incision

Nerve Injury

Nerve injury may result from direct trauma or excessive stretching during surgery. A 2022 study suggests nerve injury occurs in 1-4% of shoulder replacements. 

Nerve damage impairs the transmission of sensory and motor signals to and from the brain. This leads to symptoms like tingling, numbness, burning sensations, or weakness in the shoulder or arm. In severe cases, nerve damage may cause chronic pain or impaired function.

Trauma

Trauma to the shoulder can occur due to falls or sudden strain and can disrupt the healing process. This can result in re-injury to surgical repairs, increased pain, and potential complications like swelling or internal damage. 

Symptoms of post-operative trauma include sharp pain, swelling, and decreased range of motion. Prompt medical attention is essential to avoid complications and aid healing.

Factors Influencing Post-Shoulder Surgery Pain Levels

Post-surgery pain varies in intensity and type based on several factors. These include:

Surgery Type

Specific surgery types are also associated with increased pain. In particular, 2019 research suggests that rotator cuff repair is more painful than other shoulder surgeries. Other surgeries associated with high pain levels include partial and total shoulder replacements. 

Shoulder surgery can be arthroscopic or open. Arthroscopy uses small incisions to insert viewing and surgical instruments, while open surgery uses larger incisions. The choice depends on the patient’s condition and treatment needs.

2024 research indicates that open and arthroscopic surgery methods resulted in similar recovery times and functional outcomes. However, patients undergoing open surgery reported slightly less pain, while those having arthroscopic surgery experienced a slightly better quality of life. The arthroscopic method also had a lower, but not significantly different, complication rate compared to open surgery.

Shoulder arthroscopy for impingement and labral repair typically causes moderate pain. However, individual experiences vary depending on the surgery’s complexity and the repair’s extent. 

Lifestyle Factors

Lifestyle factors significantly affect recovery and post-surgical pain. These include:

• Smoking: Cigarette smoking reduces blood flow. This impairs the delivery of oxygen and healing agents to the surgical site, increasing pain and delaying recovery. Research from 2022 links smoking to heightened post-surgical pain. 
• Obesity: Excess weight strains the joint, worsening pain and inflammation. A 2021 study concludes that, generally, obesity is linked to increased surgery duration and higher post-surgical pain levels. 
• Sedentary behavior: Sedentary behavior limits circulation, increases stiffness, and raises the risk of a frozen shoulder due to prolonged immobilization. 
• Poor nutrition: Inadequate nutrition can lead to a reduced intake of essential nutrients necessary for tissue repair, slowing recovery. Research from 2019 shows that malnutrition worsens recovery by increasing complications and hospital stays. Malnourished patients often face higher risks of complications, longer hospital stays, increased readmissions, and greater costs after surgery.
• Stress: 2024 research indicates that high-stress levels before surgery can make pain feel more intense during and after the operation. This may happen because stress triggers the body’s release of hormones like cortisol, which heightens pain sensitivity.

Pre-Existing Medical Conditions

Certain medical conditions can slow healing, increase inflammation, or amplify pain. These include:

• Arthritis: Pre-existing joint damage can increase swelling, inflammation, and discomfort.
• Diabetes: Diabetes can affect nerve health and delay wound healing, increasing pain and disrupting recovery.
• Chronic pain disorders: Conditions like fibromyalgia are associated with increased pain perception.
• Cardiovascular issues: Reduced blood flow impairs tissue repair and increases recovery time.

Personal Pain Tolerance

Pain tolerance varies widely among individuals and may impact how post-surgical pain is perceived. Individuals with lower pain tolerance may feel significant discomfort from minor trauma or mild inflammation. 

Factors influencing personal pain tolerance include genetics, emotional state, past experiences with pain, and stress levels. 

Post-Surgical Accompanying Symptoms That Warrant Medical Attention

Some level of discomfort and stiffness is expected after shoulder surgery. However, increasing pain or worsening symptoms may signal complications such as infection, nerve damage, or improper healing. 

Symptoms that warrant medical attention include:

• Pain and swelling: Persistent or worsening pain and swelling beyond the typical healing period may suggest infection or chronic inflammation.
• Stiffness: Severe or ongoing stiffness that limits mobility could indicate scar tissue buildup or conditions such as adhesive capsulitis (frozen shoulder).
• Tingling, numbness, or burning sensations: These sensations are known as paresthesia. They occur when nerves cannot properly transmit sensory signals to and from the brain, potentially indicating nerve injury or compression.
• Joint instability: A feeling that the shoulder is loose or slipping out of place can point to ligament damage or failed surgical repairs.

Symptoms such as drainage, fever, chills, or breathing difficulties require immediate medical attention as they may indicate severe allergic reactions or infection. 

Conventional Approaches To Post-Surgical Shoulder Pain

After surgery, physicians provide care instructions, including prescribing pain-relief medications and advising on at-home care. These approaches aim to reduce pain, improve mobility, and prevent complications. While they may support short-term recovery, they can lead to side effects.

• Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation and relieve short-term pain. Long-term use may lead to side effects such as stomach ulcers, an increased risk of heart attack and stroke, and kidney dysfunction. Narcotics, or opioids, are also commonly used for post-operative pain management. They work by binding to opioid receptors in the brain to block pain signals, but they carry a high risk of dependency and side effects with prolonged use.
• RICE method. Rest, ice, compression, and elevation are traditional techniques for managing pain and swelling. However, recent studies suggest ice therapy may slow healing by reducing blood flow to the injury site.
• Physical therapy. Physical therapy is important for restoring mobility and strength post-surgery. Therapists design exercises to reduce stiffness, strengthen muscles, and improve shoulder function. 
• Assistive devices. Assistive devices such as slings, braces, or ergonomic tools can help support the shoulder, limit strain, and prevent further trauma. However, prolonged use of assistive devices may cause muscle loss, weakness, and decreased movement, which can contribute to a frozen shoulder. 

The Regenexx Approach to Shoulder Health

Physicians in the licensed Regenexx network may help reduce the need for shoulder surgery by offering innovative approaches to addressing joint health. The Regenexx approach uses advanced interventional orthobiologics to support the body’s natural healing processes, improving function and reducing pain with personalized care.

Using the industry-leading SANS (Stability, Articulation, Neuromuscular, and Symmetry) evaluation method, physicians in the licensed Regenexx network perform a comprehensive assessment to identify the root causes of shoulder symptoms. 

This includes examining the body in motion, analyzing imaging such as MRIs or X-rays, and using real-time ultrasound to observe the joint’s inner workings. These detailed evaluations help physicians understand how function has been affected and what contributes to pain. This insight allows for tailored treatments that address specific needs and reduce or delay the need for surgery. 

Regenexx-SD Injectate

Procedures using Regenexx-SD injectate include a patented protocol that utilizes Bone Marrow Concentrate (BMC), which contains the patient’s own mesenchymal stem cells. The cell processing for a Regenexx-SD injectate routinely achieves 20x concentration— above what non-Regenexx cell processing can achieve.

Regenexx-SCP Injectate

Regenexx-SCP injectate procedures represent a supercharged version of platelet-rich plasma (PRP). In this process, blood is drawn and then processed to isolate the platelets and growth factors. The growth factors are then purified, concentrated, and injected into the shoulder area using imaging guidance for precision. Regenexx-SCP injectate provides a higher concentration of growth factors than typical PRP procedures.

Regenexx-PL Injectate

Regenexx-PL injectate procedures are a highly specialized derivative of platelet-rich plasma (PRP) with a faster and more concentrated release of growth factors than typical PRP. The PL injectate is often combined with other orthobiologics such as PRP and bone marrow concentrate.

Regenexx Can Help With Your Shoulder Pain 

Shoulder pain is a common musculoskeletal issue. However, surgery isn’t the only treatment option. Physicians in the licensed Regenexx network may be able to help you better understand the root causes of your shoulder pain and use interventional orthobiologics to address joint function and pain. This innovative approach aims to reduce the risks and recovery times associated with surgery.

Are you experiencing shoulder pain? Consult with a physician in the licensed Regenexx network today.