Chronic shoulder pain
The Shoulder
Complications
Alternatives to surgery
The decision to proceed with an operation is an individual choice between every patient and their Surgeon. You will only be offered an operation if your Surgeon believes that this will help improve your symptoms. Very few operations are essential and all have a degree of risk. Some patients can learn to manage their symptoms with painkillers and improve function with muscle strengthening and physiotherapy.
Subacromial impingement
If the subacromial space narrows, the bursa or tendons can become inflamed and painful. This condition is known as a subacromial impingement.
Subacromial impingement
- weakness in the rotator cuff muscles from wear and tear
- movements in positions that narrow this space such as overhead activity
- poor shoulder posture
- bony changes
The operation is usually performed as keyhole surgery (‘arthroscopy’) but can also be performed as an open procedure.
A subacromial decompression involves increasing the space under the arch by removing the bursa, releasing a ligament and excising any bony spurs. This allows the tendon to move more freely, thus breaking the cycle of rubbing and swelling.
During your operation, the Surgeon may identify further damage within your shoulder, which requires addressing. This may require debridement (clean up), tendon repair or tendon release. If a tendon release is performed this may change the appearance of your arm muscle, called a “popeye sign”.
Subacromial decompression
General complications of any shoulder surgery
Pain levels felt after surgery vary depending on the type of surgery, individual pain thresholds, nature of the problem for which surgery was done and various other factors.
Stiffness after shoulder surgery is not uncommon and occurs as a result of pre- existing pathology, surgical scarring and prolonged post-operative protection in a sling. It is very uncommon to see significant stiffness at 1 year after arthroscopic shoulder
Bleeding during or after surgery (less than 1%). It is common to have oozing from the arthroscopic wound ports after surgery as the blood-stained sterile water used during surgery drains
Infection of the surgical wound is rare with arthroscopic surgery. Early diagnosis of post-operative infection has a significantly better outcome compared to delayed diagnosis. After your operation, you should contact the ward and your GP immediately if you get a temperature, become unwell, notice pus in your wound, or if your wound becomes red, sore or Painful.
Unsightly scarring of the skin (less than 1%). Most surgical scars have disappeared to a thin pale line by one year after surgery. If you are concerned about your scar you must discuss it with your surgeon or therapist as there are many treatments to improve scar healing.
Nerve injury is rare (less than 0.5%) with most shoulder operations, but some larger operations have a higher risk and this will be discussed with you by your surgeon.
Vascular injury is very rare (less than 0.5%) after shoulder surgery.
Anaesthetic related complications such as sickness and nausea are relatively common. Heart, lung and neurological problems are much rarer (less than 1 person in 1,000).
Frequently Asked Questions
Will it be painful?
Although you will only have small scars, this procedure can be painful due to the surgery performed inside your shoulder.
The following pain control methods may be used to ensure you have as little discomfort as possible:
- a local nerve block, known as an interscalene block
- pain killers and anti-inflammatory medications, taken regularly on discharge from the
Interscalene block
You may be offered a nerve block for the surgery, known as an interscalene block. The Anaesthetist will discuss this in detail with you before the surgery.
An interscalene block is a nerve block in the neck used to provide a heavy numbness in the shoulder and arm (in a same way that a dentist can numb a tooth) so that the shoulder surgery can be carried out with excellent pain relief.
The benefits of an interscalene block are:
- reduced risk of nausea and vomiting and sedation
- earlier to leave hospital
- early intake of food and drink
- excellent pain control
- lighter general anaesthetic with speedier recovery from the anaesthetic
- less chance of an overnight stay at the hospital
The Anaesthetist, Surgeon and you need to decide jointly whether you are suitable for an interscalene block.
Painkillers
You will be given painkillers (either as tablets or injections) to help reduce the discomfort whilst you are in hospital. A one week prescription for continued pain medication will be given to you for your discharge home. Keep the pain under control by using medication regularly at first. It is important to keep the pain to a minimum, as this will enable you to move the shoulder joint and begin the exercises you will be given by the Physiotherapist.
If you require further medication after these are finished, please visit your General Practitioner (GP).
Do I need to wear a sling?
What position should I sleep in?
Do I need to do exercises?
Yes. You will be shown exercises by the Physiotherapist and you will need to continue with them once you go home. They aim to stop your shoulder getting stiff and to strengthen the muscles around your shoulder. Do short, frequent sessions as advised rather than one long session.
It is normal for you to feel aching, discomfort or stretching sensations when doing these exercises. It is important to keep the pain to a minimum to enable to you to move the shoulder joint. If necessary, use painkillers and/or ice packs to reduce the pain. Intense and lasting pain (e.g. more than 30 minutes) means you should change the exercise by doing it less forcefully or less often.
Continue to do these exercises until you get the movement back or you see the Physiotherapist. An outpatient appointment for physiotherapy will be arranged for you in approximately 2 weeks’ time.
What do I do about the wound?
Your wound will have a shower-proof dressing on when you are discharged. You will be given extra dressings to take home with you. You may shower or wash with the dressing in place, but do not run the shower directly over the operated shoulder or soak it in the bath. Pat the area dry, do not rub. The stitches may need to be removed or trimmed at your GP practice or your hospital follow-up appointment. The nursing staff will advise you when this can happen; it is usually between 10 – 14 days after your operation. Avoid using spray deodorant, talcum powder or perfumes on or near the wound until it is fully healed. Please discuss any queries you may have with the Nurses on the ward.
When can I return to work?
When do I return to the outpatient clinic?
Are there things that I should avoid?
- There are no restrictions to movement in any direction. Do not be frightened to start moving the arm as much as you can. You may experience some pain on movement. Gradually, the movements will become less
- Avoid heavy lifting for at least 3 weeks. You may gradually return to these activities if your pain is under
- Be aware that activities at or above shoulder height, stress the area that has been operated on. Do not do these activities unnecessarily. Try and keep your arm out of positions that increase the
How am I likely to progress?
The discomfort from the operation will gradually lessen over time. Time taken to improve varies between individuals. Normally the operation is performed to relieve pain from your shoulder and this usually happens within 6 months of the surgery. There may be improvements for up to 1 year.
When can I drive?
You cannot drive while you are wearing the sling. After that, the law states that you should be in complete control of your car at all times. It is your responsibility to ensure this and to inform your insurance company about your surgery.
When can I participate in my leisure activities?
