“Dr. Diaz, I’ve heard so many negative stories about recovering from shoulder surgery. Are they true?”
Let’s talk about the facts and significant improvements in recovery:
“I have heard so many negative stories about recovering from shoulder surgery. Are they true?”
In a word, no. Many patients are sometimes discouraged from having shoulder surgery that could take away their pain because they have heard “nightmare stories” about the recovery. In fact, the patient experience following shoulder surgery has improved significantly in recent years. Many of these anecdotes date back to when we lacked the current expertise and modern techniques to effectively manage pain during surgery. Now, a quarter of the way into the 21st century, we have many solutions at our disposal that have dramatically improved pain levels after shoulder surgery. Some of the most impactful advances are:
1. Better ‘regional’ anesthesia.
‘Regional’ anesthesia refers to numbing a limb or joint so that the area cannot be felt by the patient during surgery. Most shoulder surgery is performed under a ‘block’, which is the shorthand term for regional anesthesia. This means less pain during the surgery, which means less need for general anesthesia, which in turn means less chance of experiencing the undesirable side effects of general anesthesia (nausea, vomiting, feeling ‘out of it’, aggravation of underlying medical conditions, to name a few).
The technique for placing a block has evolved and improved in the past few decades. Most anesthesiologists use live ultrasound imaging to target the nerves, which means more accurate delivery of the numbing medicine.
Within the past few years, shoulder surgeons have been using a much longer acting numbing medicine for the ’block’, which means that most patients do not experience pain for 1-2 days after the procedure. This in turn limits the need for prescription pain medication, which means fewer side effects from those (altered mental status, constipation, nausea or vomiting, and of course, addiction). Many of my patients do not end up needing the prescription pain medication at all!
2. Cryotherapy (aka “icing down”).
Icing of the shoulder for the first 24 to 48 hours after surgery has been shown to decrease pain levels and improve patient satisfaction after shoulder surgery. It is that simple!
3. Improved techniques, implants, and speed.
The past few years have seen an explosion in the capabilities of shoulder surgical repairs that can be performed minimally invasively (arthroscopic surgery). Surgical procedures that used to require big incisions are now routinely performed with arthroscopy (through tiny little incisions that accommodate a camera or ‘scope’ and specialized instruments), leading to far less pain. Repair materials and implants have been designed to be lower profile and cause less trauma during placement. Furthermore, through this innovation and years of experience, those of us who perform a high volume of shoulder arthroscopy can proceed through the operation steps more quickly. Less surgical time means less expansion of the soft tissues with the saline water we pump into the shoulder to be able to see, and that means less irritation of the nerve fibers that cause pain around the shoulder.
4. Non-steroidal anti-inflammatory drugs (NSAIDs).
For many years, we told patients recovering from rotator cuff surgery that this class of drugs could impair tendon healing.
However, that information was based on a small animal model (rats) and has been disproven in humans. Patients who took NSAIDs after rotator cuff surgery healed just as well as those who did not as confirmed by a post-surgery MRI. They also took fewer prescription opioids and reported being more satisfied with their surgical experience.
5. Positive Thinking.
One of the greatest determinants of how much pain a patient will experience after shoulder surgery is their attitude and mental readiness for the surgery. Patients who keep a positive attitude and exhibit resilience fare better compared to patients who become fixated on the pain, or ‘catastrophize’ the situation, meaning they tend to assume the worst will always happen. Even if you are anxious, which is a natural human emotion when faced with surgery, keeping a positive mindset has been proven to favorably impact pain levels and the surgical result.
Hopefully, this information will help those of you delaying shoulder care because the recovery seems daunting to revisit your options. Schedule a consultation to evaluate and come up with a solution for your shoulder pain.
Written by: Veronica Diaz, M.D., Palm Beach Shoulder Expert
