Post op shoulder injury

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C

charly

Has anyone else experienced an injured shoulder post-op? After my first surgery, it was my left shoulder, and I suffered with it for years, never connecting it to the heart surgery.

After my second surgery, when the wires were removed, (Newbies.. don't worry, it's not bad...) I felt the wire pass over the injured area in my left shoulder. I guess that pushed the nerves back into place, but I never, ever had pain there again.

One week later, my right shoulder started acting up. Finally got the diagnosis of a "nerve impingement." I had to work hard to rehab it with daily exercise. The exercises and gentle stretches allow the shoulder area (I'm assuming it's the thoracic outlet) from becoming "smaller," thereby avoiding pressure on the nerves.

My Daddy had his valve replaced in 1996, and he had the same shoulder injury. Not that I would wish this pain on anyone, but... I think he always thought I was exaggerating just how bad I was hurting. Sleeping at night is agony when you roll onto your side.

Anyway... just wondering if anyone else has experienced this. Also, I'm wondering if surgeons could brace the patients' shoulders some way in order to avoid this problem.

C
 
Shoulder pain

Shoulder pain

Yes I woke up with bad pain in the neck and shoulders. It was explained to me that when they are going to work on you they pull your arms way out and your neck way back so as to expose as much of your inner chest cavity as posssible. It makes sense that after 4-6 hours of laying in a hyper-extended position that many of the related joints and muscles would be in a ton of pain. I am having shoulder surgery after this anyways so I hope to be better within the year, but the neck pain is still really bad for me. I take my vicodin more for the neck, shoulder, and back pain than for the chest pain. I have very little pain in my chest just some stress or stretching feelings and a little shooting pain every once in awhile. I normally take care of my shoulder pain with a few anti-inflammatroies like Advil, but I hesitate to take that since I am already on blood thinnners. I am using ice and massage and some stretching exercises that the PT gave me before leaving the hospital to counter the pain for now. Oh and of course the Vicodin as well. Especially at night.

Randy
 
They do crank you wide open and it causes the pain. I'm wondering, since you said your Dad had the same problem, if you have some sort of genetic physical makeup that could be permanently disturbed by being placed in that position.
 
My right shoulder has been giving me a FIT for a few months!! I do not remember injuring myself. My PCP started me on Mobic but a few weeks into that I had some swelling in my legs so he took me off that and started me on Maxcide for the swelling:mad: This thing hurts like hell and I have a high pain tolerance! I see my cardio this Wed. and will talk to him and see about maybe a cortisome shot.

I'm sorry others are having this problem but glad to hear it may not be age related:D

Cooker
 
Hi, I have had problems with my left shoulder since my surgery a year ago. There was a definate weakness, then I just turned one day and tore my rotator cuff. The orthopedic doctor gave me cortisone which did not help, but the physical therapy did help. It is still bothersome but better. The orthopedic doctor told me that it started from the OHS. Hope it gets better.. Rose
 
I wondered the same thing -- whether the surgeons could brace or position you better to avoid nerve damage. I am 4 weeks post op. About 2 weeks after the surgery (but not at first) I started to have moderate pain in my right arm (shoulder to wrist). Surgeon and my family doctor both said it is nerve damage from having my arm twisted around during the surgery. They both also said it will resolve itself in a month or two. Sure hope they're right! One does wonder how common this problem is and whether they can't do something different (better) during the surgery. As others have written in this thread, the pain from my arm is now worse than the pain from my incision and chest (which are mostly gone at ths point).
 
Hi,

Shoulder is still killing me. Cardio says not to bother with cortisone shots as they do not last. I took a couple of Vicoden a friend gave me and they did the trick but I know they can be habit forming:cool:

Cardio has me on 400 mg Advil three times a day for 2 weeks. I questioned this with my warfarin and he said it was ok short term, hope so.

Any way I PM'ed Al for his thoughts on the most effective pain reliever while on warfarin. Any opinions would be welcome.

Cooker
 
Surgeons need to try to find a way to avoid shoulder injury

Surgeons need to try to find a way to avoid shoulder injury

But.. maybe there's no way to avoid injuring the shoulder to some degree with the traditional open heart surgery. With the advent of less invasive surgery, this type of secondary problem will probably soon be a thing of the past. Meanwhile, you've got to find a way to recover.

I know first hand about the pain you're experiencing, as does my Dad and Uncle.

(Someone speculated that my family might have a genetic predispostiion to this injury, but I don't think so, because too many others I've talked to go through it. I think the human body has a predisposition to this injury when the chest is open, then put back together not quite as precisely as it was created.)

My guess is that you, like me, have a nerve impingement. That means when you were put back together, a nerve running through your shoulder (maybe technically, the thoracic outlet,) isn't lying quite like it used to, and something is pressing on it.

The other possibility would be a torn rotator cuff, and that's something that can only be dianosed with an MRI. Usually they make you go through the agony of physical therapy with no relief before they'll schedule one. Try to get an MRI before that if you can, because


    • If it's a tear, physical therapy won't fix it unless it's really really minor, and

    • All Physical Therapists are NOT created equal. I've actually seen some therapy cause more damage.

Your doctor is absolutely correct that cortisone is not the answer. You are right that pain meds are not the ultimate answer, either. But you need something in order to sleep and function through the day, right?

Well.. even if you get enough relief to fall asleep, you have to avoid rolling onto that shoulder so the pain doesn't wake you back up. Can you find a position to sleep like that?

I found that Advil/Motrin was the best approach duing the day, but I had to take so much of it that apparently I developed an allergy to it. (Welts, shortness of breath, and fatigue. VERY scary. Ran to the doctor... he told me it was rosacea!!! But it resolved in a day and a half... at that point he admitted that rosacea doesn't resolve in a day and a half.

To this day, doctors still are skeptical about my claim that I'm allergic to Advil/Motrin. (they say it's extremely rare.. but I keep encountering others who have had similar allergic reactions!) And it's too bad that I am allergic, because it's the only pain medication that ever worked for me besides aspirin. Even with your warfarin, you will need to be on a course of Advil during the day because it is very effective at keeping the inflammation down in your shoulder that's causing the pain. They'll keep your protime regulated with your Advil until you don't need it anymore.

The only way to get past this pain is through daily therapeutic exercise. I have a few exercises and stretches for my shoulder area that I do at least 5 times weekly, or I can feel the shoulder pain starting to return.

Assuming that your injury is indeed nerve impingement, I can send you detailed instructions about those exercises. If you do them religiously, and it literally only takes a minute 3 or 4 times a day, with heat, then ice (or is it vice versa??) I think you'll recover. I did.

But, if you do nothing, and you don't move your shoulder, you risk getting "frozen shoulder." You don't need that on top of having had heart surgery.

I sincerely hope this helps you. I'm a professionaly pianist, and no one understood how bad my shoulder hurt after my heart surgery. Trying to play was AGONY!! I truly don't know how I got through it!!! It was worse than the discomfort from the incision. (That was before I knew about the therapeutic exercises.) As a matter of fact, after my first surgery, no one would even admit that my shoulder pain was attributable to the surgery. (my mom figured it out, though!)

I DO!!! feel your pain. (Does that make me a Democrat??) And I hope this helps you a bit on your journey back to freedom from pain.

Sincerely, Charly
 
I have had shoulder problems far preceeding my heart surgery. I did request of both my surgeon and anesthesiologist that they use extra care in positioning me for surgery as to not aggravate the problem. I don't think the surgery really made it any worse. My valve replacement was through a heartport procedure. I spent last summer and fall in shoulder PT after a fall. I've got a torn rotator cuff but that doesn't always need surgery. I've got the impingement thing going too but that is more from a really big spur and a bad acromium "hook". I have had several cortison shots and think that it is worth a try. I've got some other things involved that complicate it a bit but the shots were really no big deal. I personally think it is safer than being on NSAIDs except for the briefest of times. I was put on Celebrex for a while because it is supposed to be easier on the gut. Insurance did refuse to cover it though and it was rather costly.
 
Did the surgeon choose the minimally invasive heart surgery because of your shoulder problem?

I don't personally know anyone who's had that type of surgery, but I would imagine it's a LOT easier on the torso in general.

Of course, as you stated, shoulder injuries identical to mine can be caused by falls, or misalignment when lifting something heavy... all kinds of situations. I think it's always good to try to figure out the cause of any injury, be it surgery or something else, in order to determine the best way to rehab it.
 
I definately "feel" the pain you all feel. I developed tendonitis in both shoulders and arthritis in my chest. Went to physical therapy for 6 weeks after my surgery then stopped because of sternal wire pain. After the sternal wires were removed about 2 months later my own physical therapy interests perked up and have been in the PT field since. I see a lot of patients who have had any type of OHS, and they all experience shoulder pain.

I want to add I agree with Charly that
"All Physical Therapists are NOT created equal. I've actually seen some therapy cause more damage."

Which is absolutely true, just as in any other doctor or medical professional.

Since playing both sides of the field, treating and experiencing the pain. I have found for myself, I don't do weight lifting or anything but I do keep up with light stretching of my arms, shoulders and neck. I use Therabands for some other simple strenghtening exercises.

To settle the Ice/Heat questioning- This is what I have done, not recommending or giving medical advice. I use heat for tight achy muscles, and when I have pain and soreness I use ice for 10-15 mins, No longer. Usually heat to start, ice to end. No heat on anything swollen. Don't use heat or ice without first asking your doctor FIRST if it's ok. Diabetic patients always need to check with there doctors and use heat cautiously always.

Just my two cents. Sorry if rambling.
 
Fantastic!

Fantastic!

That's great advice! How cool is it that you've decided to be a PT???? I think you will make a great contribution to the field because of your unique perspective.

Thanks for the clarification re: ice/heat.

Also, I had forgotten about Therabands. I used them to rehab my shoulder, and I think they're terrific. (That is, if the exerciser keeps his or her form in check while using them!)

BTW:
I love NYC, too! Were it not for the fantastic folks at New York Hospital
(York Ave. in the 70's - I think it's NY-Presbyterian now,) I wouldn't be online.... rambling on......

Best,
Charly
 
Post op shoulder injury

I wandered into this site because lately, my left shoulder has caused me much pain,and was seeking info about analgesics that are safe for warfarin users.I had mitral and aortal replacement surgery in Feb.2004,so I think bursitis,or something similar is more likely the culprit.I just recently began seeing a new cardiologist(insurance change) but I didn't bring up the shoulder issue at our first consultation,but will at our next meeting in Sept.Any bursitis suffers out there?
 
When did your pain start?

When did your pain start?

After my first valve replacement, my left shoulder did not start acting up till a couple of months later.

My hometown cardiologist was clueless about my shoulder symptoms, so I suffered for a long time without an answer.

by the way, why do you think it's bursitis?
 
My shoulder pain is only recent.perhaps in the last 3 mos...but it is getting more bothersome...will wake me up...and I cannot fall asleep on my back unless I use a sleep aid...Bursitis seems to be common in my family so that's why I thought of it...
 
charly said:
Did the surgeon choose the minimally invasive heart surgery because of your shoulder problem?

I don't personally know anyone who's had that type of surgery, but I would imagine it's a LOT easier on the torso in general.

Of course, as you stated, shoulder injuries identical to mine can be caused by falls, or misalignment when lifting something heavy... all kinds of situations. I think it's always good to try to figure out the cause of any injury, be it surgery or something else, in order to determine the best way to rehab it.
Click to expand...

I'm not sure why he chose the heartport method...maybe just because he is an expert on that technique. There are so many people who have shoulder problems after heart surgery that I know there is a definite connection. I think the point I should have stressed is that I think you shouldn't rule out a cortisone injection. Sometimes if you just break the pain/inflammation cycle for a spell you can start to heal.
 
bvdr said:
I'm not sure why he chose the heartport method...maybe just because he is an expert on that technique. There are so many people who have shoulder problems after heart surgery that I know there is a definite connection. I think the point I should have stressed is that I think you shouldn't rule out a cortisone injection. Sometimes if you just break the pain/inflammation cycle for a spell you can start to heal.
Click to expand...

You know what? I completely agree that cortisone can help break the pain/inflammation cycle, and you're SO right that finding relief is important in order to get back on track. What I object to is injecting cortisone into the shoulder, when there's no way a doctor can truly know exactly where the injection should go. I know at least 5 people who hemmorhaged at cortisone injection sites, and they were reddish/purple and swollen, not to mention the fact that they were in much more pain as a result. (Granted, this is not typical, but apparently this happens more frequently than you'd think.)

The medical community used to state that injecting cortisone was preferable to taking it orally, since it stayed "localized" at the injured site. Fairly recent studies have shown that not to be the case.

A friend of mine who was a medical doctor in the Czech Republic and now works for the CDC in research told me that she was taught to use a highly concentrated cortisone cream, much stronger than anything you or I could buy over the counter, instead of an injection. The cream is applied heavily at the site of the injury, then wrapped in plastic wrap so it remains undisturbed for a good while. I tried it after a minor car accident reawakened my injury - and it worked very well. (a little messy, though!)

In the past, however, a short course of prednisone taken orally rather than injected, for 5 days or so with a tapered dosage, provided me with enough relief to allow me to start the physical rehabilitation that was the ultimate answer.

Of course, as we all know. physical therapy and rehab won't work for all injuries.

Whatever the case, I hope that anyone suffering from these types of problems after heart surgery can benefit from reading about what we've all been through.
 
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