Frozen Shoulder after Shoulder Reconstruction
Updated: Aug 13, 2019
"H had a shoulder reconstruction a few months ago and it's now very frozen. Any advice?"
Thank you for the question.
I'l give the following observations and advice bearing in mind that I have no details at all about the wider health history of this person, including the exact surgery, medications, followup treatment and other important information.
I do not want to come across as being overly critical of the health professionals involved because I used to own and operate a busy rehabilitation clinic and I fully appreciate just how complicated and difficult shoulder rehabilitation can be. Patients vary in the way they recovery, due to factors like the quality of the surgery, the patient's compliance and enthusiasm to participate in rehabilitation, their attitude towards pain, and even their general state of health, fitness and nutrition. Having said this, this is all the more reason for their rehabilitation programme to be proactive and comprehensive.
Frozen shoulder is a BIG problem to have because it limits so many daily activities such as dressing, let alone for safely participating in just about any kind of active sports and recreation. It is a common complication of shoulder injuries and occasionally post-surgery. It can be difficult and painful to restore normal function, once embedded, and may eventually require manipulation under anaesthetic.
Being post-surgery his problems may be due to poor post-surgical care - rehabilitation, or it could be just random bad luck but I would doubt it. There is a trend nowadays for little in the way of post-operative physiotherapy and when this happens, it tends to be too timid because everyone is afraid of causing pain and also of messing with the surgeon's wonderful work of art, then having to answer for it! No health professionals want to deal with complaints to the authorities, so there is a tendency to always play it safe. This was one of my ongoing frustrations when in the business of rehabilitation. When 90% of your income comes from just one source, in this case, Accident Compensation, just one complaint can be a financial catastrophe (ACC may stop sending patients to us until the complaint has been resolved and this may involve court action). So, everybody plays safe. But playing safe may not always be in the best interests of the patient.
The quality and the suitability of his post-surgical care, as well as the surgery itself needs to be questioned. There should be some obligation on the part of those who managed the surgery and after care to help put it right.
If a mechanic repaired your car and it functioned worse after the job, what would you expect of that mechanic: a refund, or to put it right at no extra cost to you? What's the difference, in principle between the work of a mechanic and that of a surgeon?
A shoulder reconstruction is not complete upon the patient being rolled out of the operating theatre, or the stitches being removed; the job is finished once there is full recovery of anticipated function of the limb.
He needs to have aggressive rehabilitation now to try to free and mobilise the shoulder. He will probably have scar adhesions that have to be stretched and possibly snapped (under anaesthesia) to free up the shoulder but this requires expert medical investigation and guidance. Just keeping safely within a very limited range of motion and avoiding or suppressing pain will not be productive. He needs to be carefully forcing the range of motion under expert guidance every week - millimetre by millimetre - and possibly more surgery to help free up the shoulder.
Scar shortens and tightens with time, so the shoulder may get worse than better if he is not actively mobilising it.
The current situation is unacceptable and sitting around while health professionals "wait and see" is not good treatment, if this is what is happening. He needs positive action - not sitting on one's hands.
He needs to be taking quite high doses of these regardless of whether or not he requires more medical intervention, including surgery:
These help to soften and remove scar tissue while reducing pain and inflammation. Unlike extraordinarily expensive pharmaceutical drugs that threaten to bankrupt our economies, these healthy supplements receive no tax-payer subsidies so he will just have to suck up the cost.
This is not going to be an overnight recovery. He will need to think of the process taking several months and probably years. But, as with any long journey, the best thing to do is to focus on the first step then the second, then the 3rd...