Why Does My Shoulder Hurt After Surgery
Surgery is supposed to make your life better, but sometimes it only makes things worse. One such complication that’s often reported in patients who undergo laparoscopy (a minimally invasive surgical procedure where a tiny incision is made under the skin) is post-operative pain in the shoulder area. The problem usually lasts for about three days and occurs when the patient attempts to move his or her arm and shoulder after surgery. Most people are not aware that this painful condition is actually a symptom of constriction of the muscles and ligaments of the shoulder joint itself.
The discomfort happens because the patient moves his arm against a relatively immobile chest wall, which causes muscle tension within the shoulder girdle. This muscle tension then leads to inflammation and swelling in the tissues surrounding the joint. As a result, the affected person experiences tightness in the shoulder and limited mobility in the joints of the upper limbs. Painful conditions like frozen shoulders are also known to occur as a result of similar events.
Because shoulder pain can occur as a consequence of restricted movement, it’s easy to imagine how it might happen during certain types of surgeries. For example, shoulder pain can happen after an open carpal tunnel release, since you’re likely to have trouble moving your wrist, which is now freed from its encasement in bone. In addition, some surgeons insert balloons into the abdomen to create space for the intestines and organs inside the body cavity; if the balloon is left inflated for too long, it could cause compression of the underlying structures. This type of injury could potentially affect the nerves that innervate the shoulder, including those responsible for controlling the deltoids and pectoralis major muscles.
Shoulder pain following laparoscopic surgery has been thought to be mainly caused by irritation of the phrenic nerves, which are located at the top of the breastbone and run along either side of the neck. These nerves control the diaphragm and other respiratory muscles. When these nerves are compressed or irritated by gas pressure, they become inflamed and swell. However, recent studies suggest that another reason why shoulder pain may arise is because the chest is immobilized during surgery, which leaves little room for breathing.
In this article, we’ll take a closer look at what happens to the shoulder during surgery and what role the phrenic nerves play in causing shoulder pain. We will also examine potential solutions to prevent post-surgical shoulder pain. First up, let’s talk about what exactly happens during surgery that may lead to shoulder pain.
During surgery, the surgeon uses small instruments inserted through tubes called trocars. These allow access into the abdominal cavity via two small cuts called ports, one on each side of the belly. Each port is connected to a tube and valve system that directs air used to inflate the abdominal cavity and creates negative pressure to keep fluid out. During surgery, the abdomen needs to remain pressurized with high levels of carbon dioxide gas. Surgeons accomplish this using a pump that forces CO2 down a central line leading to a series of valves that distribute the gas throughout the operating theater. To maintain adequate oxygenation, the pumped CO2 is mixed with high concentrations of nitrogen (N2). While this mixture does provide a safe environment for surgery, it also poses problems for patients who experience prolonged exposure.
When CO2 is released into the atmosphere, it reacts with water molecules to form carbondioxide acid (HCO3), which turns back into pure CO2gas. Because HCO3 is acidic, it dissolves readily into blood plasma. Once dissolved, the resulting increase in blood pH results in hypercapnia, or overburdening of the lungs with excess carbon dioxide, which can cause nausea, headaches and fatigue. Therefore, the concentration of CO2is kept low enough to avoid acidosis without being so low as to interfere with respiration. The amount of CO2released depends upon the type of operation being performed. Some operations require large amounts of CO2because they involve extensive tissue dissection. The average concentration of CO2in hospitals ranges between 5 percent and 9 percent.
So far, we’ve talked about the mechanics behind how the CO2used during laparoscopy affects the shoulder. Next we’ll discuss possible solutions to help relieve the symptoms associated with shoulder pain.
Solutions to Post-Surgical Shoulder Discomfort
There are several ways to reduce the risk of shoulder pain during and after laparoscopic procedures. If the patient becomes nauseous or airsick, he or she should lie down flat on their backs until feeling returns to normal. In addition, the patient should drink plenty of fluids to compensate for any reduction in gastric motility that may follow vomiting.
One solution to reducing the incidence of shoulder pain is to use the small intestine rather than the stomach for inflation. Small intestinal submucosa (also referred to as SIS, artificial membrane or MatriStem®) is a material derived from porcine small bowel submucosal layer that was originally developed as a medical device to treat severe acute trauma. It has recently gained popularity among laparoscopic surgeons as a means of preventing adhesions and internal scarring. Intraoperatively, SIS is placed beneath the peritoneal surface as a barrier that prevents implant migration and reduces adhesion formation, while allowing the free flow of nutrients and waste products. Studies show that intraperitoneal placement of SIS decreases the incidence of organ adhesions and improves healing time.
After surgery, patients receive drains that are attached to tubes running directly outside of the body. Drains remove debris and fluids created by surgery. Patients can expect to spend 24 hours or more lying flat in bed with their arms elevated above the head. They also need to elevate their legs higher than usual and wear loose-fitting elastic garments to protect them from getting tangled in wires and catheters.
If you’ve experienced post-surgery shoulder pain, there are several steps you can take to ease the pain and get relief. First, consult your doctor to find out whether the pain is related to the surgery or simply part of normal recovery. Your physician can recommend treatments that will help alleviate your discomfort. Second, try taking ibuprofen, acetaminophen or aspirin before going to sleep. Third, apply ice packs wrapped in a towel to the area around the shoulder. Ice helps reduce swelling. Fourth, elevate the arm above the level of the heart, which puts less pressure on the shoulder and allows blood to circulate freely. Lastly, don’t forget to breathe! Good ventilation and deep breaths promote good circulation and help flush away toxins.
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