Question: "I had surgery to correct pain in my shoulder that resulted from a car accident. Two and a half years later, I'm still having pain through my upper arm, although nothing shows up on a scan or X-ray. I can't lift my arm without some kind of pain. Could there be some kind of nerve damage?"
Answer: This is a complex question, but I hope I can provide some insight.
The nature of the original injury and surgical procedure are important variables. Each injury has its own expectations for how it will behave in the future: will it get better on its own or is surgery necessary?Likewise, each surgical procedure has its own risks and expectations.
In general, persistent pain in this situation could signify any number of problem, including:
- Stiffness: Scarring from the injury and surgery may limit normal movement and produce pain.
- Weakness: Lack of strength of the shoulder muscles may lead to abnormal patterns of movement, which can cause overuse of other muscles, fatigue and pain. Stiffness and weakness can be addressed through a supervised physical therapy program.
- Healing: Failure of the tissues or bone to heal could be a source of pain. For example, a repair of the rotator cuff may not heal or may re-tear.
- Nerve damage: Nerve damage can also produce pain. This is usually associated with weakness, muscle atrophy and sometimes numbness or tingling. Damage to a nerve may itself generate pain. The pain could also come from weakness of the muscle(s) supplied by the nerve, which can cause weakness and abnormal shoulder movement.
- Miscellaneous: Other causes can include arthritis or implanted hardware.
Not all problems can be seen on an X-ray and sometimes other testing, like an MRI test, is needed.
Paul S. Sherbondy, MD is an orthopedic surgeon with the Penn State Hershey Bone and Joint Institute—State College, home to Penn State Sports Medicine. He is on staff at Mount Nittany Medical Center. Read more about Mount Nittany's orthopedics program, an Area of Focus, by visiting www.mountnittany.org/orthopedics.
This article was originally published in the July issue of State College Magazine.