Recovering From Shoulder Surgery Phase Two
It is common for patients who have had shoulder surgery to reach a plateau around the third to four month of their recovery. They typically are able to raise their arms in forward flexion (overhead) and abduction (straight out to the side), but cannot quite get the full range of motion. There is pain at the end point of movement in these positions.
Doctors typically would order more physical therapy with a patient like this but I have found over the years that pushing too much to stretch the shoulder doesn't work.
This stiffness is a part of the natural recovery pattern after injury or surgery of the shoulder, and no amount of physical therapy can force the process to resolve more quickly. Time and patience is the best way to deal with this situation.
My advice is to use your arm for all activities as much as you feel safe and comfortable in doing so. Your stiffness and end-range pain will gradually get better over four to six months.
Why does the stiffness cause pain? This is because the shoulder is meant to be a ball that rotates in a cup. The natural rotating movement is limited because the tight healing ligaments act as a tether. When the tight shoulder is forced forward or to the side it makes the ball glide in an upward direction until it bumps against the underside of the acromion (the boney roof covering the joint). So, as the patient reaches the end of their motion, they will fell shoulder pain similar to that seen in patients presenting with classic bursitis or impingement.
Our advice is not to push beyond what is reasonably comfortable, but also not to be afraid to go to the painful point. The key is repeated movement, not forceforceful movement. Through repeated use, the ligaments will gradually stretch out and the pain will go away when the motion comes back and the shoulder can rotate freely.
I have found that sending patients to physical therapy results in attempts by the therapist to regain motion through vigorous stretching or strenuous workouts which only make the shoulder inflamed and stiff. These efforts can work against recovery.
Some doctors that I speak with at meetings say they find a move away from physical therapy and toward independent exercise with return to normal activity at the work place and at home gives better results.