mtomaino
08-09-2010, 05:55 PM
I saw a patient today who had an arthroscopic shoulder surgery for Impingement syndrome 2 months ago (see the instructional video regarding what we mean by "Impingement" and the surgery for Impingement on the shoulder section of this website.)
Her preoperative MRI showed mild tendonopathy (swelling in the rotator cuff tendon), and she had not, for all intents and purposes, responded to physical therapy. So, the surgical intervention was certainly indicated.
After surgery, however, she felt more pain than before, and at her most recent appointment with her Orthopaedic surgeon, a mere 8 weeks after surgery, she was told that she needed to see a Pain Management Physician. She was told she might have an "RSD", which is short for reflex sympathetic dystrophy---a "pain syndrome."
She was a bit dismayed by all this (needless to say) and was referred to me for a 2nd opinion. After my examination it became clear that she did not have a "pain syndrome"; rather, she was having pain due to capsular stiffness---especially her posterior capsule. In short, in the early postoperative period, she had developed a mild-moderate frozen shoulder. I recommended a cortisone shot, and referred her to one of my PT colleagues for more aggressive therapy. I shared with her that I am hopeful that her pain will dissapate as her motion improves, an reassured her that at 8 weeks after surgery, it was still quite early.
So---one might ask.......2 orthopaedic surgeons......why such different impressions?
It's hard to answer that except to acknowlege that the 1st never really examined his patient after the operation (according to her), and, therefore, may not have appreciated the stiffness that had developed.
Because "Pain" is now a recognized specialty, I have noticed that the mere mention of "Pain" too often results in a "referral to a pain physician." This is usually not appropriate until all potential "somatic" causes of pain have been ruled out.
In the setting of a shoulder condition such as Impingement, postoperative pain may result from capsular contracture, scar tissue, a partial tear of the rotator cuff, or involvement of the long head of the biceps tendon.
In keeping with my "YOUR SHOULDER. YOUR CHOICE" mantra-----------before you are told that the Pain needs to be treated by a pain physician, think about getting a second opinion by a Shoulder Specialist.
Treating your shoulder is our privilege.
Her preoperative MRI showed mild tendonopathy (swelling in the rotator cuff tendon), and she had not, for all intents and purposes, responded to physical therapy. So, the surgical intervention was certainly indicated.
After surgery, however, she felt more pain than before, and at her most recent appointment with her Orthopaedic surgeon, a mere 8 weeks after surgery, she was told that she needed to see a Pain Management Physician. She was told she might have an "RSD", which is short for reflex sympathetic dystrophy---a "pain syndrome."
She was a bit dismayed by all this (needless to say) and was referred to me for a 2nd opinion. After my examination it became clear that she did not have a "pain syndrome"; rather, she was having pain due to capsular stiffness---especially her posterior capsule. In short, in the early postoperative period, she had developed a mild-moderate frozen shoulder. I recommended a cortisone shot, and referred her to one of my PT colleagues for more aggressive therapy. I shared with her that I am hopeful that her pain will dissapate as her motion improves, an reassured her that at 8 weeks after surgery, it was still quite early.
So---one might ask.......2 orthopaedic surgeons......why such different impressions?
It's hard to answer that except to acknowlege that the 1st never really examined his patient after the operation (according to her), and, therefore, may not have appreciated the stiffness that had developed.
Because "Pain" is now a recognized specialty, I have noticed that the mere mention of "Pain" too often results in a "referral to a pain physician." This is usually not appropriate until all potential "somatic" causes of pain have been ruled out.
In the setting of a shoulder condition such as Impingement, postoperative pain may result from capsular contracture, scar tissue, a partial tear of the rotator cuff, or involvement of the long head of the biceps tendon.
In keeping with my "YOUR SHOULDER. YOUR CHOICE" mantra-----------before you are told that the Pain needs to be treated by a pain physician, think about getting a second opinion by a Shoulder Specialist.
Treating your shoulder is our privilege.