2 weeks post op some questions<

[Vera]

Hi I am 68 yo and had a shoulder repair, reattached tendon, a large bone spur removed and a bicep repair and am still in pain much of the time.

I am icing my shoulder when the pain is really bad, taking one codeine and 2 paracetamol during the day when the pain is bad and at night I take a sleeping tablet. I have to use a box sling 24 hours a day and have been told I need to use this until I am 6 weeks post op.

I do some passive exercise 3 times a day and seem to manage, I have been going out shopping or for a short walk and come home in agony.

Is this normal? Am I taking too much pain medication? Will the pain eventually wear off?

 

[Jockette]

Hi and Welcome to Bonesmart!

I am going to tag @Josephine
our forum administrator and nurse director to address your concerns.

I have not had any shoulder surgery myself, but am beginning to have some shoulder issues.

Best wishes for your recovery!

 

[skigirl]

I have had two rotator cuff tears and you had even more done to your shoulder. I found it to be a very painful surgery. So, I think you probably need more pain relief, not less. I found that the pain began to abate in the second week, but I took pain meds for at least 3 weeks.

If you are having so much pain after activity, I would ask two questions, is the strap on the sling tight enough so that your arm is totally supported? If not, tighten it up. Any movement bothered my shoulder, so I sometimes put a strap on the outside of the box sling so that it could not move forward.

By week 4 I was back to hiking, but only with an extra strap around my sling (which I hated, by the way!!) because I did slip once and went down a hill slipping on plants. landed on my rear end and finally stopped!! I was completely uninjured, but was glad i had that extra strap on.

By the end of the 4th week, I was back to coaching soccer---but with the extra strap. Are you going to PT? I found the massage and gentle movements that they supported were very helpful to recovery. The moved my arm for me so that I retained a range of motion. I was unable to make those moves myself.

The greatest pain comes when the arm moves closer to your torso, that puts the strain on your muscles and the repair. Hence the box sling which holds your arm away from your body. If the walks cause you pain, then shorten or eliminate them until your pain is under control.

 

[Josephine]

I agree with skigirl - you're not taking enough pain meds, nowhere near!

I'd really like to offer you some structured advice but in order to do that, I also need to ask you some questions. Are you willing for me to do that?

 

[Vera]

Thanks for your replies. I have not started PT yet but have been thinking that I might do so as the pain in my neck is sometimes really painful too. I’m sure it’s the sling. My specialist said to wear the sling where it feels the most comfortable. It is 3 weeks today since the surgery I have a little more movement now and at times will sit without it on. Still taking pain medication but not as often. Josephine I am happy for you to ask me more questions.

 

[Jockette]

Just want to let you know Josephine is off this week, she’ll be back the 29th.

I’m sorry you neck is getting stressed from the sling. It doesn’t take much for my neck to hurt, the slightest different angle or weight will upset it.

And please tell us the exact date of your surgery and we’ll make a signature for you.

 

[skigirl]

I think that you need PT after rotator cuff. A lot of the exercises in the beginning were done by the Pt so that I could keep my range of motion. I cold not move the arm for about two weeks, so the PT moved it for me.

 

[Vera]

Surgery was 4th October exactly 3 weeks today. My specialist gave me passive exercises to do from day 1. Some were assisted with my right hand, some just simple movement of my left arm. Where it was painful from the beginning both are not as painful now. I am going to ring the Physio today to make an appointment.

 

[Josephine]

1. what are your pain levels right now? (remember the 1-10 scale: 1 = no pain and 10 = the worst you can imagine. And don't forget to factor in other forms of pain such as soreness, burning, stabbing, throbbing, aching, swelling and stiffness).

2. what pain medications have you been prescribed, how much are you taking (in mg please) and how often?

3. are you icing your shoulder at all? If so, how often and for how long?

4. what is your activity level? What do you do in the way of housework, cooking, cleaning, shopping, etc., and

5. are you doing any exercises at home? If so what and how often?
This is the most crucial question so please help me by using the format I have left as an example
(which means please make a list and not an essay!)

Exercises done at home
- how many sessions you do each day
- enter exercise by name then number of repetitions of each

Anything done at PT
- how many times a week
- enter exercise by name then number of repetitions of each

 

[Vera]

1. Pain level full aching pain 6/10
Burning pain by late afternoon 6:/10
Jarring pain in the shoulder at times when I move my arm in the shower 9/20

2. codeine 2 every 4 to 6 hours. I have oxycontin if it gets really bad and a slow release pain medication that I can take every 12 hours. I try to avoid taking the last two unless the Odin I dream bad
Also have prescribed sleeping tablets that I take each night

3. I ice my shoulder when pain is bad

4. I can’t do a great deal but shower. I can dress myself now
Go grocery shopping with my husband short walks with my husband and dogs

5. with my arm by my side I lift it to my breast x10 x3 times a day
use my other arm to rotate my arm to 45 degrees to the side x20 x3 a day
Hand flexing turning my hand from front to underside the same amount of time

I have not started PT yet my doc had given instructions for me to take to PT once 6 weeks are over.

 

[Josephine]

a slow release pain medication that I can take every 12 hours. I try to avoid taking the last two unless the Odin I dream bad
Also have prescribed sleeping tablets that I take each night

Before I get to your answers (thank you) can you tell me the following
1. What is the name of the slow release medication?
2. what is the name of the sleeping tablet
3 what do you mean by this "unless the Odin I dream bad"

 

[Vera]

Thanks for taking the time to respond to this Josephine, I really thought my shoulder would be feeling better and while it is better compared to 3 weeks ago I am still getting quite a bit of pain at times, it is almost 4 weeks since surgery now.
Slow release tablet is Tapentadol 50 mg
Lypralin 25 mg sleeping tablet
Sorry it was supposed to say “unless I have to”

 

[Josephine]

Right - the answers!

1. Pain level full aching pain 6/10
Burning pain by late afternoon 6:/10
Jarring pain in the shoulder at times when I move my arm in the shower 9/20

2. codeine 2 every 4 to 6 hours. I have oxycontin if it gets really bad and a slow release Tapentadol 50 mg that I can take every 12 hours.
I try to avoid taking the last two unless I have to.
Also have Lypralin 25 mg sleeping tablet that I take each night

Lypralin is a trade name for pregablin which actually is NOT a sleeping tablet or a pain medication but a medication used to treat neuropathic pain, epilepsy, fibromyalgia, and generalized anxiety disorder. In other words, it alters the way the pain receptors in your shoulder communicate with your brain. So you should take it routinely as prescribed regardless of your pain levels and remember to wean yourself off it when it is time.
Tapentadol likewise, is not a regular opioid pain med but what is called a benzenoid class drug. Analgesia occurs within 32 minutes of oral administration, and lasts for only 4–6 hours. So taking it sporadically is not the best way to manage your pain.
Codeine is okay but not the best kind of pain med in my opinion. And it causes constipation! You also haven't said what dose you are taking but if it's 30mg then that's not really any good.

I noticed you not mentioned using paracetamol which is a very good, non-opioid pain medication and you could take with the Tapentadol or codeine at 1,000mg 4 times a day at 6hrly intervals.

3. I ice my shoulder when pain is bad

I suggest you ice it for at least 40-60mins and more than 4 times a day.

4. I can’t do a great deal but shower. I can dress myself now
Go grocery shopping with my husband short walks with my husband and dogs

Got it.

5. with my arm by my side I lift it to my breast x10 x3 times a day
use my other arm to rotate my arm to 45 degrees to the side x20 x3 a day
Hand flexing turning my hand from front to underside the same amount of time

Not bad

I have not started PT yet my doc had given instructions for me to take to PT once 6 weeks are over.

Okay

 

[Vera]

Josephine, do you think I am better off not taking codeine? I take 1 with 2 paracetamol sometimes every 4 hours. It does do a great deal but can take the edge off the pain.

I will take on board your suggestion and take the lypralin throughout the day.
My doctor prescribed it to take one at night.

 

[Josephine]

do you think I am better off not taking codeine?

Why do you ask?

It does do a great deal but can take the edge off the pain.

Did you mean "it doesn't do a great deal"?

I will take on board your suggestion and take the lypralin throughout the day. My doctor prescribed it to take one at night.

If that's what your GP prescribed then I should check with him first. Tell him your pain management is not very good and you wonder if you should adjust the codeine and lypralin.