After reverse shoulder surgery

My husband had shoulder repair November 25th and has had horrible pain since day one with no improvement in almost 16 weeks. He wore that huge brace/contraption & after 6 weeks his doctor had him start PT. Painful as expected but his range of motion was good but the pain seemed to intensify. After almost 7 weeks of PT , they told him they were going to discontinue therapy and he needed to see his surgeon as he shouldn't be in the amount of pain he is. He got in to see doctor & an MRI with contrast was order & done 3/10/25. Doctor also felt he shouldn't be in this amount of pain. These were the results:

FINDINGS: There are changes of interval rotator cuff surgery and biceps tenodesis. There is a small partial-thickness defect of the undersurface of the insertion of the supraspinatus tendon which could be due to a persistent postoperative defect or a tiny recurrent partial-thickness tear. No full-thickness rotator cuff tear is noted. No significant rotator cuff atrophy. Moderate to severe osteoarthritis of the AC joint. There is an effusion of the AC joint. There is a tear of the posterior glenoid labrum, likely unchanged from previous exam.

IMPRESSION: 1. Interval rotator cuff repair and biceps tenodesis. Possible small recurrent or residual partial-thickness undersurface tear of the supraspinatus. No full-thickness tears or rotator cuff atrophy.
2. Tear of the posterior glenoid labrum, likely unchanged.
3. Moderate to severe osteoarthritis of the AC joint.

We had a follow-up appointment with the doctor (so we thought) but saw the NP instead who said my husband should have been scheduled with the surgeon. My husband has had 5 post-op appointments and only seen the actual surgeon once. We find that odd, but maybe not? Anyway, the NP is very nice, thorough and explains as much as possible but is not able to make any recommendations of what's next. We did ask her about the various shoulder replacements rather than going back in for just a repair & it failing or having to come back in a couple years for a replacement. She understood our concerns & said those are good questions to ask the surgeon. For those who've already been through this we're wondering what questions/concerns we should ask when we go back on the 14th for an actual appointment with the surgeon so that we can make an informed decision. Thank you.

I'm sorry your husband is still in so much pain - This is a very difficult situation. I had a complex rotator cuff repair in October, and my recovery is progressing slowly, but there is little pain. I agree with the PT and PA that you need reevaluation by the doctor. As many as 30-50% of rotator cuff repairs are termed unsuccessful, mainly because the soft tissue doesn't heal well.

Does your husband have any other health issues that might inhibit healing, like diabetes or age over 65? My surgeon's PA added 5-6 weeks to every stage of the healing/therapy time frame for me to make sure I heal fully.

I am not an orthopedic specialist, but even when my rotator cuff and biceps had full thickness tears, I had more pain from my torn labrum, arthritis and bone spurs (osteophytes) that often accompany it. My surgeon shaved off a lot of arthritic and misshapen bone, which possibly helped make my healing more comfortable. Maybe that is part of his pain?

And the "enforced rest" after surgery helped my labrum heal a little, but it began to hurt again as soon as I started PT. My therapist now has me on an every-other-day PT schedule, which means it's going to take a long time to get back to full use.

Please let us know what the surgeon has to say?

I also have had a tough time. I had reverse TSR 9/2023. I’m still in pain when doing various movements in everyday life. Therapy for over a year and still continuing due to tightness and pain in shoulder. They said pain was from my neck (cervical stenosis) and I had a block done and still have the pain. I pray everyday for relief and pretty much just deal with it. Aspirins upset my stomach. Needless to say this was not what I expected!! Best regards and prayers sent to you.

We had a follow up with the surgeon this morning & we left not feeling that positive with the so-called answers we received. Doctor's recommendation was to get cortisone shots and continue with PT. He did not bring up the 2 additional tears including the one in the Labrum or the Osteo Arthritis. We asked him about these issues & his reply was that he couldn't guarantee that any additional surgical repair would fix this and be successful. He said 60% - 70% of the time is additional repair successful. When we asked about the arthritis, he mentioned the reverse shoulder replacement but said there would be a lifetime restriction of 5lbs with that arm and if not careful dislocation could happen. He said that reverse shoulder replacement has been very successful but restrictive. My husband is 66 and until this surgery he was still very active doing construction projects and this would be prohibited. Doctor feels that it's not the rotator cuff repair that's causing him the pain, but something with the muscles in his shoulder but made no suggestion of seeing someone about that. I suggested to my husband that possibly we would need to get a 2nd opinion. He said he would go for the additional PT (with a different facility recommended by the surgeon) for 8 - 10 weeks to see if any improvement. He will not get the cortisone shots as #1 he HATES needles and #2 feels that's just a masking not a fix. So...at this point, this will be his next step and if no success, we'll go for a 2nd opinion. Thank you all for your responses.

I had a left shoulder reversal, five months ago. I thought I was doing OK with PT and would soon be out of pain, But the pain has worsened with my increasing attempts to increase my range of motion Now I am discouraged because whenever I try to work it out at all, the pain is just too much. My surgeon doesn’t seem to be too concerned, but I am because I have lived in pain for so long. I thought this pain would subside but the more I press in with my Physical Therapy the worse it gets! Is there anyone else out there who felt discouraged at month five but have now had a good outcome after more months of Physical Therapy?
I can raise it but it hurts like the dickens…..
Thanks,
MelanieMae

I would suggest changing PT and making sure you are working with a board certified licensed physical therapist who is trained to evaluate and determine specific locations and causes of your muscle or ligament pain, and set up a program to first relieve the pain, and then worry later about easing into expanded reach. If all they are interested in is just increasing your range of motion, perhaps your shoulder was pushed too hard for its state of healing at the time and now is easy to irritate. Everyone’s body heals at it’s own pace.

@melaniemae Same here, careful with reverse sh replacement: it honestly seems hit and miss; either great results, with dramatic relief from the pain almost immediately, or makes things worse. Ive been to hell and back with this. It's 12 months on the 23rd this month. Still worse thzn before surgery so no PT for me and waiting until all the muscles and tendons repair. I have reasonable RoM but constant pain in subscap since the RSA. And it is new.

Get another opinion from another surgeon or maybe even a physiatrist. Where do you live?

@babyjayne5977
I had reverse shoulder surgery a few years ago following a detached fracture of the humeral head. I have good, not perfect, range of motion and no pain in my shoulder. However, since the surgery, I have constant numbness in my pinky and ring finger. I do not have clawing, but I have dexterity issues with my hand as well as being unable to bend the tips of my fingers. Initially, the surgeon said the nerve issue in my hand would improve, but it has not. My last consultation with another surgeon said there would likely be no improvement. No one has been able to tell me what is causing the problem. The surgeon who repaired my shoulder did not mention a lifetime restriction of 5 lbs with that arm. That is important to know as I have been lifting much more than that.

@helen48 My surgeon told me a life time restriction of 30 lbs. I have occasionally lifted slightly more than that with no problems. I had a rTSR 12 months ago. Good luck.