Massive inflammatory response after shoulder injury

@ndmcl49 Histamine issue, probably very likely. Wonder if an antihistamine would help? You probably upped your use of pain relievers with that rotator tear. That may be the biggest issue.
I have a funny response to advil, so I’m always investigating what else might be true about pain relievers. I looked this up - see attached screenshot.

@triciaot
Thank you for your response. I really appreciate your taking the time. Actually, I did not have any corticosteroids or pain medication. I think my body just went into rebellion! And I have a number of autoimmune conditions, so that may have contributed to my reaction to the rotator cuff tear.

@ndmcl49 Welcome to Mayo Clinic Connect. Your question stood out to me as I experienced something similar although the conditions were different but resulted in same physiologic response that can occur with underlying autoimmune conditions. In my case, mine was heightened by immunotherapy which led to immune checkpoint inhibitor colotis which in turn led to enteropathic arthritis, or pseudogout - in short, a huge inflammatory response resulting in 60cc of fluid accumulating in one knee alone. In fact, I learned about my own RTC (rotator cuff tear) when I had a flare over the winter that caused shoulder pain.

So, short answer: YES. This is largely due to the release of cytokines, chemical messengers of sorts in the immune system that can become activated with inflammation, infection or injury within the body. Another protein in the body also rises during such times, CRP or C-reactive protein. In cases of skin disorders, this can result in increased irritation, dryness, redness, and itching. In my case, it affected something known as the gut-joiint axis. It's really amaizing to see how interconnected the body is and how it can react - but sure is debillitating to suffer through these consequences, isn't it? Are you feeling some relief now, and how is your RTC being treated?

@grammato3 Thanks so much for your response. I was scheduling for a shoulder replacement, but decided to postpone the surgery until I get past this inflammatory phase. My range of motion and discomfort have improved and I’m able to function pretty well in the interim.
Interestingly, my liver enzymes became elevated after the tear (I have a history of mild autoimmune hepatitis), but have since returned to an almost normal. As you said, it’s amazing how interconnected everything is!
May I ask how you resolved your inflammation?

@ndmcl49 This discussion is very interesting to me right now. Yesterday I had wrist replacement surgery.

Last week I saw my rheumatologist for my semiannual visit, and when he saw the surgery on my schedule, he said "Even with your regular meds, this may cause your RA to flare. I am going to prescribe prednisone to use after surgery as soon as you recognize a flare."

Monday I saw my pulmonology team for my regular visit re asthma and bronchiectasis, and to my surprise, they said almost exactly the same thing! When I said I already had an Rx from the other doc, she said "don't hesitate to use it, so you can stay under control." I was surprised, but now that I think about it my last major bronchiectasis flare came right after rotator cuff surgery in 2024, when I was unaware of the connection. I ended up on both prednisone and antibiotics to clear it up, and wouldn't like to do that again.

Are you doing better with your pain now?

@ndmcl49: the underlying cause of colitis needed to be treated. Generally this would be a course of steroids but due to my hip issue of avascular necrosis (death of the bone as a result of compromised blood flow following a pinning for a fracture; I’ll be having a hip replacement in September), such treatment is contraindicated as it could further advance bone loss. Instead, I’ve been placed on biologics to target the GI inflammation which in turn helped suppress the joint swelling.

I had a course of PT for my shoulder which helped when the pain and range of motion was at its worst. Surgery for repair still remains an option but my priority now is the hip replacement. If I find I can manage with the shoulder limitations I currently have, I may forgo surgery as I have other conditions (metastatic melanoma) that may play a role in recovery so I’m taking it one step at a time, so to speak.

How are you managing now with the inflammation in the various areas?

@sueinmn Did you have your wrist surgery?

@sueinmn Thank you for your comment. I’m so sorry that you had flareups after your rotator cuff surgery. I did read online that RCS can trigger autoimmune conditions, even if one doesn’t have one beforehand. My neighbor had her shoulder replaced and now has Sjogren’s disease and possible lupus.
My pain level is manageable, thanks, so I’ve indefinitely postponed the surgery, at least until the skin problems have subsided.
I wish you well with your post-surgery recovery.

@ndmcl49: I ought to add that when both my knees were both inflamed with fluid I did need to have them aspirated. There is a medication for gout, unfortunately the side effect is diarrhea and I had enough of that with the colitis so I did have to live with the inflammation during the worst of it as it also affected my hip, elbow and shoulder. The winter was not a fun time! Hope your inflammation settles quickly and you’re able to possibly able to avoid surgery.

@grammato3 Thanks so much. Dealing with inflammation and discomfort can be difficult without medication, but if one can get through it, one can avoid the side effects from the medications. I hope your worst reactions are behind you.