We often get asked questions about pain medication after shoulder surgery. The rehabilitation time and the pain relief needed depends on the shoulder surgery you have had. In all upper limb surgery including procedures under general anaesthetic and awake shoulder surgery, we use regional nerve blocks, where local anaesthetic is injected along the nerves that supply the arm. After surgery with a regional anaesthetic block there should be minimal or no pain. However, as the block wears off after around 24 hours, you will need pain management, so we will send you home with the required tablet painkillers.
On the first night after your shoulder surgery we advise taking the painkillers you have been prescribed before going to bed and take them first thing the next morning when you wake up. This will mean that you have a good level of painkillers in your blood system as any block wears off.
For added pain relief we advise that an ice pack be applied to the shoulder, between painkiller doses and just before bed, because cold treatment can be great in helping pain from inflammation after surgery. You can ice the shoulder as much as you need but each icing session should last no more than 20 minutes at a time. You can purchase a useful shoulder ice pack here (paid link).
You will need to use pain killers at different points to help facilitate your post-operative physiotherapy. Patients should not see using pain medication after shoulder surgery as a failure.
Pain Medications for After Surgery
It is important to remember that taking painkillers regularly as advised will aide your recovery. Plan to take them at least 30 minutes before any physiotherapy exercises, and the same before bedtime to help you sleep better. You can find more tips for sleeping with shoulder pain here.
Paracetamol is a simple over the counter painkiller that has very few side effects or interactions with other medications. To relieve pain effectively, it needs to be taken regularly, usually 4 times a day. There is no real limit as to when you should stop taking these, but if you are taking over the counter painkillers for more than a few days, you should get in touch as there may be an issue.
Ibuprofen is another popular over the counter painkiller and can be useful in helping to reduce pain and swelling. But on their own anti-inflammatories are not great as painkillers, so only use if the pain is due to inflammation. Note that anti-inflammatories can interact with some other medications; they can cause heartburn or stomach ulcers if taken on an empty stomach, and they can also affect your kidneys, so we do not recommend using prolonged courses of more than 2 weeks.
Avoid taking anti inflammatory drugs (NSAIDS) such as Ibuprofen for a shoulder or clavicle fracture, because studies show these may slow healing of your repair.
If the above over the counter painkillers do not work, then prescription drugs may be necessary to help with shoulder pain such as Co-codamol, which is a combination of codeine and paracetamol. Note that you cannot take Co-codamol with Paracetamol or this can cause a Paracetamol overdose.
Co-codamol is a good option following shoulder procedures, but it comes with side effects including drowsiness and constipation, meaning we usually prescribe other medications along with it to prevent the constipation. If drowsiness is a major problem, Co-codamol can be used at night to help with sleep and just use over the counter Paracetamol during the day.
Codeine is an opiate drug that we would prescribe for more chronic pain, but this comes with a warning that there is a risk of addiction meaning we avoid opioid prescribing for long periods, although we have not seen addiction issues.
Diclofenac is another useful prescription painkiller for pain management, which is an alternative anti-inflammatory to Ibuprofen because it is stronger. However, we try to limit its use for surgical pain to less than two weeks due to the risk of stomach ulcers and possible kidney damage.
We rarely issue strong opioid prescriptions for pain medication after shoulder surgery, such as Tramadol or Morphine, due to significant side effects and risk of addiction.
Shoulder Issues and Surgery Options
Here we look at a few shoulder issues and post operative surgery options, including what the recovery will involve:
Frozen shoulder is also known as adhesive capsulitis, which is an inflammatory condition affecting the capsule or joint lining of the shoulder. We do not know what triggers the condition, and the cause is unknown. It is not normally associated with trauma but can occur after some acute traumatic rotator cuff tears.
The operation to treat frozen shoulder is called an arthroscopic capsular release which is usually done with the patient awake using a regional nerve block, which usually lasts between 18-24 hours. A physiotherapist will see you prior to discharge to get the arm moving while the regional nerve block is still working.
Patients need to be aggressive with their physiotherapy in order to stretch the new scar tissue formed after surgery. Pain medications are routinely prescribed and should be started before the block wears off. In most cases we expect recovery from frozen shoulder surgery to be 3 months, but pain medication after shoulder surgery is usually not needed after the first few days when the surgical pain wears off. Painkillers may be needed from time to time during the 3 month recovery period in order to allow you to do the physiotherapy comfortably and effectively. Post-operative exercises are often painful and unless pain is controlled it is difficult to do exercises properly and this can negatively impact your recovery.
Acromoi-clavicular joint degeneration happens in the AC joint, which is a small joint at the top of the shoulder that is the articulation between the lateral end of the clavicle (collarbone) and the acromion, which is part of the shoulder blade. Early symptoms of AC Joint pain can be self-managed with over the counter anti-inflammatory drugs and painkillers.
If symptoms persist, then x-rays and an MRI scan may be needed to confirm the nature of the problem. If a steroid injection into the AC Joint does not control pain, the next step in management would be to consider an arthroscopic excision of distal clavicle. In short, we use a burr to clear out the joint space and shave the lateral end of the clavicle so there is enough of a gap between the bones, so the clavicle and the acromion do not touch.
After an arthroscopic ACJ excision, the patient should be able to go home on the same day because surgery is performed awake with a regional nerve block. Pain medications are routinely prescribed during the first 24-48 hours, and patients are usually in a temporary sling for 24 hours until the nerve block wears off. Once the feeling returns to the hand, the sling needs to be removed and physiotherapy should be started. In most cases we expect recovery from surgery to be 3 months, but pain medication after shoulder surgery is usually not needed after the first few days when the surgical pain wears off. Painkillers may be needed from time to time during the 3 month recovery period in order to allow you to do the physiotherapy comfortably and effectively. Post-operative exercises are often painful and unless pain is controlled it is difficult to do exercises properly and this can negatively impact your recovery.
Clavicle fractures occur in the clavicle (collarbone) which is a bone that connects the upper limb to the trunk of the body. They are one of the most common fractures in the upper limb and are mostly caused from a fall on an outstretched hand, and some lateral clavicle fractures result from falling directly onto the side of the arm/shoulder.
The majority clavicle fractures are treated without an operation, with a sling for around 6 weeks. Significantly displaced lateral and mid-shaft clavicle fractures may require surgery to allow healing and prevent the bone from setting in a poor position, known as a mal-union. Most are easily diagnosed with simple x-rays, however in some cases when planning surgery for complex fractures, or trying to assess fracture healing, a CT scan may be required for more detail.
Clavicle fractures that need surgery are treated with plating, which involves patients having a general anaesthetic and nerve block. An incision is then made over the clavicle, the fracture fragments are reduced, and a plate applied on to the bone. Once the fracture is fixed, the wound is sutured, and a sling is applied.
Patients usually go home on the same day as surgery and follow-ups will be arranged. Once the nerve block has worn off, some discomfort may be felt, so the pain medications prescribed should be taken to avoid this. X-rays will be taken in the clinic at 2 weeks, 6 weeks, and 3 months so we can monitor how the fracture is healing.
In most cases we expect recovery from surgery to be 3 months, when patients can usually get back to full activity, but pain medication after shoulder surgery should only be need for the first few days, then before or after physio sessions.
In most cases clavicle plates are left in for life but in some high-risk cases where there is a risk of future fracture, or in cases where plates or screws are prominent, a further operation may be required to remove the plate and screws, usually 6-9 months after initial surgery.
For more details on recovery from the types of surgery we perform see the page on Shoulder Surgery Recovery for full information.
Shoulder Surgery Sling
Most patients will be sent home with a temporary shoulder sling also known as a collar and cuff. This sling is meant to support the arm overnight as it is usually floppy from the nerve block. The next morning when the arm comes back to life, if instructed, the collar and cuff should be removed and disregarded, and exercises should start straight away.
Following some types of key-hole surgery such as arthroscopic rotator cuff repair, or arthroscopic shoulder stabilisation, or open surgery such a fracture fixation, you may be sent home from surgery with a more long-term shoulder surgery sling called a Polysling. After the operation we will tell you how long the sling is to be worn for. If you need to purchase an adjustable Polysling you can buy online from Amazon (paid link).
