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Pain in Shoulder After Surgery

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QUESTION: Is it common to experience weakness in the shoulder/arm on the side of the mastectomy? I'm nearly six years past surgery. Recently, I have pain in my shoulder, especially during the night when it's more immobile. It especially hurts to move it and reach forward or across. Do you think there is any relationship between the surgery and this discomfort?

ANSWER: I'm sorry to hear that you're still having some weakness and pain in your shoulder on the side of your mastectomy after six years. It is not uncommon for women to experience numbness, pain, and weakness in the affected hand, arm, and shoulder in the immediate period following a mastectomy or axillary dissection (underarm lymph node removal). Most of these symptoms are related to the injury (stretching or cutting) of sensory nerves (the nerves responsible for feeling things). It is uncommon for any motor nerves (the nerves that tell muscles to move) to be injured by the surgery. That means that the muscles are usually ready to get back to work after the surgery. But your ability to move your arm and your shoulder may be limited by things other than strength—like pain, swelling, stiffness, and altered sensation in the armpit, shoulder, and upper arm area. If you are experiencing these symptoms, ask your doctor for a referral to a physical therapist, who can help relieve discomfort and regain range of motion. Then your muscles can get working again.

You must exercise regularly thereafter to maintain your range and strength. When new shoulder symptoms develop (pain or weakness), an evaluation by an orthopedist is warranted to be certain there has not been an injury to the rotator cuff (the group of muscles in the shoulder). Rotator cuff injuries are very common and can be treated with physical therapy and, if they are severe, surgery. New symptoms should be evaluated and assessed individually, as they may not be related to the prior procedure.

Anytime you have discomfort in an area, you tend not to use it because it hurts. Lack of use can then add to the overall problem. So, before you suffer any more than you have, take care of yourself and get some help with this as soon as you can.

—Anne Rosenberg, M.D.

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