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Shoulder Popping After Rotator Cuff Surgery

Shoulder Popping After Rotator Cuff Surgery

Physical therapist evaluating a patient who is suffering from shoulder popping after rotator cuff surgery

You can only describe the sensation in your shoulder as “intense pain”. You’ve got some weakness in your arm and have difficulty moving your shoulder, too. You may have felt a “pop”, but even if not, you remember the instant you hurt your shoulder. Also, now, whenever you move your arm, especially out to the side, your shoulder snaps, crackles, and pops. Then again, some patients tear their rotator cuff without any of these acute symptoms, especially if the tear creeps up over time with overuse.

If your tear is only partial, you probably only feel a dull pain and have some minor difficulty moving your arm. Complete tears are more painful and make it pretty much impossible to move your arm normally, especially raising it away from your side.

What Causes Rotator Cuff Tears

Many tendons and muscles connect your arm bone to your shoulder joint. Since this area has a low blood supply, the tendons and muscles tend to suffer from wear and tear as you get older. As the tendons weaken, you are more likely to injure your shoulder with activities like overhead lifting.

Rotator cuff tears are either from chronic overuse, or they happen suddenly from a specific accident. The tendon can be completely severed and split into two pieces, often breaking off where it attaches to the arm bone. Many injuries and overuse tears are partial tears, so the tendon takes damage but remains in one piece.

Treatment For Shoulder Rotator Cuff Tears

About half the time, the pain reduces, and the function returns without surgical intervention. You can’t reattach torn tendons without surgery. Still, many patients find they get enough function without pain to forego the surgery.

  • First, rest. Stop whatever activity caused the trauma or what you were doing to overuse your shoulder. Take some time off from lifting overhead, for example.
  • Start with an ice pack, on for no more than 20 minutes, and off for at least 20 minutes. Keep the ice pack wrapped in a towel to protect your skin. The cold numbs the area to provide pain relief and reduce inflammation.
  • When your doctor or physical therapist advises, you can move to adding heat. A heating pad can be delightfully soothing and helps improve blood circulation to aid healing.
  • Anti-inflammatory medicines help to control the pain. Ask your doctor or pharmacist about potential drug interactions.
  • Physical therapy helps reduce pain and improve function, possibly reducing the need for surgery. Plus, recovery results are better for patients who have physical therapy both before and after surgery.
  • Your doctor may recommend a series of cortisone injections. This steroid works to reduce inflammation, which lessens pain and temporarily improves function. These injections are often combined with physical therapy.

Shoulder Surgery for Torn Rotator Cuffs

Your doctor is likely to recommend surgery if your pains and symptoms persist over 6 months. They may also suggest surgery or large tears (over 3cm) if you have significant weakness or loss of function or if the pain affects your sleep or quality of life.

Partial tears usually get better with non-surgical interventions. But a complete tear requires surgery to reattach the tendons to the bone. Surgery is usually recommended within 3 months with a complete tear.

Shoulder Popping After Your Surgery

Some clicking and popping in your shoulder are normal for up to a year after you have surgery. The swelling and scar tissue form inside the joint, making noises when you move your arm. It takes some time for the rotator cuff and labrum to heal and reattach to the bone. So, you may hear (or feel) the popping sensation while healing continues.

Some specific shoulder injuries can cause popping, so always make sure you mention the popping noises to your physical therapist at Summit Physical Therapy in Merrick, NY.

1. Rotator Cuff Re-Tears

Even after surgery, the tendons in your shoulder can re-tear from overuse or heavy overhead lifting. The pop or cracking sound may happen at the moment you re-tear your tendon or whenever you try to move your arm. The popping noise is probably no different than from before surgery if you have a re-tear injury.

2. Labral Tears

When pain comes with grinding or popping, you may have a labral tear, especially after an injury, dislocation, or subluxation (partial dislocation).

3. Impingement

As tissue rubs against itself in your shoulder blade, it irritates the tendons and bursa. This is commonly caused by repetitive movements, like swimming or working construction. 

4. Bursitis

When the bursa, the fluid-filled sacs in your shoulder, get inflamed, they can hurt, and you may hear popping when you move your arms.

5. Osteochondroma

Benign bone growths can appear on the rib cage, shoulder, or scapula. You might hear a pop when you raise your arm, but it rarely causes pain.

6. Osteoarthritis

Bones rub together, indicating the cartilage has started to break down. The popping noise in your shoulder could be an early sign of osteoarthritis. 

Pain and popping noises in your shoulders need assessment, especially after a recent injury. The physical therapists at Summit Physical Therapy in Merrick, NY, will assess your condition and recommend an appropriate treatment.

Rotator Cuff Re-Tears

Surgery repairs the tear by suturing the tendon back into the original position. However, it is possible to re-tear your rotator cuff, even after you’ve had surgery. Re-tears are most common after repairing a large tear. If you have pain, popping, or difficulty using your shoulder, you may have a re-tear.

Complications that Make Re-Tears More Likely

Rarely a surgical complication makes it more likely that you will re-tear your rotator cuff. More frequent reasons are:

  • Surgical sutures pulled out
  • Muscle contractions during post-surgical immobilization
  • Age of patient
  • Patients not following post-surgery instructions
  • Changes in the tendon
  • Patient general health
  • Specific medications
  • Pushing too hard and doing too much

Sometimes, you might not even notice a re-tear, but your surgeon or physical therapist may notice during a follow-up assessment. In a physical exam, your shoulder may have some reduced range of motion, function, or strength.

If you do too much, too soon, your repair could fail. After 3 months, you only have about half of the strength of the repair. So, the first 3 months are the most important in your recovery. Pain is not a reliable indicator of progress, so always follow your surgeon’s and physical therapist’s instructions for a successful recovery.

If you have persistent pain, popping, or trouble working with your arm and shoulder after a few months, this could be a sign you have a rotator cuff re-tear.

You’ll begin with the same conservative treatments as before your surgery. Rest, modified activities, wearing a sling, and physical therapy help improve function and stability and reduce pain.

Surgery for Rotator Cuff Re-Tears

If your shoulder still pops, hurts, and doesn’t work right, you may need to consider repeat surgery. Sometimes it’s necessary to remove the frayed ends of the tendons. With extensive tearing, tendons can be transferred. Sometimes it is the bone quality at fault, so joint replacement becomes a possibility.

The post-surgical phase is even more critical for rotator cuff re-tears. Expect a thorough, steady physical therapy rehab program to allow your tendons the time they need to heal for a better outcome after a re-tear.

Wearing a Sling

Usually, you will wear a sling for 4 to 6 weeks, day and night, depending on the nature of your surgery. It is critical that you don’t use your arm muscles. 

Your sling should be comfortable, with your hand in the middle of your stomach. Pillows, cushions, and blankets may make it easier to get comfortable. Avoid low furniture like couches and chairs or recliners that are hard to get into or out of without using your arm.

Physical Therapy After Shoulder Surgery

Physical therapy usually starts 10 days to 3 weeks after your shoulder surgery unless otherwise directed by your surgeon. Your commitment to your physical therapy and home exercise program is critical to getting your shoulder back to working normally.

If you had a shoulder manipulation performed under anesthesia, your surgeon might recommend that your physical therapy begin the same day and continue for three days. Follow the instructions from your physical therapist very closely.

To start, your physical therapist uses passive motion to keep your muscles supple. After your shoulder has healed some, your physical therapist will move into more active therapies to help rebuild your strength and flexibility.

In Conclusion

Don’t ignore that shoulder popping after rotator cuff surgery. It may be the normal sounds of healing, or it may require specific intervention. If you ignore the pain or popping noises, your shoulder may not heal properly. Check out some frequently asked questions about shoulder pain or call Summit Physical Therapy in Merrick, NY, for an appointment today.

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