How can I reduce internal adhesion formation after shoulder surgery?

From the Guidelines

To minimize internal scar tissue buildup after shoulder surgery, it is crucial to start with a structured physical therapy program, incorporating gentle stretching exercises and considering anti-inflammatory medications, as these interventions can significantly impact morbidity, mortality, and quality of life. When considering the management of internal scar tissue after shoulder surgery, the focus should be on minimizing its formation and impact on shoulder function.

• A structured physical therapy program under professional guidance is essential, typically beginning 2-6 weeks post-surgery, depending on the surgeon's recommendations 1.
• Gentle stretching exercises focusing on shoulder mobility, such as pendulum exercises and wall walks, should be performed daily to maintain range of motion and reduce stiffness.
• Anti-inflammatory medications like NSAIDs (e.g., ibuprofen 400-800mg three times daily with food or naproxen 250-500mg twice daily with food) for 1-2 weeks can help reduce inflammation, though it's crucial to consult a doctor before starting these medications 1.
• Massage therapy targeting the affected area can help break down adhesions when performed by a qualified therapist.
• Heat therapy (15-20 minutes several times daily) can increase blood flow and tissue elasticity, aiding in the healing process. In severe cases where conservative treatments fail, corticosteroid injections or arthroscopic surgery to remove extensive scar tissue may be recommended by a doctor, as these interventions can significantly improve quality of life and reduce morbidity associated with excessive scar tissue formation. Given the potential for significant morbidity and impact on quality of life associated with internal scar tissue buildup, early intervention with a combination of physical therapy, gentle stretching, and appropriately selected medications is key, and the choice of intervention should always prioritize minimizing morbidity, mortality, and maximizing quality of life 1.

From the Research

Reducing Internal Scar Tissue Buildup after Shoulder Operation

To minimize internal scar tissue buildup after a shoulder operation, several strategies can be employed:

• Adjusting surgical practice: Minimizing the invasiveness of surgery, reducing surgical trauma, and avoiding the introduction of foreign materials into the body can help decrease the formation of adhesions 2.
• Using adjuvants: Applying barriers, such as hyaluronic acid-phosphate-buffered saline solution or bioresorbable membranes, to protect peritoneal surfaces from indirect surgical trauma can reduce adhesion formation 2.
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Ibuprofen, a nonselective NSAID, has been shown to limit adhesion formation after flexor tendon repair, possibly due to its inhibition of both COX-1 and COX-2 3.
• Physiotherapy interventions: Certain physical therapy techniques, such as manual therapy, mobilization, and exercise, can help improve pain, range of motion, and functional status in patients with adhesive capsulitis, a condition characterized by the thickening and contraction of the gleno-humeral joint capsule 4.
• Topical NSAIDs: Topical application of NSAIDs, such as diclofenac, ibuprofen, and ketoprofen, can provide pain relief in acute musculoskeletal conditions, including sprains, strains, and overuse injuries, with minimal systemic adverse events 5.

Key Considerations

When attempting to reduce internal scar tissue buildup after a shoulder operation, it is essential to:

• Be aware of the potential for adhesive complications and take steps to minimize them 2.
• Consider the use of adjuvants, such as barriers, to protect peritoneal surfaces from indirect surgical trauma 2.
• Explore the use of NSAIDs, including ibuprofen, to limit adhesion formation 3.
• Incorporate physiotherapy interventions to improve pain, range of motion, and functional status 4.
• Utilize topical NSAIDs for pain relief in acute musculoskeletal conditions 5.