Is Shoulder Pain Normal After Appendix Surgery? Here’s What You Need to Know!

Despite the advantages of laparoscopic surgery, many patients report experiencing shoulder or subcostal pain after the procedure.

After an appendectomy, patients often experience unexpected shoulder pain. (Pixabay).

Published on:

17 Dec 2024, 4:00 am

After undergoing an appendectomy, many patients expect relief from the painful symptoms of appendicitis. However, an unexpected discomfort can arise—shoulder pain. While it may seem unrelated to abdominal surgery, this common post-operative symptom can leave many wondering why their shoulder hurts. If you’ve recently had your appendix removed and are dealing with this puzzling pain, you're not alone. Here’s a closer look at what might be causing the pain and how you can find some much-needed relief.

Appendectomy is one of the most commonly performed surgical procedures. While the open method was once the standard treatment for acute appendicitis, laparoscopic appendectomy has gained significant popularity in recent years.

In laparoscopic surgery, creating a pneumoperitoneum is a crucial step, allowing the surgeon to view and access internal organs through small incisions. This process involves introducing gas, typically carbon dioxide (CO2), into the abdominal cavity to create space for the surgeon to work without interference from surrounding organs. Pneumoperitoneum helps the surgeon see and access organs more easily, allows for smaller incisions, reduces pain and scarring, and ensures stable pressure, minimizing complications.

In laparoscopic surgery, creating a pneumoperitoneum is a crucial step, allowing the surgeon to view and access internal organs through small incisions. (Pixabay)

Why Shoulder Pain Occurs After Laparoscopic Appendectomy

Despite the advantages of laparoscopic surgery, many patients report experiencing shoulder or subcostal pain after the procedure. This can be puzzling, as the pain seems unrelated to the surgical site. The main cause of this discomfort is referred pain, which occurs when the body perceives pain in an area other than where the injury or irritation actually occurs.

The Role of the Diaphragm and Its Connection to the Shoulder

The diaphragm is a muscle that separates the chest from the abdomen and plays an important role in respiration. During laparoscopic surgery, CO2 gas is introduced into the abdominal cavity to create a pneumoperitoneum. This gas can irritate the diaphragm, which is closely linked to the phrenic nerve. The phrenic nerve not only controls the diaphragm but also has branches that connect to the shoulder area, particularly the C4 spinal nerve. As a result, irritation or stretching of the diaphragm from the CO2 can cause pain signals to be transmitted to the shoulder, leading to referred pain. This is why patients may experience shoulder pain despite the surgery being performed in the abdomen. The pain typically occurs in the right shoulder but can also be felt in the left shoulder, depending on which part of the diaphragm is irritated. This pain usually begins one or two days after the surgery, as the CO2 gas gradually irritates the diaphragm.

Expert Insights

For a clearer understanding of the connection between laparoscopic surgery and shoulder pain, check out this Instagram reel by Dr. Hunter Norton, a Urology PGY-1 resident, (@nort_fam). In the video, Dr. Norton explains the mechanism behind referred pain after surgery and the role of the diaphragm in causing post-operative discomfort.

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How Long Will the Pain Last?

For most patients, shoulder pain lasts only a few days and usually subsides as the CO2 gas is absorbed and the irritation to the diaphragm decreases. However, in some cases, the pain may persist for up to a week or more, depending on individual factors such as the amount of CO2 used, the duration of the procedure, and the patient’s sensitivity to the irritation.

Managing Post-Surgery Shoulder Pain

While shoulder pain is common after laparoscopic appendectomy, it is usually mild and temporary. There are several ways to manage this discomfort:

Over-the-counter pain relievers such as ibuprofen or acetaminophen can help reduce pain and inflammation, unless advised otherwise by your doctor.
Applying heat or cold to the shoulder can provide relief, with heat helping to relax muscles and cold numbing the area, after the first few days.
Gentle movement or light stretching, as advised by a healthcare provider, can help relieve muscle tightness.
Positioning during rest can help prevent further irritation, such as using pillows to support the body in a comfortable position.

When to Seek Medical Attention

While shoulder pain is usually harmless, it’s important to seek medical advice if:

The pain becomes severe or doesn’t improve within a few days.
There are additional symptoms, such as difficulty breathing, chest pain, or fever.
Signs of infection appear at the surgical site, including redness, swelling, or discharge.

Shoulder pain after an appendectomy might feel unsettling, but it’s generally temporary and part of the healing process. Most of the time, it will go away on its own within a few days. If it persists or you experience other concerning symptoms, it is advisable to contact your doctor. Rest easy knowing this discomfort is usually nothing to worry about!

References:

Kim, Bomi, Jungbin Kim, Inseok Park, Hyunjin Cho, Geumhee Gwak, Keun Ho Yang, Byung-Noe Bae, and Kihwan Kim. "Unmodifiable Clinicopathological Risk Factors of Shoulder Tip or Subcostal Pain after Laparoscopic Appendectomy." Journal of Minimally Invasive Surgery 23, no. 1 (2020): 43–48. https://pmc.ncbi.nlm.nih.gov/articles/PMC8985640/. Accessed December 17, 2024.
Mishra, R.K. "Management of Postoperative Shoulder Tip Pain after Laparoscopy." World Laparoscopy Hospital, March 7, 2023. https://www.laparoscopyhospital.com/worldlaparoscopyhospital/index.php?pid=257. Accessed December 17, 2024.

By Dr. Sruthi Suresh

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