Common pain generators after total shoulder arthroplasty and their pesky relatives

Although anatomic and reverse total shoulder arthroplasty (TSA) are generally very successful procedures with predictable pain relief, a small percentage of patients experience refractory pain postoperatively. Common etiologies of pain following such surgery are infection and joint instability in the early postoperative period, as well as implant loosening beyond 2 years postoperatively. However, once these causes of pain are ruled out, less common etiologies should be considered. These less common causes of postoperative pain include psychological factors (i.e., depression and anxiety), physiologic (i.e., narcotic dependence and neurologic), mechanical (i.e., symptomatic hardware and acromioclavicular arthritis), or secondary gain (i.e., workman's compensation and insurance issues).