Potential Issues After Surgery:
After surgery, potential issues might include lymphedema in the affected upper limb, tightness in the chest wall or underarm of the operated side, limited shoulder mobility or pain, weakness in the affected upper limb, and impaired cardiovascular and pulmonary functions. Early intervention, consultation, and the development of a suitable rehabilitation exercise plan can help maintain your quality of life and prevent complications.

Physical Therapy and Exercises After Surgery:

1. Preventing Swelling:
   Exercise 1: Lie down with the affected arm opened at 45-90 degrees, place two pillows underneath the arm to elevate it above the heart. Extend the wrist and straighten the elbow for about 5 seconds (Figure 1), then bend the wrist and elbow to touch the shoulder for about 5 seconds (Figure 2). Repeat the back-and-forth motion 10 times, 3 times a day.
   Exercise 2: Sit or stand, raise both arms above your head. Follow the recommended frequency as mentioned above (Figure 3).
2. Preventing Scar Adhesions in the Incision:
   After the scar has initially healed (about 3 weeks), apply gentle pressure to the scar and surrounding tissues to soften them, reduce adhesions, and flatten the scar.
   Scar Massage: Gently press on the scar and apply stable pressure along the length of the scar. After the pain sensation decreases, you can vertically press and move the scar up and down, repeating 3 to 5 times. You can also massage the muscles around the incision.
3. Preventing Reduced Shoulder Joint Mobility or Pain:
   Fear of pain or tearing around the incision can lead to insufficient movement post-surgery. Prolonged immobilization can cause muscle stiffness, reduced blood circulation, and limited mobility. Over time, this might lead to symptoms and pain similar to frozen shoulder. Appropriate and gradual movements are necessary to prevent future issues.

Wall Climbing Exercise (Abduction, Flexion):
Exercise 1: Stand straight facing a wall with both palms against it, arms flexed (Figure 4). Use your fingertip pads to lift both hands along the wall until you feel a gentle tension (not pain) for about 15 seconds. Lower them back down. Repeat 10 times, 3 times a day.
Exercise 2: Stand straight facing a wall, place the affected arm against it with the arm extended sideways (Figure 5). The rest of the motion is the same as exercise 1.

After Surgery, potential complications might include:

• Infection around the surgical site, with a likelihood of less than 1%.
• Swelling or bruising near the incision site.
• Postoperative bleeding leading to hematoma. This usually occurs within 2 to 4 hours after surgery but can also happen within minutes. Large hematomas might cause breathing difficulties and require urgent attention, with a rate of occurrence less than 1%.
• Unilateral recurrent laryngeal nerve paralysis resulting in hoarse voice. Bilateral recurrent laryngeal nerve paralysis can lead to breathing difficulties, with a likelihood of about 1%.
• Paralysis of the superior laryngeal nerve causing an inability to produce high-pitched sounds.
• Postoperative hypocalcemia or hypoparathyroidism, leading to numbness or muscle cramps. This condition is relatively common but often temporary.
• Despite a high success rate for surgery of secondary hyperparathyroidism, 2 to 12% of patients may experience continued or recurrent high blood calcium after surgery. Common reasons for failure include gland rupture during surgery, failure to locate all four parathyroid glands, and the presence of more than four glands or ectopic glands.

Postoperative Care:
Regularly monitor parathyroid hormone levels and supplement calcium as necessary.