Shoulder pain and dysfunction are common complaints that can significantly impact quality of life. Deciding whether to pursue shoulder surgery is a complex decision that should be guided by evidence-based care and research. At Accelerate Sport and Spine in New Braunfels, Tx, we see a lot of shoulders. Both athletes and non-athletes. Many come to us for a second opinion or after a failed surgery/rehab process. Surgery is great when it’s the right person, and the right shoulder. That does not mean surgery is always the best answer. I want to talk about the pros and cons of shoulder surgery, signs that surgery may be warranted, outcomes of surgical versus non-surgical approaches, and the short- and long-term risks involved.
Here are some questions to ask:
- What do I need to return to post surgery?
- How long can I afford to be without the use of my arm?
- Can I afford surgery?
- Have I given non-surgical treatments enough time and effort?
- Will surgery allow me to return to activities better than not doing surgery?
Signs That Surgery May Be Warranted
- Persistent Pain and Functional Limitations:
Patients who experience persistent pain and functional limitations despite conservative treatments (e.g., physical therapy, medications, injections) for 6-12 months may be candidates for surgery (American Academy of Orthopaedic Surgeons, 2023).
- Significant Structural Damage:
Conditions such as full rotator cuff tears/labral tears, or severe osteoarthritis may require surgical intervention, especially if imaging (MRI or X-ray) plus exam confirms significant limitations (Mather et al., 2013).
- Instability or Recurrent Dislocations:
Patients with recurrent shoulder dislocations or instability may benefit from surgical stabilization to prevent further damage (Mohtadi et al., 2014).
Pros and Cons of Shoulder Surgery
Pros:
- Pain Relief : Surgery can provide significant pain relief for patients with structural damage (Mather et al., 2013). Whether this is due to the rehab and recovery process or the surgery is not clear.
- Restored Function : Surgical repair can restore shoulder function, particularly in cases of full rotator cuff tears or instability (Mohtadi et al., 2014).
- Long-Term Stability : Surgery can prevent recurrent dislocations and further joint damage (American Academy of Orthopaedic Surgeons, 2023).
Cons:
- Surgical Risks : Complications such as infection, blood clots, and anesthesia risks are inherent to any surgery (Mather et al., 2013).
- Recovery Time : Post-surgical rehabilitation can take 6-12 months, requiring significant time and effort (Mohtadi et al., 2014). Success is deemed 85% preinjury ROM/Strength.
- Cost : Surgery is often more expensive than non-surgical treatments (American Academy of Orthopaedic Surgeons, 2023).
Surgical vs. Non-Surgical Outcomes
Research shows that surgical outcomes may be superior for specific conditions, for example rotator cuff repair surgery has been shown to improve pain and function compared to non-surgical treatments in patients with full-thickness tears (Mather et al., 2013). Partial tears show better outcomes with non-surgical approaches. Similarly, surgical stabilization for recurrent dislocations reduces the risk of future dislocations compared to non-surgical management (Mohtadi et al., 2014). However, for conditions like shoulder impingement or mild osteoarthritis, non-surgical treatments (e.g., physical therapy, corticosteroid injections) can be equally if not more effective in the short term and long term without he significant risks of surgery. (American Academy of Orthopaedic Surgeons, 2023).
Short- and Long-Term Risks
Surgery:
- Short-term risks include infection, bleeding, and anesthesia complications.
- Long-term risks include stiffness, re-tears (e.g., rotator cuff), and the need for revision surgery (Mather et al., 2013).
Non-Surgery:
- Short-term risks include prolonged pain and limited function.
- Long-term risks include progression of damage (e.g., arthritis, muscle atrophy) and chronic pain (American Academy of Orthopaedic Surgeons, 2023).
The decision to pursue shoulder surgery should be based on a thorough evaluation of the patient’s condition, imaging findings, and response to conservative treatments. That is why at Accelerate we rely on our 3 Step Process when it comes to evaluating injuries. While surgery offers significant benefits for specific conditions, it is not without risks. Non-surgical approaches remain a viable option for many patients, particularly those with mild to moderate symptoms. Consulting with an expert is essential to make an informed decision. We do that evaluation as part of our rotator cuff and shoulder rehab in New Braunfels.
References
- American Academy of Orthopaedic Surgeons. (2023). Shoulder Surgery: When Is It Necessary? Retrieved from (https://www.aaos.org)
- Mather, R. C., et al. (2013). “Cost-effectiveness Analysis of Rotator Cuff Repair Versus Nonoperative Treatment.” Journal of Bone and Joint Surgery , 95(16), 1488-1495.
- Mohtadi, N. G., et al. (2014). “Arthroscopic Versus Nonoperative Treatment of Shoulder Instability: A Systematic Review.” Arthroscopy: The Journal of Arthroscopic & Related Surgery , 30(5), 636-648.
