As always the answer to that question is disappointing. The answer I’d love to give you is no. Shoulders rarely need surgery.
The first surgery I’d like to talk about is the surgery for “impingement”
So many people are told they have “shoulder impingement”….. if you are one of them seek a new physiotherapist or if it’s the doctor that has convinced you of this then go to a physio you trust instead. Impingement is a well outdated, overused term that means nothing really. And yet, still, there are doctors out there telling people they need surgery for their “shoulder impingement”
“Should I get surgery for shoulder impingement?”
No! Shoulder surgery should be the absolute last thing you try. The shoulder surgery for shoulder impingement is called “Subacromial decompression”. The shorthand for this surgery is S.A.D. I think sad is a very apt way to describe this surgery.
Surgeons reckon that your pain is due to a small space under the acromion in your shoulder and it is compressing your rotator cuff. Therefore, they think, chipping away some bone to make room for your rotator cuff to move will reduce your pain.
But, often space is the same on both sides. Both shoulders aren’t sore. Shouldn’t both shoulders be sore if the small space is on both sides? Also, if the space under the acromion has always been small then how come your shoulder has only become sore now?
Surgeons often tell you this surgery will alleviate your pain and get rid of your problem. They may be in passing mention that you may have to see the physio after surgery. What they neglect to mention is that oftentimes post-surgical rehab takes longer. You have to be in a sling after surgery. You have to allow for healing time after surgery. All of this lengthens the time of your rehab. Also, there may be a waitlist for surgery which delays you starting to solve the problem.
Surgery for “shoulder impingement” when compared to non-surgical rehab had no differences for the patients six months after surgery, no differences a year later, and no differences five years later. Surgery is also likely to mean the overall cost of your treatment is twice as much as if you just went to physiotherapy alone. This is why I think sad is an apt name for this surgery. It is more expensive, it takes longer and the results are no better.
The next surgery I want to talk about is rotator cuff repairs.
“My doctor says there is a tear in my rotator cuff, surely I should get surgery for a tear?”
Not necessarily, a lot of different structures in the body tear and you would look at me like I had ten heads if I said that I thought you needed surgery. Hamstrings tear, quads tear, calves tear… Surgery is not the first port of call for these things so it doesn’t have to be for the rotator cuff either.
First things first, I feel I should tell you some facts about rotator cuff tears that might make it seem more reasonable that I think surgery for a rotator cuff tear is excessive. Rotator cuff tears are far more common than you think. Why is it nobody you don’t hear more about it? Well, a lot of people have rotator cuff tears and have no pain. up to 20% of adults with no shoulder pain have rotator cuff tears.
“But, I have a full thickness tear?”
Of that 20% of adults with rotator cuff tears and no shoulder pain, 15% of them have full-thickness tears. They have full-thickness tears, no pain, and are able to use their shoulder all they want.
Half of everyone over the age of 60 has a rotator cuff tear. Every second person over the age of 60 doesn’t complain about shoulder pain or need shoulder surgery though. A study done recently even found that 40% of professional baseball players have rotator cuff tears but they have no pain and are able to keep playing a professional sport. A rotator cuff tear does not always mean you will have pain. It also means that a repaired tear will remove the pain.
In fact, if I put 100 people in a room and I took an MRI of all their shoulders. On average, I’d be likely to find that 20 of them have full-thickness tears on their rotator cuff. Six or seven of these people on average would have pain. That is just one-third of the people with full-thickness tears have pain. That means two-thirds of people with full-thickness tears do not. You are more likely to have no pain with a full-thickness tear than you are to have pain with a full-thickness tear.
Again, a bit like the “impingement” surgery your surgeon may mention to you that you have 3-4 months of rehab ahead of you with a physio. But, then again, he may not. It is very likely that these 3-4 months of physiotherapy, where I would focus on building strength back into your shoulder, would have done enough to fix your problem anyway.
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