Shoulder pain – Will I need an operation?

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By Mr Harry Brownlow, December 2017

Will I need an operation?

Almost always the answer will be no.

Most of my patients are successfully treated without ever having to have an operation.  Only about 2 in 10 people, in my care, end up needing surgery.  Almost always the need for surgery is because all other modes of treatment have been tried and failed.

However sometimes it is clear that an operation is the best choice; either because non-operative measures are never going to help, or because you have tried all the other options already.

When you go to see a shoulder specialist with a problem the focus of the first consultation should be about getting a clear diagnosis. Often this is possible from listening carefully to your story and then  performing a clinical examination. Sometimes more information is required and this might be in the form of an xray or other types of imaging (MRI, CT scan, Ultrasound scan) or even blood tests.

Once a clear diagnosis has been obtained then the various treatment strategies can be reviewed. Often treatment will start with any number of non-surgical approaches such as physiotherapy, chiropractic or osteopath treatment, acupuncture and deep tissue massage, cortisone injections, shockwave therapy, or even just a bit more waiting! However sometimes it is clear that an operation is the best choice; either because non-operative measures are never going to help, or because you have tried all the other options already.

Here are some of the commonest shoulder diagnoses and their typical treatment plans.
Shoulder impingement
A recent high profile study (CSAW , 2017) of the common problem of shoulder impingement showed that most people get slowly better even without an operation. I find one or more cortisone injections in conjunction with physiotherapy can be very helpful at relieving symptoms.

Rotator cuff tear
Rotator cuff tears are common. There is more and more evidence to suggest that the majority of tears happen as a consequence of aging and the genes that you have inherited.  So if your rotator cuff happens to tear, without having sustained a significant injury, then it is because you have poor quality tendon tissue. So surgery will be a low priority on your treatment plan.  Again a good physiotherapy programme and cortisone injections can be very helpful.

Dislocated shoulder
If you are a young collision athlete then I’m afraid it is statistically likely that you will go on to have repeated dislocations unless you have an operation. But for most other dislocators there is a definite role for high quality, personally directed physiotherapy together with reviewing your technique with a sports professional.

Frozen shoulder
For the vast majority of people this is an entirely self-limiting condition over about 18 months. That means that without any treatment your shoulder will make a slow but full natural recovery. However the idea of 18 months of pain and stiffness seems rather daunting for most people so many will choose to have some kind of intervention.

Calcific tendonitis
Acute calcific tendonitis is agony but relatively short lived and very rarely needs surgical intervention. Chronic calcific tendonitis is a cause of shoulder impingement (see above) and will improve naturally over time, although the time frame, ranging from months to years, is entirely unpredictable!

Shoulder fractures
A big national investigation (PROFHER Study, 2015) showed that, ultimately, there was no difference in outcome between those patients who had an operation and those who did not have an operation for most common shoulder fractures. This means that there is now a discussion to be had between the surgeon and patient as to whether surgery for a shoulder fracture is really necessary and that non-surgical treatment may often be the safer course of action

Clavicle fractures
A new study into the treatment of clavicle fractures (The Clavicle Trial, 2017) confirmed a prior Canadian study that people who had an operation for their clavicle fracture were more likely to heal and had a quicker return to normal life than those treated non operatively. However, by 9 months after fracture, it didn’t much matter how you had been treated as both groups did equally well.

Remember your specific treatment plan should be discussed with your shoulder specialist and this broad overview should not be used for self-treatment. Also remember that these are my algorithms and some shoulder clinicians may have different opinions.

As you can see, most shoulder problems can be treated without having to have an operation. So don’t worry, even though you might be seeing a surgeon, it is more than likely you will end up being treated without a trip to the theatre!