When considering shoulder surgery, the information you receive can be OVERWHELMING. So, what do you really need to know to make the best decision for yourself? This blog will outline my suggestions based on research AND what I have experienced with patients thus far!
*If you are considering shoulder surgery, PLEASE READ ON or send to someone who may be considering shoulder surgery!!*
Deciding whether or not to undergo shoulder surgery can be a difficult and personal decision. The decision should be guided by several qualified medical professionals who have all determined surgery is your BEST option. However, here are some general guidelines to consider when making this decision!
- Your current shoulder range of motion
- Your limitations in life
- Your quality of life – the influence of pain
- Your duration of symptoms
- Your strength before surgery
- Your past treatment effectiveness
- Your chance of the shoulder getting worse
- Your risk vs benefit analysis: based on most of the above!
**Now, what to consider in each of these categories.**
- YOUR CURRENT SHOULDER RANGE OF MOTION
- Using your shoulder day to day requires moving your shoulder in all directions, some of which are shown here.
- If you lose a significant range of motion which hinders your daily activities and hobbies, surgery may be a solution to help you get that range of motion back!
- Many times, detailed REHABILITATION can help you regain most or all of your pain free range of motion, which would then eliminate the need for surgery. Keep this in mind!
- YOUR LIMITATIONS IN LIFE
- Many patients consider surgery once they are unable to perform their daily activities.
- The more your shoulder pain or shoulder range of motion interferes with your ability to GO PLACES or DO THINGS- the more likely it is that surgery is an option to regain the life you deserve.
- If you realize you are avoiding spending time with your family, performing your favorite activities, calling out of work, shoulder surgery may be an option.
- YOUR QUALITY OF LIFE- THE INFLUENCE OF PAIN
- Many of you would say, “I will get surgery when the pain is too much to handle.” This is definitely part of the consideration.
- However, along with PAIN, there needs to be an indication that surgery would help. Usually, this means getting images (x-rays, MRIs, CT scans) and determining there is a STRUCTURE that can be surgically modified.
- If a physical exam determines that this structure is causing the pain, then surgery is a great option.
- HOWEVER, many times pain is NOT coming from a specific structure, and surgery would not help the pain. Getting multiple opinions is a great way to decide if pain is an indicator for YOU to get surgery.
- YOUR DURATION OF SYMPTOMS
- If your symptoms started this week after a major accident which resulted in shoulder damage, shoulder surgery may be a good option for the traumatic damage.
- If your symptoms started 4 years ago and have slowly gotten worse and you have not sought treatment yet, surgery may not be a great option for you.
- People with conditions that continue to degenerate the BONE are usually good surgery candidates. People with conditions that affect the SOFT TISSUES (rotator cuff, ligaments, labrum) are usually BAD surgical candidates.
VIDEO TO HELP YOU TEST YOUR OWN SHOULDER STRENGTH
- YOUR STRENGTH BEFORE SURGERY
- If you feel you are losing strength in your shoulder, this can be very concerning.
- Some guidelines state that if you have weakness, shoulder surgery may be a BAD option. However, if a good rehabilitation program can bring your strength back, then surgery would be unnecessary.
- The moral of the story here is: if you are indicated for surgery and can get strong BEFORE surgery, you will have better outcomes. If you cannot gain strength with rehabilitation at all, then surgery may be necessary to start this process.
- YOUR PAST TREATMENT EFFECTIVENESS
- THIS IS MY #1 CONCERN!!!!
- What have you tried for conservative treatment, and has it worked a little, a lot, or not at all?
- Was it: chiropractic, physical therapy, medications, injections? What results did you see?
- Also, most surgeons will not operate until they are SURE that you have exhausted conservative care. Those who fail these treatments options (when the treatment is thorough and tried for long enough) then are GREAT surgical candidates. These patients have the best results from surgery.
- YOUR CHANCE OF THE SHOULDER GETTING WORSE
- If your shoulder condition is likely to continue to progress rapidly shoulder surgery may be indicated. (Examples: severe instability, repetitive dislocations, rapidly progressing arthritis)
- Shoulder surgery is LESS indicated when conditions progress slowly. (Examples: Most osteoarthritis cases, rotator cuff disorders, long term pain not explained on imaging).
- YOUR RISK VS BENEFIT ANALYSIS: BASED ON MOST OF THE ABOVE!
- Very simple: do the benefits of the surgery OUTWEIGH the risks?
- Will you decrease your pain?
- Will your range of motion increase?
- Will your quality of daily life be significantly improved?
- If you and your doctors agree on the risk vs benefit analysis and the answer is YES, then the surgery is indicated and the best solution for you.
SUMMARY
As you can see, a lot of thought goes into the decision to have surgery. These are the main points as I see it! As you may have noticed, what you see on an x-ray or MRI is NOT the main indicator to have shoulder surgery.
I hope this was useful. As always, I am available for questions at any time. Schedule a call with me at 386-200-9367 to ask questions about your individual case!
-Dr. Casey
PS- all of these guidelines were inspired by research, but are my own opinion. Your decision to have surgery is personal and should always be considered carefully with your surgeon, orthopedist, primary, chiropractor, and other practitioners!