Important Considerations Before Going Under the Knife
There are times when shoulder surgery is the best option.
Rotator cuff tears resulting from a hard fall or accident are often good candidates for surgery. If the accident was bad enough to have potentially dislocated or fracture the shoulder, we advise an urgent trip to have it evaluated by a sports medicine professional.
But for many rotator cuff tears, surgery is not the best option.
Most shoulder problems can be fixed with a smart rehab program—avoiding the pain, downtime and cost of surgery.
Be sure to consider the following before choosing to go under the knife for a rotator cuff repair.
1. Can Your Life Handle the Ordeal of Surgery?
Rotator cuff surgery is not like replacing the worn out tires on your car—an hour at the tire center and you are back on your way good as new.
Shoulder surgery includes a life altering recovery process. Will the current demands on your life allow for weeks of painful sleepless nights and needing assistance with basic tasks like tying your shoes and washing your hair?
Expect discomfort with no shoulder activity for up to eight weeks, and then lifting no more than 5 pounds for another 20 weeks. If that doesn’t excite you, then…
Shoulder surgery should be the last option to fixing a rotator cuff tear.
Especially when other treatment options are as effective as surgery.
Yes…you read that right!
Many medical studies show that a proper rehab exercise program can be as successful as shoulder surgery.
Success is defined as the patient being able to perform the same activities they were doing prior to the injury – without pain and maintaining these results long term (for years.)
2. Can You Afford the Cost of Surgery?
Shoulder surgery often exceeds the costs of nonoperative treatment by about $13,000 (ref).
Even with insurance, the cost of taking time off work, and using taxis and Uber to get around adds up fast.
The significant extra cost and hassle of surgery should come with better outcomes – but it doesn’t.
A recent study showed 3 out of 4 people with rotator cuff tears were able to avoid surgery and return to their normal lives by using a proper rehab program to treat their shoulders (ref).
You might be worried that passing on surgery will end up coming back to haunt you down the road?
A study in the Journal of Shoulder and Elbow Surgery, followed patients who passed on surgery for 13 years. They found 9 out of 10 had little to no pain in their shoulder without surgery (ref).
That’s a long term outcome I can handle considering the costs of rehab is minimal.
3. Are You OK With the Risks?
In addition to the commonly known risks of surgery (infection, pain, failed procedures, etc.), it’s important to consider the longer term risks on performance.
First, let’s look at elite overhead athletes, because they are special cases. Many assume the highest level athletes—with unlimited money and resources— will get surgery because they can afford the best care.
This is not always true, because surgery could threaten their performance!
Changes in anatomy and movement of the shoulder following surgery can forever impact performance. Shoulder range of motion, mechanics, and strength are affected for a long time and sometimes forever (ref).
For example, it’s reported that only half of the Major League Baseball players who undergo shoulder surgery will have a successful return (ref). With those kinds of numbers, it’s important to have exhausted all other options first.
But this applies to the other 99% of athletes who do not receive a paycheck or scholarship for sports performance. Because what’s the risk of conservative management?
That’s right! Relatively no risks exist for conservative management for a degenerative rotator cuff tear. Those tears often take years of faulty mechanics and other factors to develop. If done properly, a 6 week trial of conservative management will not make things worse.
Worse case scenario, if a few weeks of rehab don’t improve things, your shoulder will be in better shape to have the surgery.
For that reason, trying an exercise plan before deciding on surgery is absolutely worth it!
Boiling it Down
Ultimately, every condition is unique and deserves individualized decision making. Hopefully this article has made you aware of the success of a shoulder pain rehab program, even for conditions as severe as a rotator cuff tear. We want you to be more active in the discussion regarding the next steps for YOUR treatment plan!