Advances over the past decade mean that most shoulder operations are now performed arthroscopically, through small keyhole incisions, with a camera and instruments passed into the joint. For patients this generally means less discomfort after the operation and a faster recovery than with traditional open surgery. Open surgery continues to have an important role, particularly for joint replacement and for repairing fractures, where direct access to the bone is needed.
It is worth saying at the outset that surgery is not the answer to every shoulder problem. A great many shoulder conditions settle with activity modification, a well-directed physiotherapy programme, simple analgesics and, in selected cases, an injection. Surgery is considered when those measures have not controlled the symptoms, or when the structural damage, such as a torn tendon, a torn labrum, a worn-out joint surface or a displaced fracture, makes it unlikely that they will. The purpose of a consultation is to work out which situation applies to you.
Where an operation is appropriate, the choice of procedure depends on what has been damaged and on what you need the shoulder to do. Two people with the same diagnosis may reasonably be offered different operations, and the planning usually relies on imaging as well as examination: a CT scan to measure bone loss before a stabilisation procedure, for example, or an MRI to assess tendon quality and muscle condition before a cuff repair.
Every operation carries risk. These include the risks of general anaesthetic, infection, injury to nerves around the shoulder, stiffness including frozen shoulder which can be precipitated by surgery, and the possibility that the problem recurs or that the repair does not heal. Reported rates of infection after arthroscopic shoulder repair are under 0.2%, and nerve injury is rare, but these risks are real and are discussed in full in consultation before any decision is made. Individual results vary.
Rotator cuff, bursa and impingement
Reattaching torn rotator cuff tendons to the bone, performed arthroscopically. A sling is typically worn for 6 weeks while the tendon heals, followed by graded rehabilitation.
Shaving the underside of the acromion to create more space for the rotator cuff, usually for impingement. Recovery typically takes about six weeks.
Arthroscopic removal of a calcium deposit from a rotator cuff tendon in calcific tendonitis, often combined with an acromioplasty.
Instability and labral surgery
An overview of stabilisation surgery for a shoulder that dislocates or slips out of position, and how the procedure is chosen.
Reattaching the torn labrum to the rim of the socket and tightening the capsule, for traumatic anterior instability without significant bone loss.
Transferring a block of bone from the coracoid to the front of the socket, with repair of the labrum, where bone has been lost from the socket rim.
Filling a defect in the back of the ball of the shoulder so that it cannot engage on the front rim of the socket and cause the joint to dislocate.
Joint replacement
Replacing the worn ball-and-socket joint with a prosthesis, usually for severe osteoarthritis. A sling is worn for 6 weeks and recovery generally takes 3 to 6 months.
A replacement in which the positions of the ball and socket are reversed, used for severe arthritis with an irreparable rotator cuff tear and after certain fractures.
Frozen shoulder
An arthroscopic release of the contracted joint capsule for a severely stiff shoulder, followed by an intensive physiotherapy programme to maintain the movement gained.
AC and sternoclavicular joint
Keyhole removal of a small amount of the outer end of the collarbone for painful AC joint arthrosis, preserving the ligaments behind and above the joint. Recovery is typically about six weeks.
Reconstruction of the joint at the inner end of the collarbone where it meets the breastbone, for instability or dislocation of that joint.
Biceps and other tendon surgery
Reattaching the long head of the biceps tendon to the bone of the upper arm, used where that tendon is a source of pain or is damaged.
Repair of the biceps tendon where it attaches at the elbow, usually after a rupture sustained lifting against resistance.
Repair of a torn pectoralis major tendon, an injury most often seen in weight training.
Fractures and bone surgery
Open reduction and internal fixation, in which a displaced fracture of the shoulder blade, collarbone or upper arm bone is realigned and held with plates and screws.
Treatment of an os acromiale, a segment of the acromion that has not fused to the rest of the bone and has become a source of pain.
Removal of part of the shoulder blade, used for conditions such as a painful snapping scapula that has not responded to other treatment.
Arthroscopic exploration of the nerves around the shoulder where one of them is thought to be compressed, allowing the compressing structure to be released.
What to do next
If you are considering an operation, the starting point is a diagnosis. The conditions these procedures treat are described under shoulder injuries and conditions, and background on the joint is on the shoulder anatomy page. What happens after surgery, including healing times, sling use, physiotherapy and practical matters such as showering and dressing, is covered under rehabilitation, and the patient videos are indexed under videos.
To arrange an assessment, see consultation. The surgery FAQs answer common questions about preparing for an operation, the hospital stay, pain relief and returning to work and driving. The consultation FAQs explain what to bring to your appointment, and accommodation has information for patients travelling to Brisbane for surgery.
These pages are general information and are not a diagnosis. Individual circumstances vary, and the right treatment for you can only be determined after assessment. Any procedure carries risk; these are discussed in consultation.
