Sarah Lewis, PharmD
What is shoulder surgery?
Shoulder surgery repairs a damaged, degenerated or diseased shoulder joint. It is a treatment for a variety of diseases and conditions in your shoulder joint. These commonly include rotator cuff tears, shoulder dislocations, and shoulder separations. Shoulder surgery can potentially help restore pain-free range of motion and full function to a damaged shoulder joint.
Your shoulder joint is formed where the upper arm bone (humerus), shoulder blade (scapula), and collarbone (clavicle) meet. Ligaments are tissues that connect these bones within your shoulder joint. A group of four muscles surround these bones to form your rotator cuff. These muscles are attached to your bones by tendons, which are tough pieces of connective tissue. Your shoulder joint also includes layers of cartilage, joint (synovial) fluid, and a bursa sac that helps cushion your joint.
Shoulder surgery is a common but major surgery with serious risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having shoulder surgery.
Types of shoulder surgery
The types of shoulder surgery procedures include:
Arthroplasty replaces or resurfaces a diseased joint. It involves removing arthritic or damaged surfaces of bone and replacing them with artificial material or an implant called a prosthesis. It can include a partial replacement or a total replacement of your shoulder joint. Your doctor may recommend shoulder arthroplasty for degenerative diseases of the shoulder, such as osteoarthritis and rheumatoid arthritis. Some fractures of the shoulder joint may also require joint replacement.
Arthroscopy is surgery using an arthroscope. An arthroscope is a long, thin instrument that contains a small camera. It is inserted into the joint through an incision over or near the joint. The camera transmits pictures of the inside of your joint to a video screen viewed by your doctor while performing surgery. Your doctor may recommend arthroscopic shoulder surgery for shoulder dislocations, shoulder tendonitis, certain rotator cuff problems, soft tissue (muscle) repairs, frozen shoulder, and the repair of torn cartilage or ligaments.
Rotator cuff repair reattaches a torn rotator cuff. It is a treatment for a torn tendon in your shoulder joint.
Soft tissue repair treats damage to the shoulder muscles.
Other procedures that may be performed
Looking for a Doctor?
Your doctor may perform other procedures in addition to shoulder surgery. These include:
Bone fracture or dislocation repair. Severe injuries may require surgical repair. These injuries include certain types of fractures of the collarbone, humerus, and shoulder dislocations.
Bursectomy or bursa sac repair treats a damaged bursa sac. Your bursa sac provides cushioning for your joint.
Why is shoulder surgery performed?
Your doctor may recommend shoulder surgery to treat a damaged, degenerated or diseased shoulder joint.
Your shoulder joint consists of your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle). Your tendons are strong pieces of connective tissue that attach muscles to the shoulder and arm bones. The rotator cuff is a group of muscles and tendons that surround the shoulder joint. Ligaments connect the bones of your shoulder joint and hold it together. A bursa sac lies between the bones and tendons in the shoulder to cushion the joint.
The shoulder joint can be damaged by aging, disease, overuse or injury. Your doctor may only consider shoulder surgery for you if other treatment options with less risk of complications have not worked. Ask your doctor about all your treatment options and consider getting a second opinion before deciding on shoulder surgery.
Your doctor may recommend shoulder surgery to treat:
Arthritis, shoulder inflammation caused by either osteoarthritis or rheumatoid arthritis
Bursitis, inflammation of your bursa sac
Cartilage conditions, such as loose or torn cartilage
Fracture of the upper arm bone (humerus) or the collarbone (clavicle)
Frozen shoulder, also known as adhesive capsulitis, which is stiffness of the shoulder joint
Rotator cuff tears, both partial and complete tears
Shoulder dislocation that recurs often
Shoulder separation, which is a partial or complete tear some of the shoulder ligaments
Tendonitis, or inflammation of your tendon that is not responding to more conservative treatment
Who performs shoulder surgery?
An orthopedic surgeon performs shoulder surgery. An orthopedic surgeon is a surgeon who specializes in surgical treatment of diseases and conditions of the bones and connective tissues.
How is shoulder surgery performed?
Your shoulder surgery will be performed in a hospital or outpatient surgical setting. The procedure and technique varies depending on the specific surgery, but it is generally performed using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and an arthroscope through small incisions in your shoulder. This approach is also known as arthroscopy. An arthroscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your body to a video screen viewed by your surgeon while performing the surgery. Minimally invasive surgery generally involves a faster recovery, less pain, and less risk of complications than open surgery. This is because it causes less damage to tissues and organs. Your surgeon will make small incisions instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery.
Mini-open surgery uses newer technology and combines minimally invasive arthroscopic techniques with a smaller open procedure. The incision is one to two inches long, which is smaller than a standard open surgery incision. This technique allows more extensive repairs than are possible with minimally invasive surgery. It also causes less damage than traditional open surgery because your muscles remain attached during surgery.
Open surgery involves making a large incision in the shoulder. Open surgery allows your surgeon to directly view and access the surgical area. It generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery.
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia that may be used
Your surgeon will perform shoulder surgery using either general anesthesia or regional anesthesia.
General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain. You may also have a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.
Regional anesthesia is also known as a nerve block. It involves injecting an anesthetic around certain nerves to numb a large area of the body. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your shoulder surgery
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will receive.
A surgical team member will start an intravenous (IV) line.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of shoulder surgery?
As with all surgeries, shoulder surgery involves risks and possible complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Blood clot, in particular a deep vein thrombosis
Potential complications of shoulder surgery
Complications of shoulder surgery include:
Blood vessel, nerve or muscle damage
Deltoid detachment, a complication of open surgery on the rotator cuff. In open surgery, your surgeon moves the deltoid muscle out of place in order to reach your rotator cuff and then stitches it back in place. It is vulnerable to injury and detachment until it heals.
Failure of the repair to heal or to relieve symptoms
Nerve damage, which can lead to numbness and tingling in the affected arm
Problems with a newly replaced joint, such as wear and tear of a new joint requiring another replacement
Stiffness and loss of range of motion, which is usually temporary and responds well to aggressive physical therapy
Tendon re-tear, which is more common with larger tendon tears
- Weakness in your shoulder
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This includes physical therapy, occupational therapy and other rehabilitation treatments.
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my shoulder surgery?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for shoulder surgery by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing varies depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Showering the evening before and the morning of surgery with an anti-septic soap.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a brief doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need shoulder surgery? Are there any other options for treating my condition?
Which type of shoulder surgery procedure will I need?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
What kind of assistance will I need at home?
What kind of physical therapy or rehabilitation will I need?
What medications will I need before and after the surgery? How do I take my usual medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my shoulder surgery?
Knowing what to expect can help make your road to recovery after shoulder surgery as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
You will go home on the same day of surgery for an outpatient procedure if you are recovering well. A hospital stay of one to two days is needed for an inpatient procedure.
Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. You will likely wear a sling for several weeks after surgery. Your doctor will refer you to an exercise rehabilitation program to help you recover. Full recovery takes a few weeks to several months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after shoulder surgery. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Chest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Pain that is not controlled by your pain medication, worsening pain, or pain that is different or occurs in a new area, such as in your arm or leg
Unexpected drainage, pus, redness or swelling of your incision
Weakness, numbness or difficulty moving the shoulder or arm
How might shoulder surgery affect my everyday life?
Shoulder surgery may cure your condition or reduce your symptoms so you can lead an active, normal life. For example, shoulder surgery may relieve your pain and restore strength and good range of motion to your shoulder. Shoulder surgery will not prevent future damage to your shoulder. You can help prevent further shoulder problems by:
Carrying heavy objects close to your body
Following any restrictions on contact sports
Practicing good posture
Strengthening your shoulder muscles with exercises as recommended by your healthcare provider
Using proper body mechanics when lifting heavy objects
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- Rotator Cuff Tears: Surgical Treatment Options. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00406
- Shoulder Problems. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Shoulder_Problems/
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