Expert assessment for your shoulder concerns
But how do you know if you need shoulder surgery and what types of surgery are there? What are their success rates, and how long does it take to recover?
In this article, we review common shoulder conditions that may require surgery, the types of surgeries available, and the procedures offered by Circle Health Group hospital, The Blackheath Hospital in London, U.K.
Shoulder surgery might be helpful if other non-surgical therapies do not relieve your pain or restore your shoulder’s mobility and function.
Dr Adel Tavakkolizadeh, an orthopaedic surgeon at The Blackheath Hospital, explains that most shoulder problems usually respond well to conservative treatment, such as medication, physiotherapy, or activity modification. These problems tend to be muscle, tendon, and other soft tissue injuries.
Partial injuries such as shoulder sprains can also recover on their own. However, Dr Adel Tavakkolizadeh says, “complete disruptions of ligaments and tendons [may require] more invasive interventions.” More serious degenerative conditions like arthritis in the shoulder may also require more investigations, and ultimately surgery.
Some of the conditions that may require shoulder surgery include:
The group of tendons surrounding your shoulder form the rotator cuff. This structure gives it stability. Tears in these rotator cuff tendons can happen suddenly due to trauma, or gradually due to age-related wear and tear. Rotator cuff tears result in pain and weakness around the shoulder.
This is a chronic condition that damages the cartilage in the shoulder. The shoulder consists of three joints (four according to some experts), two of which give it mobility. The first one — which we typically think of as the main shoulder joint — is a ball and socket joint. It is called the glenohumeral joint. The second one is where the collarbone meets the shoulder blade, and it is called the acromioclavicular joint.
Severe arthritis can affect both of these joints, gradually destroying the cartilage on the ball and socket of these joints. Pain, stiffness, and cracking sounds are the most common symptoms of arthritis.
Also known as adhesive capsulitis, this is a condition in which the connective band of tissue around the shoulder — called the shoulder capsule — thickens and becomes stiff.
There is also less synovial fluid in the shoulder. Synovial fluid normally lubricates all of your joints. The absence of this fluid makes the shoulder tight, stiff and painful, gradually making it harder to move.
There are three main bones in the shoulder that commonly get fractured, or broken, in the shoulder: the collar bone, the top of the upper arm bone (humerus), and the shoulder blade.
In tendinitis, the rotator cuff becomes inflamed. In impingement, the bone on top of your shoulder can rub against, or impinge, against the tendon and the bursa — a sac filled with lubricating synovial fluid. This causes pain and irritation.
Often seen in people who also have problems with their rotator cuff, this condition is the inflammation or tearing of the biceps tendon. The biceps muscles and tendons pass through the big ball and socket joint of the shoulder, so damage or a tear in the tendon can cause significant shoulder pain.
This occurs when the bones on either side of the shoulder joints do not align. Depending on the joint that is affected, dislocations can be:
Before deciding to take the surgical route, several non-surgical treatment options may help your shoulder condition. These include:
Arthroscopic shoulder surgery, also known as shoulder arthroscopy or keyhole shoulder surgery, has become increasingly common in recent years. This is mainly due to the high success rate that arthroscopy has shown for other joint surgeries, such as knee surgeries.
When it is used to treat conditions, the arthroscope is used together with other small tools that are inserted through an additional incision. During this procedure, you may undergo general, local, or spinal anaesthesia.
At The Blackheath Hospital, Dr Tavakkolizadeh explains, arthroscopy is the “default technique” used for most shoulder procedures.
Shoulder arthroscopy can be used for various conditions, and what happens in the procedure depends on what it is trying to treat. Below are some of the procedures that use the arthroscopic technique.
In this surgery, the tendon is reattached to the head of the humerus bone with special sutures. Loose fragments of the tendon are also removed from around the shoulder joint, along with other damaged tissue and debris, in a procedure called debridement.
If the rotator cuff tear is only partial, however, debridement may be sufficient.
Arthroscopically, the shoulder can be stabilised in one of two ways:
Arthroscopy can also treat the following conditions:
Most people do not develop complications from shoulder arthroscopy. However, as with any surgical procedure, there are risks, such as:
Your consultant will talk you through any possible risks during your consultation.
There are three types of shoulder replacement procedures, and they all affect the main ball and socket joint in the shoulder (the glenohumeral joint):
Nowadays, surgeons are performing “an ever-expanding number” of shoulder replacements, explains Dr Tavakkolizadeh, due to the proven success of this procedure. The operation is still “a lot less common than hip and knee replacements, but the numbers for shoulder replacements have significantly gone up in the last 10 to 15 years,” he says.
Typically, shoulder replacements last for more than 10 years.
Studies have found that patients report long-lasting benefits for this period, including less pain, more strength, improved mobility, and greater ability to perform everyday tasks.
“Whilst you do not regain 100% normal range of movement, you generally tend to get an improved range of movement with no pain, which means [that shoulder replacement] improves people's quality of life in terms of sleep, function, doing day to day activities and even returning to doing some recreational activities.”
Although shoulder surgery is considered safe, as with any surgical procedure, there are some risks. The risks of open shoulder surgery will depend on the specific procedure you are having. However, the overall risks include:
Your surgeon will discuss these specific risks with you before the surgery.
“The more invasive the procedure, the longer the recovery process,” explains Dr Tavakkolizadeh. For example, “the recovery journey tends to be much shorter after keyhole surgery versus an open surgery,” he says. “This is obviously different from shoulder replacements,” he adds.
More specifically, “for most rotator cuff repairs and stabilisation procedures, people may end up being in a sling for about four weeks, but even during that time, they can do certain movements. They can move the elbow, wrist and hand, they can still be pretty independent, but they are not doing anything physical for some time.”
“With shoulder replacements, [...] most people notice a significant improvement even within a matter of weeks because the arthritic pain is gone. And the surgical pain tends to ease off after a few weeks.”
However, Dr Tavakkolizadeh adds, “The recovery period [from shoulder replacement surgery] goes on for many, many months, so people achieve the best possible outcome after an operation potentially six to nine months’ time.”
With certain smaller surgeries, such as debridement, “we are not repairing or fixing anything, we are only tidying things up and cleaning things out,” the consultant explains. So, “people get going pretty much straight away, and the recovery tends to be much, much quicker — in weeks and possibly a few months.”
You will be placed under the supervision of a physiotherapist to help with the early stages of your post-surgery recovery. They will recommend strengthening exercises that will help you recover and regain the flexibility and function of your shoulder.
Shoulder replacement surgeries are also varied and individualised to the patient’s needs, he adds. For example, the joints may be only partially resurfaced or changed entirely. Joint replacements themselves are also specifically designed for people who not only have arthritis but who may also have problems with their tendons.
The hospital also boasts great outpatient and inpatient facilities, which are constantly being upgraded. “Surgeons have access to all the modern imaging modalities to be able to provide appropriate investigations for people, and the theatre set up at the hospital is excellent,” Dr Tavakkolizadeh adds.
“[The Blackheath Hospital] is a friendly working environment where most people have been there for some time, and generally it feels like a family-run practice.”
The following consultants offer shoulder surgery at The Blackheath Hospital:
Cost can often be an important factor in the decision to undergo surgery.
The Blackheath Hospital offers fixed-price packages which include:
A breakdown of costs is available for various shoulder surgeries, including:
If you have private health insurance, you can use it to pay for care and treatment at The Blackheath Hospital. We also offer flexible payment options if you are paying for your own treatment.
You can book a private consultation online today or call 020 8318 7722 to speak with one of the friendly team members at The Blackheath Hospital.
The Blackheath Hospital in London is in the centre of Blackheath village, a stone's throw from the Blackheath train station. It is easily accessible to patients living in Greenwich, Lewisham and Bexley via the M25, A20 and A2.
It is located at 40–42 Lee Terrace, Blackheath, London, SE3 9UD. For instructions on how to get to us by road, train, or bus, click here.
We look forward to welcoming you to The Blackheath Hospital.
Tracy shares her story about having shoulder surgery at Blackheath Hospital.
The surgery successfully alleviated the excruciating pain Tracy was experiencing, as well as the root cause of her shoulder issues.
