Should I Do Shoulder Surgery?

röntgen image of shoulder girdle

Whether or not to do shoulder surgery depends on the type of shoulder injury you have incurred and how you wish to use your shoulder in the future. Regardless, of whether you’re opting for a SLAP repair, Labral Repair, or Biceps Tenodesis, each and every surgery is a very personal decision.

Not mine, nor your surgeon’s. So, make sure you talk to multiple health professionals, read up, and talk to people who had the surgery you’re planning to do. That being said, in this article I’m going to do my very best to help you make an informed decision.

Are you ready?

Then let’s do this!

1. Did You Try Conservative Treatment?

Before you even think about surgery, you should always have a complete overview of your options.

To get a clear overview, ask your orthopedic specialist, physiotherapist, and/or general practitioner what treatment options are available/recommendable for you in your situation.

Then, for each option ask the following questions:

  • What do you think would happen if I follow this option?
  • What do you think would happen if I wouldn’t follow this option?
  • What are the risks of following this option?
  • How long will it take before I can climb again with this option?
  • What are the long-term consequences if I do or do not follow this option?
  • What will be the effect of this option on my future climbing performance?

Don’t be surprised to get very different answers from the various healthcare professionals. Specialists and physiotherapists work with different models of the body and thus see injuries in a different light. Specialists often see problems in a definite sense: “if something is broken it’s broken.”. A physiotherapist on the other hand might look at the entire body and accept that tissue will stay broken but that you might be able to train around/compensate for it.

If you have an answer to all of the questions, and conservative treatment is one of the options that suits your situation, you should always try this first. Nowadays, treatment methods within (sports) physiotherapy have developed to such a level that plenty of surgeries can be omitted.

Conservative treatment does take from several weeks to months for it to have a significant effect though. Thus, try it for 3-6 months up to a year depending on the injury you have. You should see significant changes over this period, and come closer to your desired climbing goals.

On a side note, if none of the answers you get feel right, get a 2nd, 3rd, or 4th opinion. I don’t care how many people you need to see. But you need to make sure you feel comfortable about your decision.

And finally, use Google and the experiences of others to your advantage. This might give you a better idea of what options are out there.

2. Are YOU Ready to do Shoulder Surgery?

If you have an idea that surgery might be the right treatment strategy for you, then the most important question becomes: “are you ready to do surgery”?

I was advised to remove part of my medial meniscus in my left knee, and it took me months to accept that I needed the surgery to get my full knee function back. Other people around me, be it patients or family have behaved similarly. I believe it’s important you give yourself time to accept the conclusion that you will benefit from the surgery, this will greatly enhance your mental state and trust that you’ll get better.

Let’s now have a look at how to assess your situation in order to see if you’re ready for surgery.

2.1 Assessing Your Situation

To ensure that surgery is the right decision for your situation I think it’s important to consider the following factors:

2.2 The Results/Prospects of Conservative Treatment

If conservative treatment is a valid option for your injury, then you should at least try it for 3-6 months and see significant improvements. If you don’t see any, or it seems unlikely you’ll achieve your desired climbing level, surgery is a valid choice.

2.3 Your Age

If you’re healthy and below 35 years old (remember that age is just a number, if you’re older your body might still have the healing capacity of a 35 year old) your healing capacity should be good and usually fast. Which speaks to both conservative treatment and post-surgery rehab. Still, a torn labrum or an unrepaired SLAP tear when you’re young might bother you somewhere in the future. If you are older you’re farther from your peak performance level and might not want to climb as hard anymore. This should all be considered in your decision-making.

2.4 Your Rock Climbing Goals

More ambitious rock climbing goals mean that you need to stress your body more. So, if you are ambitious choose the line of treatment that makes/leaves your body strongest.

2.5 Your Private Situation

Do you need help with certain activities after surgery? Think of cooking, taking a shower, dressing, or taking care of your children/parents. And what about your financial situation, will your insurance pay for the surgery, or is it on your own budget?

2.6 Your Work Situation

How are things at work? Are you employed or do you have your own business? Who’s going to take over your responsibilities while you’re gone? Can you delegate your work to make sure that you can focus on your recovery after surgery?

2.7 Which Structure is Damaged?

If your injury is in passive structures in the shoulder like ligaments, bones, cartilage, or labrum, surgery is usually more effective than when you have an injury in muscles or tendons.

2.8 Do You Know a Great Rehab Professional?

Even after conservative fails, you’ll need to return to your physiotherapist after surgery. As things go, surgery is only the start of your rehab process. And as much as it’s a step forward it’s also a step backward. In the case of shoulder surgeries, you’re often advised to not move your arm beyond certain limits to let the operated structures recover. However, this also means you lose muscle mass, mobility, strength, and coordination. These abilities you all have to get back after recovery of the operated structures. So, make sure you know a great rehab professional that can help you get back to climbing.

And the final point is of course, are you comfortable with your surgeon? I believe this to be a very important factor in the success of your surgery, so that’s why I dedicate the next chapter of this article to the subject.

3. Deciding on the Right Surgeon

Have you considered that if you do surgery, you’ll be either entirely or partially passed out? And the person with the knife can do whatever he or she wants to you? This is not to make you scared, but to motivate you to look for a surgeon whose operating abilities you really trust. It’s not always the doctor with the flashy talk, fancy clinic, and the biggest car who operates best. So, make sure you asked all your questions and got all the injuries beforehand. This way you can completely give over to your surgery and focus on the best outcome.

See if your surgeon takes time to understand your situation and behaves accordingly. Furthermore, experience is important but young doctors can also be very skillful and might have a better focus. And like with anything else, if you know people who can recommend someone, this could add to the trustability is a good indication. Personally, I find the following traits important in a surgeon:

  • Modest
  • Realistic
  • Open to your questions and concerns
  • Calm
  • Relaxed
  • Takes time to understand and inform you en to make sure you both feel confident with each other.
  • Doesn’t make big claims, ones that I’ve heard from my patients:
    • “If you don’t do this surgery now, you’ll have osteoarthritis with 50” (impossible to prove and might happen but doesn’t need to mean anything as injury doesn’t equal complaints)
    • “If you do this surgery now, you’ll be back to climbing (or other sport) in 4 months” (when it’s at least 6 months). The surgeon that previsions slower recovery than the other is most likely not worse but more realistic.

4. Take-Home Messages

The most important thing about going for shoulder surgery is to remember that it’s a decision only you can make, so make sure you have all the information to make an informed decision. Furthermore, I believe you should not only have a strong indication that surgery will help you, but you also need to feel ready. If you’re in a mental state of confidence in your surgeon, yourself, and a great outcome, surgery will have a much greater effect. And finally, remember that surgery is always followed by a (long) rehab period which requires time, dedication, and effort every day of the process. Rehabilitation is an elite sport, so be ready.

Joël Broersma

Hey, I'm Joël, a Dutch Physical Therapist living & working in Switzerland. I'm an avid rock climber and sports & movement lover in general.

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