The 4 Questions to Ask Before Shoulder Surgery

Shoulder pain is more common than you might think — about 1 in 3 people will experience it in their lifetime. In fact, it’s the third most common musculoskeletal complaint after back and knee problems.

If you’re dealing with shoulder pain, stiffness, weakness, or instability, you may be wondering:

• Do I need surgery?

• What type of surgery is best for my condition?

• When is the right time to even consider it?

In this article, we’ll tackle those questions head-on. We’ll explore the main types of shoulder surgery — including arthroscopy, arthroplasty, and acromioplasty — and explain when surgery can help and when it might not be necessary.

Shoulder Problems: The Big Four

Your shoulder symptoms usually fall into one of these categories:

• Painful

• Stiff

• Weak

• Unstable

Let’s look at each in more detail.

1. The Painful Shoulder

Pain is often the main reason people consider surgery — but rushing into surgery for pain relief isn’t always the right move.

Instead, the first step is a proper diagnosis:

• Your clinician will ask detailed questions.

• Test your shoulder’s movement and strength.

• Use imaging (X-rays, MRI, ultrasound).

But here’s the challenge: Pain doesn’t always show up clearly on scans.
One useful tool is a diagnostic injection — if the pain improves, that gives a good clue about what’s causing the symptoms and whether surgery could help.

Also, some pain isn't caused by structural damage. Sometimes, nerve sensitivity is the main issue — and in these cases, surgery might not help and could even make things worse.

2. The Stiff Shoulder

Stiffness may come from a condition like frozen shoulder or post-injury adhesions.

In some cases, a procedure called capsular release (often done via arthroscopy) can help speed up recovery. That said, not all stiff shoulders require surgery — and many improve with time and the right rehab plan.

Imaging or arthroscopy is often used to confirm what’s going on inside the joint.

3. The Weak Shoulder

Weakness can stem from:

• Nerve injuries

• Rotator cuff tears

• Or muscle imbalances

It's critical to determine the root cause — and whether the weakness is temporary or permanent.

In certain cases, especially with large, irreparable rotator cuff tears, a reverse shoulder replacement (arthroplasty)might be considered.
This is a specialist procedure, best reserved for clearly diagnosed cases — usually in older adults.

4. The Unstable Shoulder

Instability may be caused by:

• Repeated dislocations

• Muscle imbalance

• Ligament laxity

• Previous injuries

It’s particularly common in younger athletes or active individuals.
In these cases, early surgical intervention may help restore confidence and prevent long-term damage. This is one of the few instances where a proactive approach to surgery is often recommended.

Before Considering Shoulder Surgery

Surgery isn’t the first step. In nearly all cases, non-surgical (conservative) treatment comes first, including:

• Physiotherapy

• Education about your condition

• Corticosteroid or diagnostic injections

• Imaging to clarify the diagnosis (MRI, X-ray, ultrasound)

If your pain isn’t improving, that doesn’t mean surgery is automatically the next step. It means your case should be reassessed.

Use this process:
Assess → Treat → Reassess → Adjust Treatment → Reassess

The 4 Key Questions to Ask Before Surgery

Ask yourself (and your healthcare provider):

1. Is there a clear structural diagnosis?

2. Will surgery likely improve function?

3. Have non-surgical treatments failed?

4. Can symptoms still be managed without surgery?

Decision Flow:

• YES – NO – NO – YES → Continue non-surgical care

• YES – YES – YES – NO → Surgery may be appropriate

• NO – NO – NO – YES → Get a second opinion or more testing

Types of Shoulder Surgery

Here’s a breakdown of the most common procedures:

Arthroscopy ("Keyhole Surgery")

• Minimally invasive

• Small camera inserted into the joint

• Can diagnose and treat:

  • Rotator cuff tears

  • Impingement

  • Frozen shoulder

  • Instability

Benefits:

• Less pain

• Smaller scars

• Faster recovery

• This often creates a "window of opportunity" to make physiotherapy more effective.

Arthroplasty (Shoulder Joint Replacement)

Used mainly for severe arthritis or irreparable damage.

• Total Shoulder Replacement: Replaces both sides of the joint, lasting 15–20 years.

• Hemiarthroplasty: Replaces just the humeral head — often used in younger patients.

• Reverse Shoulder Arthroplasty:

  • Used when rotator cuff tears are beyond repair

  • Reverses the ball-and-socket orientation

  • Restores function but has a higher risk of complications

Subacromial Decompression (Acromioplasty)

• Removes bone spurs or thickened tissue causing impingement

• Aims to reduce pain and allow rehab to be more effective

Note: This is a controversial surgery. Some studies show no added benefit over physiotherapy, but good outcomes are seen when patients are carefully selected.

Before You Decide on Surgery

Discuss the following with your surgeon or therapist:

Set Realistic Expectations

• Know how long recovery takes

• Understand that pain from nerve sensitivity can linger after surgery and require specialist rehab

Weigh the Risks

• All surgeries carry risks: infection, nerve damage, implant failure, persistent pain. Make sure these are discussed first. 

Prepare to Rehabilitate

• "Prehab" before surgery improves outcomes

• Rehab after surgery is crucial to restore strength and mobility

Final Thoughts

Shoulder surgery can be life-changing — but it’s not the only answer, and it’s not always the right answer.

Take your time, ask questions, and make sure your treatment path fits your personal goals and diagnosis.

If you found this article helpful, please share it with someone who’s struggling with shoulder pain or uncertainty around surgery.

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Written by Daniel Lawrence, Physiotherapist & Health Educator