Shoulder Surgery

The shoulder trades stability for range of movement. It moves further than any other joint in the body, and the price of that is a joint held together largely by soft tissue rather than by bone. That is why it is injured so often, and why the injuries fall into recognisable patterns.

Rotator cuff tears

The rotator cuff is four muscles and their tendons wrapping the top of the arm bone, keeping it centred in the socket while the larger muscles move it. Tears happen suddenly, from a fall or a heavy lift, or gradually through years of wear, which is why they are common in trades involving overhead work.

Typical symptoms are pain on the outside of the upper arm, worse at night and when reaching overhead, and weakness lifting the arm out to the side.

Not every tear needs repairing. Treatment depends on the size and pattern of the tear, the quality of the tendon, how much strength has been lost, and what you need the shoulder to do. Where the tendon has retracted badly and the muscle has wasted, a repair may not hold, and a different approach is better. There is a longer explanation in our guide to rotator cuff tears.

Instability and dislocation

A shoulder that has dislocated once is more likely to dislocate again, particularly in younger patients. Each episode can cause further damage to the labrum and to the socket rim.

Some shoulders stabilise with rehabilitation alone. Others need the labrum repaired or, where bone has been lost from the socket, a reconstruction that restores it. Recurrent instability in someone whose work or sport puts the arm at risk is usually worth addressing rather than tolerating.

Arthritis of the shoulder

Where the cartilage surface wears out, the shoulder becomes stiff as well as painful, and the pain becomes more constant rather than only occurring with particular movements.

Early arthritis is managed without surgery: activity modification, rehabilitation, and injection. When those stop working and the joint is genuinely worn, shoulder replacement is an option, including reverse replacement where the rotator cuff has failed as well as the joint surface.

Impingement, bursitis and tendinopathy

Pain when reaching overhead, without a full tear, is extremely common. Most of it settles with a properly structured rehabilitation programme aimed at how the shoulder blade moves, rather than at the shoulder itself. Injection can help where pain is preventing you from doing the rehabilitation at all.

Surgery has a much smaller role here than it once did, and we would rather do the rehabilitation properly than operate on something that will settle.

Shoulders that have already been operated on

If you have had shoulder surgery and it has not worked, that is a distinct problem with a distinct assessment, and it is Dr. Ackland’s principal area of experience. See revision shoulder surgery.

What to expect from an appointment

You will be examined, and any imaging you already have will be reviewed. Bring the images themselves rather than only the report where you can.

You should leave knowing what is wrong in plain language, whether an operation is indicated, and what the alternative is if it is not. Recovery timelines will be discussed honestly, including the parts that are inconvenient.

Surgery, when needed, is performed at New England Baptist Hospital.