Shoulder pain is a common complaint that can significantly disrupt daily life. Deciding whether to pursue surgery is complex, as intervention is typically reserved as the final step in a structured treatment plan. Understanding the specific circumstances that necessitate an orthopedic consultation and the criteria for moving past non-surgical management helps guide the decision toward functional recovery. The need for surgery depends on the nature of the symptoms, the response to conservative care, and the presence of underlying structural damage.
Symptoms That Demand Professional Evaluation
Certain symptoms serve as red flags, indicating a potentially serious underlying issue that requires immediate professional assessment. Persistent pain that does not resolve within a few weeks using basic measures like rest and over-the-counter medication warrants an orthopedic consultation. This is especially true if the pain consistently interferes with normal daily activities or sleep.
Night pain is a specific symptom, particularly if it worsens when lying on the affected side. This pattern often suggests irritation or injury to the rotator cuff tendons. A sudden and complete loss of motion or strength following a specific injury also requires prompt evaluation to rule out an acute, full-thickness tendon tear.
Instability is another alarming symptom, described as a sensation that the shoulder is about to “pop out” or is “slipping” (subluxation). This feeling indicates a lack of stability in the joint capsule and ligaments, suggesting potential damage like a labral tear. New or sudden weakness, the inability to lift the arm, or the development of unusual clicking, popping, or grinding noises also signals mechanical damage.
Failure of Conservative Treatment Options
Surgery is seldom the first course of action, as most shoulder conditions respond favorably to non-operative treatment. Initial management, termed “conservative care,” typically consists of targeted physical therapy (PT), anti-inflammatory medications, and localized corticosteroid injections. The failure of this systematic approach is a primary indicator that surgical intervention may be necessary.
Physical therapy aims to restore range of motion, improve joint mechanics, and strengthen supporting muscles, especially the rotator cuff. PT requires an adequate period to demonstrate effectiveness, often three to six months, before being deemed unsuccessful. Failure means persistent severe pain, inability to regain functional mobility, or a lack of objective strength improvement despite consistent adherence.
Corticosteroid injections are used to reduce pain and facilitate PT by delivering a powerful anti-inflammatory agent directly to the area. While they provide short-term relief, the effects are not permanent if an underlying structural problem exists. If two or more injections combined with months of physical therapy do not result in lasting improvement, a definitive structural repair may be needed. For full-thickness rotator cuff tears, a trial of physical therapy for at least three months is a common threshold before considering surgical repair.
Structural Damage Requiring Surgical Repair
Specific objective findings from diagnostic imaging often mandate surgery, regardless of the patient’s subjective symptoms or treatment history. Imaging studies, such as Magnetic Resonance Imaging (MRI), X-rays, or Computed Tomography (CT) scans, reveal anatomical damage that only a structural repair can fix. One of the most common findings leading to surgery is an acute, full-thickness tear of the rotator cuff, especially in younger patients or when the tear is large.
These tears represent a complete separation of the tendon from the humerus, which prevents the muscle from effectively moving the arm. Delaying repair of a large tear can lead to the muscle and tendon tissue retracting and developing fatty infiltration, which makes a successful repair significantly more difficult later on.
Another absolute indication for surgery is recurrent shoulder instability, defined as a shoulder that frequently dislocates or partially dislocates. This instability is often linked to specific bony or soft-tissue defects, such as a Bankart lesion or a Hill-Sachs lesion, which create a mechanical block to joint stability.
Advanced Osteoarthritis
Advanced glenohumeral osteoarthritis, where the joint cartilage has worn away causing bone-on-bone friction, requires a joint replacement procedure. This procedure, such as a total shoulder arthroplasty, restores a smooth articulating surface. The most severe form, called cuff tear arthropathy, involves both severe arthritis and a massive, irreparable rotator cuff tear, often necessitating a reverse total shoulder arthroplasty.