The shoulder is a ball-and-socket joint, offering the widest range of motion in the human body. This mobility, however, relies heavily on a complex network of muscles, tendons, and ligaments for stability. Most shoulder pain or limited movement is managed through conservative approaches, including rest, anti-inflammatory medication, and physical therapy. Surgery is reserved for cases where structural damage is significant, the body cannot heal itself, or non-surgical treatments have repeatedly failed. These severe injuries often involve major soft tissue tears, chronic joint instability, or extensive damage to bone and cartilage surfaces.
Severe Tendon and Labral Tears
Surgery is necessary when major tendons are completely torn or significantly damaged, making natural healing impossible. A full-thickness tear means the tendon has completely separated from the bone. These major tears often retract from the humerus and require surgical reattachment using anchors and sutures to restore the mechanical connection. A large, retracted partial-thickness tear that fails to improve after three to six months of physical therapy also typically requires surgical repair to prevent enlargement and muscle atrophy.
The labrum is a ring of cartilage that surrounds the shoulder socket, acting to deepen the socket and improve joint stability. Tears to this structure, such as a Bankart lesion or a Superior Labrum Anterior to Posterior (SLAP) tear, require attention when they cause mechanical symptoms. These symptoms include catching, locking, or grinding, indicating that the torn flap of cartilage is physically impeding smooth joint movement. Repairing the labrum involves reattaching or trimming the damaged tissue to eliminate these mechanical obstructions and restore the deep socket contour.
Recurrent Joint Instability and Ligament Separation
While a first shoulder dislocation is often treated conservatively, repeat dislocations are a strong indication for surgical stabilization. Each dislocation stretches or tears the supporting ligaments and capsule, leading to chronic instability where the joint easily slips out of the socket during normal activities. Recurrent instability often causes bony defects, such as a Hill-Sachs lesion or a Bankart lesion, which mechanically predispose the shoulder to future dislocations. Surgical procedures like a capsular shift or labral repair are performed to tighten the stretched joint capsule and ligaments or to repair the damaged bony socket, limiting the excessive movement that causes dislocation.
The acromioclavicular (AC) joint connects the collarbone to the shoulder blade. This joint is held together by a set of strong ligaments, and injury to these structures is often graded by severity. Surgery is typically reserved for high-grade separations, classified as Type III and above, where both the AC ligaments and the deeper coracoclavicular ligaments are completely torn. Complete tearing allows the clavicle to be significantly displaced upward, creating a noticeable bump and causing chronic pain and weakness. Reconstructive surgery is performed to reduce the displaced clavicle back into its correct anatomical position and stabilize it, often using fixation devices or grafts to recreate the function of the torn ligaments.
Complex Fractures and Advanced Joint Degeneration
Severe traumatic injuries resulting in complex bone breaks frequently require immediate surgical intervention to restore the joint’s architecture. Fractures of the proximal humerus are common, but only those that are significantly displaced or comminuted necessitate an operation. These severe breaks disrupt the blood supply to the bone fragments and make non-operative healing unlikely, requiring Open Reduction and Internal Fixation (ORIF) with plates and screws to realign and hold the fragments in place. If the fracture involves extensive damage to the joint surface, the immediate need may be for a partial or total shoulder joint replacement rather than fixation.
Advanced joint degeneration is a chronic condition that necessitates surgery. This condition involves the progressive breakdown and loss of the smooth articular cartilage, leading to painful bone-on-bone friction. When the cartilage is completely eroded, the only viable treatment to relieve pain and restore function is a total shoulder arthroplasty, which replaces the damaged ball and socket with prosthetic components. Rotator cuff arthropathy occurs when a massive, irreparable rotator cuff tear leads to arthritis, requiring a specialized reverse total shoulder arthroplasty to stabilize the joint using the deltoid muscle.