Physical therapy and medications are often the first treatment for shoulder injuries. However, shoulder surgery is also an option to repair joints, rotator cuffs, or dislocations, to name a few.

The shoulder contains the most mobile joint in the body. This mobility makes the shoulder joint very vulnerable to injuries.

Often, nonsurgical options such as physical therapy and anti-inflammatory medications are the first-line treatments for shoulder issues. If these options are not effective, shoulder surgery may be considered to repair or replace joints, bones, or tendons in the shoulder area.

Surgical techniques can range from minimally invasive arthroscopic procedures to more traditional open surgeries. This article reviews the most common types of shoulder surgery.

When do you need shoulder surgery?

Shoulder surgery is usually secondary to first-line treatments such as pain management and physical therapy. However, surgery may be a good option if any of these situations apply:

  • You have not seen improvement with physical therapy and medications.
  • Your shoulder pain keeps you awake at night.
  • Your shoulder pain radiates throughout your affected arm.
  • You’re in pain even when at rest.
  • Your range of motion continues to be compromised.
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Rotator cuff muscles are critical to your shoulder’s range of motion and stability. A rotator cuff is a group of four muscles and their tendons. Although they attach as one unit to the humerus (upper arm) bone, each separate component can tear.

Rotator cuff injuries are very common.

Surgery for a complete rotator cuff tear usually involves reattaching a tendon to its original site on the upper arm bone (humerus). A partial tear may need only a minor procedure to repair the damage.

Depending on the level of damage, this surgery can be done in one of three ways:

  • an open surgery (where the surgeon makes one large cut in order to see what they’re operating on)
  • fully arthroscopic (minimally invasive)
  • a hybrid “mini-open” repair

These techniques all report similar success rates and recovery outcomes. While surgery for a torn rotator cuff is not usually a first-line treatment, you may be a good candidate for this surgery if any of these situations are true:

  • You have a tear larger than 3 cm (1.18 inches).
  • You have had symptoms longer than 6–12 months.
  • Your tear was due to a recent injury.
  • You have a great deal of weakness and loss of function in your shoulder.

Learn more about rotator cuff repair here.

A SLAP tear is an injury to the ring of cartilage surrounding the socket of your shoulder joint. This injury can be caused by trauma or repetitive use.

Minimally invasive arthroscopy is usually used in SLAP repair surgery. There are several different types of SLAP tears that will require different surgical strategies. After a recovery period, most patients report improved strength and reduced pain.

Learn more about SLAP tear repair here.

Total shoulder replacement might be needed in cases of severe arthritis or a fractured shoulder joint.

The surgery involves taking out any damaged areas of the shoulder joint and replacing them with artificial parts. Often this means replacing the damaged ball and socket joint with a highly polished metal ball attached to a stem, and a plastic socket.

A shoulder hemiarthroplasty is commonly used for fractures of the humeral head. This procedure replaces just the humeral head of the shoulder joint rather than the entire ball and socket.

The specific type of shoulder replacement will depend on your injury, the quality of your bone and joint, and what your surgeon believes is best for your health needs.

Learn more about shoulder replacement surgery here.

Surgery for a shoulder dislocation may be recommended to help improve shoulder stability and tighten or repair torn or stretched tendons and ligaments. Arthroscopy is usually the recommended surgical option, as it’s minimally invasive and can minimize damage to nearby tissues.

For younger athletes, shoulder dislocation surgery after a first injury may decrease the rate of future shoulder dislocations, per research published in 2019.

Learn more about arthroscopy for shoulder dislocation here.

Frozen shoulder (adhesive capsulitis) is a painful condition that limits the range of motion in your shoulder due to thickening joint tissues. Frozen shoulder is most common in women between ages 40 and 60 years old, according to the American Academy of Orthopaedic Surgeons (AAOS).

Physical therapy is the primary treatment for frozen shoulder, but surgery may be suggested if nonsurgical methods are not effective.

The goal of surgery for frozen shoulder is to stretch and release the stiffened joint capsule. This can either be done by shoulder arthroscopy or manipulation under anesthesia. These methods may also be used in combination with each other.

Per the AAOS, surgical recovery times vary from 6 weeks to 3 months, but most patients report positive long-range outcomes.

Learn more about arthroscopy for frozen shoulder here.

Your acromioclavicular (AC) joint is where the end of your collarbone and shoulder blade meet. AC joint injuries account for about 40% of all shoulder injuries and are usually due to direct trauma.

Surgery is usually only recommended if improvement is not seen via conservative methods.

AC joint surgery involves removing the damaged end portion of the collarbone and replacing torn ligaments. This can be done either arthroscopically or with open surgery. Recovery from AC joint surgery may take up to 6 months or more.

Learn more about acromioclavicular joint repair here.

Shoulder impingement is when the upper outer edge of your shoulder blade pinches or rubs against the rotator cuff beneath it. This can cause pain and irritation.

Shoulder impingement usually responds well to physical therapy and medication, but surgery may be used in severe cases. Surgery is often a minimally invasive procedure that expands the shoulder joint to relieve the pinched tissues.

Core decompression for humeral head avascular necrosis is another procedure that may be used to retain a humeral head that has been damaged due to a lack of blood supply.

Learn more about arthroscopic shoulder impingement surgery here.

The shoulder is a complex joint that’s vulnerable to several types of injuries. In many cases, shoulder injuries can be resolved with a combination of physical therapy and pain management.

When these conservative methods are not effective, or in cases of severe injury, surgery may be used to repair damaged bones or tendons.

Regardless of the surgical technique used, shoulder surgeries are often effective at relieving pain and restoring shoulder function.