Is Shoulder Surgery Worth It?
Jeff Williams, owner of an integrated chiropractic clinic reveals the research
The question of whether or not a person truly needs surgery is a tough one to answer. Mostly because every patient is different, every patient heals differently, and every injury is different.
However, we do not have to answer the question from an opinion-based perspective. We can answer the question based on research. There are lots of interesting studies we could talk about but I want to pick 4 in particular to frame our discussion.
- One will show you that 75% of full-thickness tears can be rehabilitated without the use of surgery.
- The next will show you there was no difference between those that had rotator cuff repair vs. those that had no surgery at all.
- The third will back up the second paper and bolster the findings.
- The last one will show you how the research shows the most common surgeries that are done for musculoskeletal pain have no firm basis in the research and are unfavorable to having surgery.
Let me start here; I am NOT against surgery. Some patients absolutely need it. I go to the medical doctors when I am sick or for my check ups. I work with those in the medical field as part of an integrated team.
What I absolutely AM against is necessary surgery, suffering, recovery, and certainly repeated surgery. Repeated surgery is much more common than you would hope. Surgery is permanent. If it can be avoided through non-pharmaceutical exercise/rehabilitation, why would you not?
People hurt their shoulders in an endless variety of ways. From just working out with bad posture to actually having a traumatic fall like we see on hoverboards or off of a treamill or something similar on social media. It's times like these that chiropractors come in handy!
Rehabilitation Over Surgery
A research paper in 2018 published in the Journal of Shoulder and Elbow Surgery (not a chiropractic journal) wanted to find out what happens to shoulders 5 years later if they simply did not have surgery for shoulders that would have been deemed surgical.
These patients all had full-thickness tears and had hurt for over three months. They had these patients undergo a nonsurgical, home-based exercise treatment program and followed up with them regularly.
Listen closely: at the 5-year mark, approximately 75% of the patients remained successfully treated with nonsurgical treatment and they enjoyed a quality of life score of 83 out of 100.
The conclusion was, “The operative and the nonoperative groups at the 5-year follow-up were not significantly different.”
Surgery For New Shoulder Tears
In this second one, the researchers wanted to compare early surgery with no surgery for a traumatic rotator cuff tear. This was what is called a randomized controlled trial which is higher-level research. This was also in the Journal of Shoulder and Elbow Surgery. Again, not a chiropractic journal.
One group of patients had surgery while the other had exercises prescribed. Before I get to the results, I want to point out that 6.5% of the surgically-repaired shoulders tore again.
The findings of the paper were, “We found no significant differences in clinical outcomes between (rotator) cuff repair and nonoperative treatment at 12-month follow-up.” 
Rotator Cuff Repair vs. No Repair
For our third selection, this one is a very reliable, high-level, and important paper that was in the Cochrane Database of Systematic Reviews (also not a chiropractic publication) just last year in 2019. They compared the benefits and risks of rotator cuff repair.
The research concluded, “[surgery] may provide little or no clinically important benefits for pain, function, overall quality of life, or participant-rated global assessment of treatment success when compared with non-operative treatment.” 
Most Common Musculoskeletal Surgeries Are Not Adequately Researched
The last one we will talk about took my breath away when I first saw it. It may do the same with you. It came out in Pain Journal in 2020. Once again, this is not a chiropractic journal.
The goal here was simply to find out how many of the most common musculoskeletal surgeries have been adequately researched. What they found was disturbing.
This paper was written to demonstrate that observational evidence is not enough when you consider the costs and risks of having to undergo surgery. Observational study means they take a look at you and think, “Yeah….they seem to be good.” That’s observation but it is not research.
They say surgical procedures that should undergo randomized controlled trials with blinding and showing statistical and clinically important symptomatic improvement when compared to no surgery at all.
Wouldn’t you expect that they already did this? Apparently, they have not.
They selected 6,735 research papers on these surgeries. Surgeries that ranged from shoulder surgeries of all kinds to knee replacement, carpal tunnel surgery, hip replacement, low back fusions, and more.
What they found was that of those 6,735 studies, only 64 of them, less than 1% of them, even compared having the surgeries to not having them at all. Less than 1%.
Of those 64 studies that actually compared surgery to having no surgery at all, only 9 of them were actually favorable to have the surgery. NINE.
They say, “We conclude that many common surgical procedures performed for musculoskeletal conditions causing chronic pain have not been subjected to randomized trials comparing them to not performing the procedure. Based on the observation that when such studies have been performed, only 14% (on average) showed a statistically significant and clinically important benefit to surgery; there is a need to produce such high-quality evidence to determine the effectiveness of many common surgical procedures.
Furthermore, the production of high-quality evidence should be a requirement before widespread implementation, funding or professional acceptance of such procedures, rather than the current practice of either performing trials after procedures have become commonplace, or not performing comparative trials at all.”
In conclusion, I would have to say that the experts have shown many different ways that most probably do not need surgery and can be successfully rehabilitated without surgery. Not only that, when surgery is done, there is typically no real difference between those that went through the surgery and those that did not. As an exclamation mark to the discussion, the most common surgeries for musculoskeletal conditions have no high-quality research proving they even work compared to not having the surgery in the first place.
In my opinion, if a patient is looking at having shoulder surgery, they should be finding an Amarillo doctor that specializes in being a pain relief clinic. A doctor like an evidence-based, patient-centered chiropractor, and/or physical therapist. We are your best chance at getting over it and getting back to your life and we do it non surgically, non pharmacologically, safely, and smartly.
Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast (http://www.chiropracticforward.com). Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected] more about Dr. Williams and his practice at https://www.amarillochiropractor.com.
Dr. Williams was voted Best Chiropractor In Amarillo in the Best of Amarillo 2020. Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109. If you are searching for a chiropractor near me, Dr. Williams is your Amarillo Chiropractor.
1. Boorman RS, M.K., Lollinshead RM, What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elbow Surg, 2018. 27(3): p. 444-448.
2. Ranebo MC, H.H., Holmgren T, Adolfsson LE, Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: a prospective randomized trial. J Shoulder Elbow Surg, 2020. 29(3): p. 459-70.
3. Karjalainen TV, J.N., Heikkinen J, Johnston RV, Page CM, Buchbinder R, Surgery for rotator cuff tears. Cochrane Database of Systematic Reviews, 2019. 12.
4. Harris IA, S.V., Mittal R, Adie S, Surgery for chronic musculoskeletal pain: the questions of evidence. Pain, 2020. 161(9): p. S95-S103.
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