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  • Review Article
  • Published:

Surgical options for patients with shoulder pain

Nature Reviews Rheumatology volume 6, pages 217–226 (2010)Cite this article

Subjects

Abstract

Shoulder pain is a common musculoskeletal complaint in the community, which can arise from diverse causes. Regardless of the cause, mild cases can often be effectively treated conservatively, with options including rest, physiotherapy, pain relief and glucocorticoid injections. If conservative strategies fail after a 3–6 month period then surgery might be considered. Generally, the proportion of patients with shoulder pain who require surgery is small. When surgery is considered, a clear diagnosis and structural information from imaging are required. The indications for surgery, and success rate, depend on the specific diagnosis as well as on the individual clinical presentation. Evidence from case series suggest that surgical interventions for shoulder pain are effective when used appropriately. This article outlines the surgical management of the most common painful conditions that affect the shoulder, including impingement, rotator cuff tear, frozen shoulder, osteoarthritis, rheumatoid arthritis and calcific tendonitis.

Key Points

  • Surgery for painful shoulder conditions is rare, but might be considered when conservative treatment fails and in the context of a clear diagnosis and structural information from imaging

  • The benefit of surgery for frozen shoulder is unproven and most cases resolve with conservative treatment

  • Arthroscopic subacromial decompression is commonly performed and can be effective for calcific tendonitis and impingement; acromial spur removal might not be necessary

  • Rotator cuff repair relieves pain and improves function for symptomatic full-thickness tears, although 20–70% will re-rupture within 6 months; the role of surgery for partial-thickness tears is unclear

  • Surgery for osteoarthritis associated with or resulting from massive rotator cuff tear is not effective at restoring motion, although pain relief can be satisfactory

  • Joint replacement surgery for osteoarthritis and rheumatoid arthritis is effective for pain relief, but post-operative problems can arise from failure of the glenoid component

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Figure 1: Diagram showing the anatomy of a normal shoulder.
Figure 2: Guidelines to assist with initial management of shoulder problems.
Figure 3: Appearance and repair of rotator cuff tears.
Figure 4: Management of a patient with a massive rotator cuff tear.
Figure 5: Shoulder replacement surgery for a patient with osteoarthritis of the shoulder joint.

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  1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Windmill Road, Oxford, OX3 7LD, UK

    Salma Chaudhury, Stephen E. Gwilym, Jane Moser & Andrew J. Carr

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Chaudhury, S., Gwilym, S., Moser, J. et al. Surgical options for patients with shoulder pain. Nat Rev Rheumatol 6, 217–226 (2010). https://doi.org/10.1038/nrrheum.2010.25

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