Surgery for common shoulder problems
About this PSP
Shoulder pain and loss of shoulder function are very common, with four percent of the population visiting their GP each year and 50 percent still reporting pain and disability after six months.
More and more patients are now referred to secondary care - hospital specialists - for surgical treatments. There is much that is still unknown about which patients with common shoulder problems are best treated with surgery, at what stage this surgery is best advised, and how best to ensure a good and rapid recovery. There are also uncertainties about which operations and techniques might be best, and when such operations should be considered over conservative treatment such a physiotherapy.
This PSP was funded by the British Elbow and Shoulder Society, and the British Orthopaedic Association. It was supported by and based in the National Institute for Health and Care Research (NIHR) Oxford Biomedical Research Unit and Oxford Biomedical Research Centre.
The Surgery for Common Shoulder Problems PSP published its Top 10 in June 2015.
PSP website
Articles and publications
Impact after the Top 10
Key documents
Top 10 priorities
(in no order of priority):
- For the main shoulder conditions of arthritis, frozen shoulder, impingement, rotator cuff tears and instability, can you predict which patients will do well with surgery to help them decide on whether to have surgery or not?
- In patients with 3 and 4 part proximal humeral fractures what is the long term outcome of reverse total shoulder replacement compared to hemiarthoplasty (half shoulder replacement)?
- Does arthroscopic (keyhole) subacromial decompression surgery in patients with degenerative rotator cuff tendon problems improve outcome and prevent further tendon degeneration and tears compared to patients with no surgical intervention?
- Does early mobilisation and physiotherapy after shoulder surgery improve patient outcome compared to standard immobilisation and physiotherapy?
- In patients with shoulder arthritis is a hemiarthroplasty (half shoulder replacement) or a total shoulder replacement or a reverse (ball on shoulder socket and socket on arm bone) replacement most effective?
- Are patients (including older age groups) with rotator cuff tendon tears in their shoulder best treated with surgery or physiotherapy?
- How can we ensure the patients see the right doctors and clinicians promptly and correctly, and does this lead to better outcomes (results)?
- In patients with Frozen Shoulder, does early surgery improve outcome compared to non-surgery treatments such as injection and dilatation?
- In patients with newly diagnosed calcific tendinitis (calcium in a shoulder tendon), is early surgical intervention more clinically effective than non-operative treatments?
- Do patients with partial thickness rotator cuff tendon tears benefit more from a surgical repair compared to a decompression and debridement (cleaning up operation) alone?
The remaining questions discussed at the workshop were (in no order of priority):
- In patients with acute (traumatic) grade III acromioclavicular joint (collar bone joint) dislocation, is there a better outcome from early surgical reconstruction versus no surgery/conservative (non-surgical) treatment?
- In patients with massive rotator cuff tendon tears of the shoulder, does a partial repair with a tendon augment/graft give better outcomes (results) than a partial repair alone?
- What are the best peri-operative (during and in the first week after surgery) pain treatments for patients having different types of shoulder surgery?
- Can we improve the information given to patients pre-operatively about predicting their post-operative recovery in terms of pain, length of rehabilitation and return to work and sport?
- How successful from the patient's perspective are the commonly performed shoulder operations that are used to treat the main shoulder conditions (frozen shoulder, impingement, rotator cuff tears, instability and arthritis)?
- In patients who have had a subacromial decompression (keyhole shoulder operation), which post-operative rehabilitation package provides the quickest recovery?
- For patients with a first time shoulder dislocation, is surgery more effective than structured physiotherapy rehabilitation?
- What is the best treatment for patients of differing ages with massive (greater than 5cm detachments) rotator cuff tender tears?
- Which patients with recurrent shoulder instability/dislocations will have a good outcome from surgery?
- In patients with rotator cuff tears, does cuff repair surgery provide a better outcome than subacromial decompression alone?
- Are reverse shoulder replacements (ball on shoulder socket and socket on arm bone) in patients with cuff tear arthritis more effective in the long term compared to no surgery?
- Do early surgical treatments such as debridement/chondroplasty (reshaping/smoothing joint surface) in patients with early osteoarthritis of the shoulder delay progression of arthritis compared to patients with no intervention treatment?
- In patients with rotator cuff tears when is surgery successful and when is it not?
- In patients with chronic (had for several months) Grade III AC Joint dislocation (collar bone joint dislocation), what are the success rates of the common surgical reconstruction techniques?
- In patients with early rotator cuff tendon disease, does arthroscopic subacromial decompression (keyhole shoulder surgery) improve patient outcome compared to conservative treatment (no surgery)?