Questions to Ask Before Shoulder Surgery
These are questions to ask the surgeon before shoulder surgery is booked, written for anyone who has been offered a labrum repair, a stabilisation after a dislocation, a tendon repair or a replacement. The 58 questions run in the order the decision does: the diagnosis, whether to operate at all, the operation itself, the risks, the weeks in a sling at home, then rehabilitation and the return to work and sport. Before shoulder labrum surgery in particular, the tear type, any damage to the bone, the biceps tendon and the chance of another dislocation each have a question of their own.
The questions
Each question, and why to ask it
The diagnosis
What is the diagnosis, and what did the scan actually show?
Why ask it
Ask to see the images and have the finding pointed out on the screen. A scan can show changes that cause no symptoms, so the follow-up is how much of your pain this one explains.
Which part of the shoulder is damaged: the labrum, the rotator cuff, the biceps tendon or the joint surface?
Why ask it
Several structures in the shoulder can produce much the same pain, and each one leads to a different operation. Have the surgeon name every part that is involved and say which of them is the main problem.
If the labrum is torn, where is the tear and what kind is it?
Why ask it
Labrum tears are described by where they sit on the rim of the socket, and you may hear names such as SLAP or Bankart. Get yours drawn on a diagram, since its position shapes both the repair and the restrictions afterwards.
Is my shoulder unstable, stiff, weak or simply painful, and which of those is the operation aimed at?
Why ask it
Those are four separate complaints, and one operation may not treat them all equally. The complaint the surgeon names as the target is the one to judge the result by a year from now.
What on my scan will still be there after the operation?
Why ask it
Wear in the joint, a second small tear or a bone spur is sometimes left alone on purpose. Hearing that now stops a later scan report from reading like an operation that failed.
Does this look like damage from one injury, such as a dislocation, or wear that has built up over years?
Why ask it
A shoulder that came out of joint in a fall is a different conversation from one that has ached for years. Say exactly what happened and when, then ask how that history changes the advice.
Has a dislocation damaged any bone, on the socket or on the ball of the joint?
Why ask it
A shoulder that has come out can chip the rim of the socket or dent the ball, and surgeons weigh that when choosing between a labrum repair and a bigger stabilising operation. If bone is involved, ask how much and how it was measured.
Could any of this pain be coming from my neck and not from the shoulder joint?
Why ask it
Trouble in the neck can be felt in the shoulder and upper arm, and an operation on the shoulder would leave it untouched. If nobody has examined your neck, say so before a date is set.
Do I need any more tests before we decide, such as an MRI with dye or a CT scan?
Why ask it
A surgeon may want an MRI with contrast for a clearer look at the labrum, or a CT to measure the bone of the socket. For each extra test, ask what result would change the plan.
Surgery or not
What are my options apart from surgery, and what have we not tried yet?
Why ask it
Physiotherapy over months, injections and a change of activity come before surgery for many shoulder problems. That they exist is not the point: which of them has a realistic chance in your shoulder is.
What happens to this shoulder if I leave it alone for six months?
Why ask it
For some tears the concern is that muscle retracts or changes over time, which narrows the options later. For others, waiting costs only time. Which of those applies to you is the heart of the timing decision.
How many weeks of physiotherapy count as a fair trial before we call it a failure?
Why ask it
"I tried physio" can mean three sessions or four months of daily exercises. Pin down what a proper course looks like for your problem, and what result at the end of it would settle the matter either way.
Would an injection help me decide, or only put the decision off?
Why ask it
An injection is sometimes given to find out where the pain is coming from as well as to ease it. Before agreeing, get clear on what a good or a poor response would tell the surgeon, and on whether a gap has to be left between an injection and an operation.
If my shoulder has dislocated before, how likely is it to come out again without surgery?
Why ask it
For many people offered a labrum repair or a stabilisation, the whole decision turns on this. The answer shifts with your age, your sport and how many times the shoulder has already come out, so ask for the figure the surgeon would give for you.
Does my age, job or sport change whether you would operate?
Why ask it
The same labrum tear may be handled one way in a twenty-year-old who plays rugby and another way in a sixty-year-old who swims. The useful part of the answer is which facts about you carried the most weight in the recommendation.
For someone my age with this problem, how often does the operation work?
Why ask it
There are two numbers here: how often the repair holds, and how often people say the shoulder feels better. They are not the same figure, and the gap between them is the honest picture. Check too whether the figures come from the surgeon's own patients or from published results.
What is the best this shoulder is likely to be afterwards, and what will probably not come back?
Why ask it
A consultation tends to dwell on the good outcome; this asks for its ceiling. If throwing hard, sleeping on that side or heavy overhead work is what you are hoping for, name it and ask where it falls.
Is there any harm in timing the operation around my work, my season or my family?
Why ask it
A planned shoulder operation can often be fitted around a calendar, though not put off without limit. Once you know how far the date can slide before it affects the result, count the sling weeks back from whatever you need the arm for.
If I want a second opinion, how do I get my scans and your notes to another surgeon?
Why ask it
Put this way it is a practical request and not a challenge, and the reaction tells you something too. Whether you need a referral, and whether a second visit is paid for, depends on your insurer or health service.
The operation
What operation are you proposing, and what does it repair?
Why ask it
Repair, release, decompression, debridement, and replacement are different operations with different recoveries. Getting the name of the procedure lets you ask everything else precisely and gives you a term to use with your employer and insurer.
Will this be arthroscopic or open, and why that choice for me?
Why ask it
Keyhole surgery means smaller cuts, but the repair underneath and the weeks in a sling can be much the same. A good answer points to the size and position of your problem, not to habit.
Will you be putting in anchors, screws or an implant, and do they stay in for good?
Why ask it
Many repairs are held by small anchors set into the bone, and a replacement is an implant by definition. What yours would be made of, whether it shows up on later scans and whether it ever has to come out are all fair to raise.
If this is a replacement, which type are you planning, and how long should it last?
Why ask it
There is more than one design of shoulder replacement, and the choice usually turns on the state of the rotator cuff and the bone. How long an implant lasts varies with age and use, so ask what the surgeon tells people like you, and what a second replacement would involve.
Will you do anything to the biceps tendon, and what would that change for me?
Why ask it
One of the biceps tendons attaches at the top of the labrum, so it often comes up in the same operation. If the surgeon plans to release it or fix it somewhere new, ask how that affects the look of the arm, its strength and the early restrictions.
What might you find during the operation that would change the plan?
Why ask it
Some decisions are only made once the camera is inside and the tissue can be seen. Knowing the alternatives beforehand means the consent form covers them, and you wake up to an operation you had already discussed.
Who will perform the operation, and how many of these do you do a year?
Why ask it
A surgeon who does this procedure regularly should have a number ready. In a teaching hospital a trainee may do part of the operation under supervision, and it is normal to be told who.
What is the anaesthetic plan, and will I have a nerve block?
Why ask it
A block is often used alongside a general anaesthetic and leaves the whole arm numb and heavy for a while. The details usually come from the anaesthetist: how long it lasts, what it feels like wearing off, and whether to take pain relief before it does.
How long will the operation take, and what position will I be in?
Why ask it
Shoulder operations are commonly done with the patient sitting up or lying on one side, which is worth knowing if you have neck, back or blood pressure problems. The expected length also tells whoever is waiting when to start expecting a call.
Do any of my medicines, supplements or health conditions need a plan before the date?
Why ask it
Blood thinners, diabetes medicines and some supplements are often adjusted around an operation, and the instruction differs from one drug to the next. Get yours in writing with dates, and find out who to phone if you take something by mistake.
Is there anything I should do before the operation to improve the outcome?
Why ask it
Answers may cover stopping smoking, blood sugar control, exercises to do beforehand, dental treatment and getting the house ready. Press for the one that matters most in your case and how many weeks ahead it has to start.
What would make you delay or cancel this operation?
Why ask it
A cold, a cut or spot near the shoulder, or a blood test that comes back abnormal can each move a date, depending on the unit. Knowing the list means you phone ahead and do not find out in a gown on the morning.
What will this cost me, and who can give me the figure in writing?
Why ask it
The surgeon, the hospital or day unit, the anaesthetist, the sling and months of physiotherapy may each be charged separately. How much of that reaches you depends on your country, your insurer or your health service, so ask the office who prepares the estimate and whether approval is needed first.
Risks
What are the risks of this operation, and which are most likely in my case?
Why ask it
Stiffness, infection, nerve irritation and a repair that fails are the usual headings. Which one leads depends on the procedure, and something in your history, such as diabetes or smoking, may shift the numbers for you.
How often does this repair fail or the shoulder dislocate again, and what happens then?
Why ask it
After a labrum repair or a stabilisation, the number to ask for is the chance of the shoulder coming out again; after a tendon repair, the chance that it does not heal. What the second operation would be shows how much rides on the first.
Will I lose any movement for good, such as turning the arm outwards?
Why ask it
Tightening a loose shoulder can cost some rotation, which matters to throwers, swimmers and anyone whose work means reaching behind their back. Ask how much loss is usual after this repair and whether it tends to ease.
Could the nerves in my arm or hand be affected, and how would I know?
Why ask it
Numbness from the block is expected for some hours, so find out what is normal on the first night and what is not. Then ask which lasting symptom, a weak grip or a numb patch for instance, should have you phoning the team.
What are the signs of infection or a blood clot, and who do I call out of hours?
Why ask it
Get a number that is answered at night and at weekends, not only the clinic line. Have the surgeon separate the symptoms that mean phone now from the ones that mean go straight to an emergency department.
I have had surgery on this shoulder before. How does that change the risks and the likely result?
Why ask it
A repeat operation works through scar tissue and around whatever was put in last time. Bring the earlier operation note if you can get it, and check whether the odds you were quoted are for first operations or repeat ones.
What is the chance I end up no better, or worse, than I am now?
Why ask it
That is a different number from the complication rate, because an operation can go to plan and still leave the pain. The second half of the answer is what the surgeon offers next to the patients it does not help.
Sling and home
Will I go home the same day, and what has to happen before I can leave?
Why ask it
Day units commonly want your pain under control, you up and moving, and an adult to take you home and stay the night. Hear the conditions now, so that nobody is ringing round for a lift at four in the afternoon.
What is the plan for pain in the first two weeks, including at night?
Why ask it
Nights are often the hard part after a shoulder operation, once the block has gone and there is nothing to distract you. Get the plan as a list: which medicines, how long any strong ones are meant to last, and how they are stepped down.
Will I be in a sling, and for how long?
Why ask it
The sling is the part that reshapes daily life: sleeping, dressing, washing, driving. Ask whether it comes off for exercises, whether it is worn at night, and what type it is, since one with a pillow that holds the arm away from the body is bulkier than a plain one.
What can I not do in the first six weeks, and what happens if I do it by accident?
Why ask it
Early on a repair is protected by the rules, not by its own strength. Go through real examples: reaching behind you, lifting a kettle, pushing up out of a chair, catching yourself in a stumble, and what one slip actually risks.
How should I set up a bed or a chair for the first nights?
Why ask it
Many people sleep propped up or in a recliner for a while after a shoulder operation, and that is easier to arrange before the date than with one arm afterwards. The ward nurses or the physiotherapist can show where a pillow goes to support the elbow.
How do I wash, dress and look after the wound with one arm?
Why ask it
Find out when the dressings can get wet, whether the sling comes off in the shower and how to get a shirt on without lifting the arm. Being shown once by a nurse beats reading it in a leaflet.
Are there exercises I should start on day one, before physiotherapy begins?
Why ask it
Teams often want the fingers, wrist and elbow kept moving, and sometimes gentle pendulum swings, while the shoulder itself is left alone. Have each exercise demonstrated before you leave, along with how many times a day to do it.
Should I use ice packs or a cold therapy machine, and for how long?
Why ask it
Opinions differ on how much a rented machine adds over a bag of frozen peas in a towel. Go with what this team recommends, hear how to protect the skin, and check whether the cost is covered where you are.
How much help will I need at home, and for how long?
Why ask it
With one working arm, cooking, washing your hair and fastening clothes all slow down. Say if you live alone, care for someone or are the one who lifts the children, because the answer changes with it.
When is my first follow-up, and what will be checked?
Why ask it
The first visit usually deals with the wound and the stitches, and it is often when the surgeon explains what was found and what was done. A copy of the operation note or the keyhole pictures is worth requesting at that visit, since a physiotherapist can work from it.
Rehab and return
When does physiotherapy start, how often, and for how long?
Why ask it
Rehabilitation runs for months after the wound has healed, and much of the result is earned there. If the referral can be made before the operation, a waiting list does not eat the first weeks.
Is there a written rehabilitation protocol for this operation, and can I have a copy now?
Why ask it
Many surgeons keep a week-by-week protocol for each operation they do. A copy lets you plan work and childcare around it, and lets a physiotherapist outside the surgeon's own clinic follow the same rules.
Which movements stay off limits longest after this particular repair?
Why ask it
The answer depends on what was fixed: after one kind of labrum repair it may be the arm out to the side and turned back, after another it may be loading the biceps. Ask to be shown the position, so you recognise it when you drift towards it.
When can I drive, sleep lying flat, work at a keyboard, and lift overhead?
Why ask it
Write the expected week beside each of the four. Driving is the one that is not only the surgeon's call: the rules, and what your insurer expects after an operation, depend on where you live.
If my job involves lifting, driving or overhead work, when can I go back, and on what duties?
Why ask it
A desk and a building site get very different answers. A letter giving separate dates for light and full duties helps, and how sick pay or leave works is a matter for your employer and varies by country.
When can I return to sport or the gym, and what test decides it?
Why ask it
Contact sport, throwing, swimming and weights each tend to get their own date after a labrum repair or a stabilisation. Ask whether clearance rests on the calendar alone or on strength and movement you have to demonstrate.
What should I do if progress stalls or the shoulder gets stiffer during rehab?
Why ask it
Plateaus are common in shoulder rehabilitation and often pass, but some need the surgeon to look again. Agree now what counts as behind schedule and whether your physiotherapist can contact the surgeon directly.
What does full recovery mean here, and how long does it take?
Why ask it
There are two dates in the answer: when you can expect to feel mostly normal, and when the shoulder is as good as it will get. For many repairs those are months apart, so plan around the second one.
Will I need to protect this shoulder, or keep up exercises, for life?
Why ask it
Some people are told to keep a short strengthening routine going indefinitely, and some are advised against certain lifts or positions for good. That is better heard before the operation than at the final appointment.
Preparing for a shoulder consultation
Practical guidance for the conversation itself
Matching the list to your operation
Labrum repair or stabilisation
When the shoulder has dislocated or keeps slipping, put four things at the top: the type and position of the labrum tear, whether any bone was damaged, the chance of another dislocation with and without an operation, and the arm position that will be restricted afterwards. Anyone who plays sport should add the return question and ask what test gives clearance.
Rotator cuff or other tendon repair
Here the size of the tear and whether it can still be repaired lead the conversation, followed by how often a repair of that size heals. The sling time and the week you may first lift the arm under its own power are the two numbers to write down.
Shoulder replacement
Ask which type of replacement is planned and why, how long the implant is expected to last, and whether any lifting limit applies for life. The questions about the hospital stay and help at home carry more weight here than they do for keyhole surgery.
A date already booked
If the decision is made, skip the first two groups. What you need now are dates and durations, so bring a calendar and mark the sling, driving and work milestones on it while you are still in the room.
What to bring and note
- 1Write down what you can no longer do, with examples: reaching a seatbelt, washing hair, sleeping on that side, hours of sleep lost.
- 2Note how long the problem has been there and whether there was a single injury or a gradual onset.
- 3List what has already been tried: physiotherapy sessions and over what period, injections and the effect of each.
- 4Bring all medicines including anything affecting blood clotting or diabetes, and note any previous anaesthetic problems.
- 5Say which arm is dominant and what your work and home life require of it.
Planning around the sling
- Arrange front-fastening tops, slip-on shoes, and a recliner or wedge pillow before the date rather than after.
- Move everyday items to waist height on the side that will still work.
- Confirm the physiotherapy appointment is booked before you go into hospital.
- Ask your employer what light duties exist, and get the expected time frame in writing from the surgical team.
- If you live alone, arrange for someone to stay the first few nights and to be reachable after that.
On second opinions
Asking is routine
For a planned shoulder operation there is usually time for a second opinion, and asking for one is an ordinary request. It earns its place most when surgery was offered at a first visit without a detailed look at the scan or at the options short of an operation.
Take your imaging with you
Take the images themselves and not only the report, since a second surgeon reading a written summary has less to go on. How you get a copy, and whether there is a charge, depends on the hospital and the country, so ask the imaging department.