Non-surgical shoulder treatment should be the first thing you try, especially before considering shoulder surgery. Although there are some shoulder injuries that require shoulder surgery, non-surgical shoulder treatments are effective at relieving pain and improving function in a large percentage of shoulder injuries.
I treat shoulder injuries on a daily basis as a chiropractor and rehab professional, which gives me a unique perspective on why you should try non-surgical shoulder treatments first. If you’re looking for non-surgical shoulder treatments, in this content, I’ll cover these common topics relating to non-surgical shoulder treatments:
- The downsides of shoulder surgery operations
- Effective non-surgical shoulder treatments
- Advantages of non-surgical shoulder treatment
You can see by the picture that the shoulder joint has a lot going on, it’s a complicated joint. It has such a large range of motion and supported by the rotator cuff muscles.
The Downsides of Shoulder Surgery Operations
If you’re considering shoulder surgery, although often effective, it has a number of drawbacks. If you’re trying to avoid shoulder surgery, let’s look at some of the drawbacks you should consider beforehand.
Shoulder surgery can be expensive. Depending on your insurance, shoulder surgery can be quite expensive. It will likely use up your insurance deductible, and then you may be responsible for co-insurance (typically somewhere around 20% of the remaining cost) after you meet your deductible.
Based on data from New Choice Health, a company that analyzes the costs of medical procedures, arthroscopic shoulder surgery averages $25,925 in the US. There are a number of factors such as your location and what specific procedure is performed that affect the price.
Remember, that number only covers the costs associated with the procedure. It doesn’t cover costs like your appointment before surgery or rehabilitation and medications after surgery.
There is a long period of recovery after shoulder surgery. Although shoulder surgery typically doesn’t take too long to perform, the recovery process is extensive. Premier Orthopaedics, a clinic who performs arthroscopic (minimally invasive shoulder surgery) estimates the recovery period can last up to 6 months.
You’re most likely going to have your shoulder immobilized for a while during the healing process. Generally, 6-12 weeks after shoulder surgery you’re only performing limited shoulder range of motion activities. After this 6-12 weeks, the next 3-6 month post-operative period requires physical therapy to strengthen your shoulder and get back to a pre-injury level of function.
Shoulder surgery isn’t always successful. Generally, rotator cuff repair has positive long-term results, but there is still a significant proportion of shoulders that fail to heal. You’re not guaranteed a full recovery after surgery and there are a number of factors that can affect recovery.
Patient factors that can affect the success rate of shoulder surgery include age, size of a rotator cuff tear, atrophy of the rotator cuff, tendon shortening, muscle retraction, smoking, osteoporosis high cholesterol, and diabetes.
Surgeon factors that can affect the success rate of shoulder surgery include the type of surgery you have, quality of your rehabilitation program, surgeon skill, and whether you have supportive treatments like platelet-rich plasma or mesenchymal stem cell treatments following surgery.
I’m definitely not anti-surgery when it comes to severe shoulder injuries. If your shoulder is severely damaged, surgery is probably the best option for relieving pain and getting back as much function as you can. When one of my patients has severe shoulder damage, I have no problem referring them for an orthopedic surgery consult. However, I do think that many patients undergo shoulder surgery before they’ve tried non-surgical shoulder treatments that could have helped them recover without surgery.
The supraspinatus muscle is the most common injured muscle of the rotator cuff. Testing it for weakness can help you determine if you’ve injured your rotator cuff. I show you how to test the supraspinatus muscle in this video.
Effective Non-Surgical Shoulder Treatments
Your shoulder pain could have a number of causes, and with a good exam we can figure out what’s causing your shoulder pain. We can often time do this with a good physical exam, and without an MRI. Once we know what the problem is, if you’re a candidate for non-surgical shoulder treatments, we can try some of these therapies to relieve pain, improve range of motion, and get you back to full function:
Shoulder Strengthening and Flexibility Program. You NEED to be doing this if you’re going to try non-surgical shoulder treatments. Even if you’re having some of these other treatments, a shoulder strengthening and flexibility program should be a part of your recovery. We’ll determine which muscles are tight, weak, and possibly damaged and restore flexibility and muscle strength to these areas.
Here are rotator cuff strengthening exercises I prescribe patients who need to strengthen the rotator cuff –> Rotator Cuff Strengthening With Kettlebells
Dry Needling for Shoulder Pain. In addition to a shoulder strengthening and flexibility program, adding dry needling as a non-surgical shoulder treatment can relieve shoulder pain, reduce shoulder tightness, and improve shoulder pain-related disability. Widespread use of dry needling is fairly new and shows promise that it can help with shoulder pain, see this 2016 study in the Journal of Pain –> Exercises and Dry Needling for Subacromial Pain Syndrome: A Randomized Parallel-Group Trial
I wrote this piece that goes into more detail about dry needling for rotator cuff injuries and has a number of links in it that discuss dry needling for the shoulder –> Dry Needling for Rotator Cuff Injury
Chiropractic Care for Shoulder Pain. Chiropractic adjustments, also known as chiropractic manipulative therapy, have fair evidence as a non-surgical shoulder treatment as well. I sometimes treat shoulder discomfort with neck, upper back, and shoulder manipulation to relieve pain and restore movement to fixated joints. Chiropractic care is safe and when combined with a shoulder strengthening and flexibility program, dry needling for shoulder pain, and other treatments is an effective non-surgical shoulder treatment as evidenced here -> Manipulative Therapy for Shoulder Pain and Disorders: Expansion of a Systematic Review
This image shows some of the areas in the shoulder where rotator cuff injuries cause pain. Dry needling is effective at relieving shoulder pain referrals from myofascial trigger points.
Advantages of Non-Surgical Shoulder Treatments
If shoulder surgery is an option for you, there are a number of benefits to avoiding shoulder surgery to consider before going that route.
- Non-surgical shoulder treatments are almost always going to be cheaper than shoulder surgery.
- You won’t have to be immobilized for a significant period of time and will be able to move your shoulder if you choose rehab over surgery.
- You avoid the preparation from surgery and taking time off of work. You’ll have to make the therapy appointments, but you can typically fit them in over before/after work or during lunch.
- The side effects and risks of non-surgical treatments are minimal. There aren’t a lot of risks involved in the non-surgical options and side effects are typically minimal.
- The biggest benefit, in my opinion, is that shoulder surgery will still be an option if non-surgical options aren’t successful. I try and stress this to my patients because I’ve treated a number of patients who were considering shoulder surgery based on their doctor’s opinion, but were able to avoid it with the treatments we provide.
Remember that not everyone can avoid shoulder surgery, and that’s why orthopedic surgeons are really valuable. They can do some really amazing things with a scalpel.
However, they’re not always extremely familiar with different rehab treatments that can be amazing themselves. The best thing to do is to schedule an exam with a chiropractor or physical therapist and get their opinion. I’m always optimistic, but when I have significant doubt whether I can help I let my patients know.
Dr. Jason Williams DC is a chiropractic physician practicing at AccessHealth Chiropractic in Cary, NC. He treats neuromusculoskeletal pain and injuries using chiropractic manipulation, dry needling, acupuncture, rehab exercise strategies, and other supportive therapies. Primary areas of focus include back pain, neck pain, muscular pain, extremity pain, and orthopedic injuries. Dr. Williams is experienced in treating athletes, especially those in the CrossFit, Brazilian Jiu-Jitsu, Muay Thai, and MMA community.
If you’re interested in whether he or another AccessHealth provider can help you, navigate to our contact page or follow this link to request an appointment.