Thinking Twice About Shoulder Surgery

Thinking Twice About Shoulder Surgery: Why Science Says You Should Try Physical Therapy First

If you've been told you need shoulder surgery for a rotator cuff tear, impingement, or labral tear, you might want to reconsider. Dr. Ian Harris, a renowned orthopedic surgeon and author of Surgery, The Ultimate Placebo, along with major scientific studies, suggests that many common shoulder surgeries offer no better results than conservative treatment—or even fake (sham) surgeries (Harris, 2016).

So, before scheduling surgery, let’s look at what the science really says.

Most Shoulder Damage Seen on MRIs Doesn’t Cause Pain

Many patients assume that if an MRI shows a rotator cuff tear, labral tear, or bone spur, surgery is the only option. However, imaging studies prove that these issues are incredibly common in people without any pain at all (Needell et al., 1996; Minagawa et al., 2013; Schwartzberg et al., 2016).

Key Research Findings:

• 89% of people over 40 have osteoarthritis or rotator cuff degeneration, yet many have no pain (Needell et al., 1996).
• 65% of rotator cuff tears on MRIs were in people with no symptoms (Minagawa et al., 2013).
• 55–72% of middle-aged people had labral tears on MRIs but reported zero pain (Schwartzberg et al., 2016).

What This Means for You:
Your MRI might show a "tear" or "damage," but that doesn’t mean it’s causing your pain. Surgery to “fix” an MRI finding may not actually be fixing anything that needs repair.

Shoulder Surgery Often Fails to Provide Long-Term Relief

Dr. Ian Harris argues in Surgery, The Ultimate Placebo that many shoulder surgeries are no better than placebo treatments (Harris, 2016). His research highlights that procedures like subacromial decompression (for impingement), rotator cuff repairs, and labral surgeries often provide no more benefit than sham surgeries or physical therapy.

Subacromial Decompression Surgery – No Better Than Fake Surgery

A systematic review and meta-analysis showed that subacromial decompression surgery for impingement:
❌ Did not reduce pain more than placebo surgery.
❌ Did not improve function.
❌ Came with risks of complications, including frozen shoulder and infection (Lähdeoja et al., 2019).

Dr. Harris' Conclusion: This surgery is unnecessary and ineffective. The same results can be achieved through physical therapy without the risks of surgery.

Rotator Cuff Surgery – High Failure Rate

Dr. Harris highlights that rotator cuff repairs fail in up to 60% of cases, yet many patients feel fine even if the repair fails. This suggests that:

• The body can adapt to a tear without surgery.
• Surgery is not always necessary, even for large tears (Harris, 2016).

Labral Repair Surgery – Often a Waste of Time

MRIs show labral tears in over 50% of middle-aged people who have no pain, meaning that repairing them may not actually address the true source of pain (Schwartzberg et al., 2016).

Dr. Harris argues that many labral surgeries are performed because of MRI findings rather than clinical necessity, leading to unnecessary procedures that don't improve patient outcomes.

Physical Therapy Works Just as Well—Without the Risks

Physical therapy has been shown to provide equal or better outcomes than surgery for many shoulder conditions—without the risks, cost, or downtime (Lähdeoja et al., 2019).

Key Benefits of Physical Therapy:

✅ Reduces pain and improves function as effectively as surgery.
✅ Strengthens surrounding muscles to compensate for structural changes.
✅ Avoids complications like infection, stiffness, and long recovery times.
✅ Costs significantly less than surgery.

Dr. Harris' Conclusion: Most patients with shoulder pain should try at least 3-6 months of physical therapy before even considering surgery.

When Might Surgery Be Necessary?

While most people do not need surgery, there are a few cases where it may be the best option:
You have a severe rotator cuff tear that causes significant weakness or loss of function.
Your shoulder is completely dislocated and unstable.
You have tried physical therapy for 6+ months with no improvement.

Even in these cases, discussing conservative options first with a physical therapist or orthopedic specialist is essential.

Final Thoughts: Should You Get Shoulder Surgery?

Surgery is rarely necessary for most cases of shoulder pain.
⚡ Physical therapy is just as effective—and often better—without the risks.
Save your time, money, and recovery period—explore non-surgical options first!

Dr. Ian Harris’ Bottom Line: Many common shoulder surgeries are unnecessary and provide no better results than conservative care. Instead of rushing into surgery, focus on physical therapy and lifestyle changes first.

Before committing to surgery, talk to a physical therapist to see if a structured rehab program could be your best path to recovery.

Want to learn more about how physical therapy can help your shoulder pain? Contact us today!

References

• Harris, I. A. (2016). Surgery, The Ultimate Placebo: A Surgeon Cuts Through the Evidence. NewSouth Publishing.
• Lähdeoja, T., Karjalainen, T., Jokihaara, J., et al. (2019). "Subacromial decompression surgery for adults with shoulder pain: a systematic review with meta-analysis." British Journal of Sports Medicine, 0, 1–10.
• Needell, S. D., Zlatkin, M. B., Shem, J. S., Murphy, B. J., & Uribe, J. W. (1996). "MR imaging of the rotator cuff: peritendinous and bone abnormalities in an asymptomatic population." American Journal of Roentgenology, 166(4), 863–867.
• Minagawa, H., Yamamoto, N., Abe, H., et al. (2013). "Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village." Journal of Orthopaedics, 10(1), 8-12.
• Schwartzberg, R., Reuss, B. L., Burkhart, B. G., et al. (2016). "High prevalence of superior labral tears diagnosed by MRI in middle-aged patients with asymptomatic shoulders." Orthopaedic Journal of Sports Medicine, 4(1), 1-7.

Read more about effective shoulder pain treatment: Shoulder Pain Therapy | Superior Physical Therapy