Most people think the choice is simple: rehab or surgery.
But with shoulders, that’s often the wrong question.
The real choice is usually rehab—or surgery plus rehab.

We can see from the anatomy of the region that to maintain a normal pain free shoulder, we need the health of a wide range of structures in the shoulder complex.

These structures–muscles, tendons, ligaments–can be affected by acute injury, chronic stress, repetitive injury, or degenerative changes over time.

The following categories includes the most common shoulder problems that may require surgery.

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The shoulder is easily the most amazing joint in the human body. If you don’t believe me, watch international level gymnastics sometime and take notice of the incredible things that athletes do with their shoulders.

The shoulder has the largest range of movement of any joint in the body, and yet with the right training and fitness people can walk on their hands or carry out amazing manoeuvres on Roman rings at gymnastic competitions.

Analysing these abilities of the shoulder, we can see that the shoulder has mobility, strength and stability. These three are often seen as being mutually exclusive, but the shoulder manages all three in its optimum state.

So how does the shoulder girdle manage this? Because it comprises a complex of joints which are stabilised by a complex arrangement of muscles and ligaments:

◆ The glenohumeral joint (GHJ) is the “ball and socket” joint between the humerus (upper arm bone) and the scapula (shoulder blade). The socket is deepened by a ring of cartilage—the glenoid labrum. The glenoid labrum provides better stability.

◆ The acromioclavicular joint (ACJ) is the joint between the acromion (part of the scapula) and the clavicle (collar bone).

◆ The scapulothoracic articulation is not actually a joint but an area where the scapula moves across the ribs under the control of several muscles.

These joints are moved by and stabilised by a range of muscles. The most important group of muscles for the GHJ is the Rotator Cuff—the Supraspinatus, Infraspinatus, Subscapularis and Teres Minor muscles. These muscles attach the scapula to the head of the humerus and stabilise the GHJ. Their tendons form a cuff around the head of the humerus, providing both movement and stability.

Without a functioning rotator cuff, we are actually unable to raise our arm past horizontal. At the very least we experience shoulder pain on overhead activities, as the humeral head can rise compressing the subacromial/subdeltoid bursa. Damage to the rotator cuff is one of the most common reasons for shoulder surgery.

The GHJ is surrounded by a joint capsule, a sleeve of ligamentous type tissue strengthened by several ligaments. A potential complication of shoulder surgery is “frozen shoulder”, where the capsule becomes inflamed and ultimately thickened and tight. This can cause restricted and painful movement and delayed recovery.

So in summary the glenohumeral joint:

◆ is a large ball sitting in a small shallow socket,

◆ is held together by a loose joint capsule (to allow a large range of movement),

◆ has a capsule strengthened by several ligaments,

◆ is stabilised by the rotator cuff group of muscles and their tendons, and

◆ is moved by many muscles travelling between the spine, thorax, scapula and upper arm.

In this way the shoulder meets our requirements of mobility, stability and strength. It does however leave the shoulder susceptible to any injury or degenerative changes of these structures.

Although a rehabilitation exercise program can achieve a lot, there will be times where surgical help is required.

If you want to see how all these structures move together, I suggest other shoulder anatomy resources at:

www.theshoulderphysio.com/anatomy.

How to Recover from Shoulder Surgery

Chapter 1: A Tale of Two Shoulders

Let me tell you the story of two patients with the same surgery on the same day who ultimately had very different recovery paths.

It was 1997. The young orthopedic surgeons in the medical center where my clinic was located were well-trained and using the latest techniques in shoulder surgery. On a Wednesday in mid-July two men presented for their first rehabilitation session 5 days after rotator cuff shoulder surgery—let’s call them Bill and Jim.

Jim was 39 years old, fairly fit, but irritated that this process was taking him away from his work. He had had a moderate size rotator cuff tear repaired. Bill was 82 years old, fit and keen to get on with his rehabilitation. He also had a moderately sized rotator cuff tear repaired by the same surgeon with the same technique on the same day. At this point most clinicians would expect that Jim, being 40 years younger, would make a faster recovery than Bill. This was not to be the case.

Jim had done no preparation for his surgery. He was unaware of the details of his shoulder surgery and had read none of the printed materials supplied by the surgeon. He had not taken the surgeon’s advice to see me for an exercise program prior to the surgery. Since the operation he was struggling at home with simple daily activities such as washing and dressing.

Bill, on the other hand, was well prepared for the surgery. He had in fact been to see me three weeks earlier and started a simple exercise program. He had read everything he could lay his hands on, so knew the post-operative process and how to manage at home, despite living alone.

From this point on, the differences between Jim and Bill increased further. Jim often missed review sessions with me, and at these sessions admitted to going at times several days without doing his simple home exercise program. His unspoken attitude was that if the surgeon had done an expert job, he shouldn’t need to do any more. In contrast, Bill kept appointments, did a few minutes of exercise every day as instructed, but was careful not to over-stress the shoulder, and so protecting the repairing rotator cuff from injury.

And so how did Jim and Bill progress in their recovery? It would be great if I could report that with an excellent orthopedic surgeon and the latest modern surgical techniques that they both had the same progress! Obviously, this wasn’t the case, otherwise I wouldn’t be telling the story, I wouldn’t need to write this book, and you wouldn’t need to read it.

Bill’s progress was better than average—his pain settled quickly in the postoperative period. By the time the surgeon allowed him to stop using the sling 5 weeks after surgery, his range of shoulder movement was improving rapidly. Importantly, he had coped well at home with his arm in a sling for 5 weeks. At 3 months he had almost full range of movement; by 6 months he was doing a “return to golf” rehabilitation exercise program.

Jim however was struggling. He refused to take the pain and anti-inflammatory medication that had been prescribed by his orthopedic surgeon, and so his pain levels were much higher than Bill’s. As he was only occasionally doing his home exercise program, and was experiencing significant pain, his shoulder was getting very stiff. He was taking advice from acquaintances rather than his health professionals, and so was attempting to overcome the stiffness by doing his exercises more aggressively but infrequently.

At five weeks when he was advised to stop wearing his sling, he experienced a spike in his pain level. At this point he had very poor active range of motion with marked pain at the limit of movement.

By six months after surgery Jim was still experiencing quite a lot of discomfort over the shoulder and could not sleep on that side. His active range of movement was still restricted in every direction.

At 12 months post-operatively he still had not reached the level of recovery that Bill had at six months.

Why I Was Driven To Write This Book

Cases like Bill and Jim, and countless others in the 20 years since then, have made me realize that it is the patient who controls their recovery, not me as their physical therapist.

Several years ago, as a guest of that same orthopedic surgeon who operated on Bill and Jim, I attended a conference for orthopedic surgeons who specialize in the shoulder. On the last day of the conference, at a panel discussion in front of the 450 delegates, a professor of orthopedic surgery from the UK said:

“Your orthopedic surgery of the shoulder is only as good as the post-operative physiotherapy program.”

I would take that one step further and say:

“The post-operative recovery from orthopedic surgery of the shoulder is only as good as the patient makes it.”

When I can help patients make the right decisions about their shoulder rehabilitation and provide them with the knowledge and tools to have a speedy and effective recovery, then I am a happy Physiotherapist!

As I have publicly stated on LinkedIn:

“My purpose is to make a significant positive impact on the physical health of the clients who attend my physiotherapy clinic or consult with me online.”

This book allows me to do this on a grander scale, reaching far more people than I could in several lifetimes individually. I won’t now be so frustrated by those who refuse to be helped. And so, I set out to make a positive and meaningful difference with my words. And this book helps me reach more people and achieve that mission.

To take control of your recovery from shoulder surgery, you need to understand the basics of your surgery rehabilitation, and the process of healing. This will help you lose your anxiety and focus your attention and energies on getting well fast and efficiently. Recovery from shoulder surgery is a process, and it takes time. This timeline can be accelerated by avoiding complications, appreciating your physical limitations through each phase of the recovery process, and following the right steps in the process to promote faster healing.

Why You Should Read This Book

So, who could benefit from reading this book?

This book will help if you or a loved one:

◆ Have been referred to an orthopedic surgeon with a view to surgery for a shoulder problem.

◆ Have already seen an orthopedic surgeon and are considering shoulder surgery based on the surgeon’s advice.

◆ Have booked in for shoulder surgery.

◆ Have recently had shoulder surgery.

Once you understand the basics of the preparation for surgery, the surgery itself, and the rehabilitation program, there is much less fear and anxiety about the whole process. The predictability of the process becomes reassuring, allowing you to focus your entire attention and energy on rehabilitating your shoulder back to full pain-free function.

The knowledge and tools in this book help you make a speedy recovery, with less anxiety and pain, and ultimately a better return to full function of your shoulder.