Surgery is an art based on science. With good training, one can consistently reproduce a surgical procedure and hence the likely outcome. However, there are number of variables that need to be taken into consideration. This includes a very important variable which is you, the patient.
Surgery caries an element of risk. It is only recommended when one has exhausted all simple non-operative treatment methods and still has problems that affect activities of daily living, work, or the general quality of life. The non-operative methods could be physiotherapy and exercises including use of gadgets like body blade, or activity modifications. One may have tried treatment from the alternative healthcare pathways as well. I would then consider the surgical options available and the risk benefit ratio before recommending surgery.
The human body is the most complicated machine that we know of. We have not understood everything about it. But we can do many things including surgical procedures to reduce the suffering in many patients. However, with every heart beat the body gets that bit older and one cannot win the fight over natural aging process.
Purpose of surgery:
The aim of the surgery in the shoulder is to try and remove the offending part or to contain/reverse the pathology. For example removing the offending bone spur, repairing a torn tendon or replacing a worn out joint. This is done using the latest available equipment and many operations can now be done via key-hole methods.
Most operations are now done under general anaesthesia. This means that one would be asleep. Now a days, anaesthesia is very safe. Many of the shoulder operations are done as day case procedures. Even after a 2 hour anaesthesia, many patients will be ready to return home on the same day after the operation. There are many techniques of pain management including nerve blocks or local anaesthesia to keep one comfortable.
Types of surgery:
In my practice, more than 90% of the elective shoulder surgery is done as key-hole procedure. This means a quicker recovery, less pain and potentially less complications. In contrast, some surgery needs to done via the traditional open technique. This includes joint replacements and repair of a large to massive rotator cuff tear.
I still do tennis and golfer’s elbow releases by a small ‘mini-open’ approach using a special ‘wand’ to promote faster healing. .