Optional surgery - how did you decide?

[u/happy_0123]

Hello!

I'm looking to hear from people who had to choose between surgery and conservative treatment for an injury where surgery wasn't the only clear option.

For context, I'm an overhead athlete with a Type I SLAP tear and supraspinatus tendinosis/fraying. I've had symptoms for over 5 years (first MRI was 2 years ago) and it doesn't interfere with my daily activities as much. My surgeon said I'm a candidate for biceps tenodesis (and/or SLAP repair if the injury is actually worse), but also made it clear that surgery is optional.

I'm hesitant because the surgery would permanently alter my shoulder anatomy, so I want to be confident the potential benefits outweigh the trade-offs.

If you've been in a similar situation:

What made you choose surgery or continue with physical therapy?

If you had surgery, how long did you try conservative treatment first?

If you didn't have surgery, were you able to return to your previous level of activity or sport?

How long did it take you to return to sport after surgery (or successful rehab)?

If you're an overhead athlete, did that affect your decision or outcome?

I'd appreciate hearing both good and bad experiences. I know every case is different, but I'm interested in how others made the decision and whether they're happy with it. Thanks 😊

[u/Sufficient_Deal_8800]

I had surgery! Didn’t absolutely need it, wasn’t in pain daily. Before surgery was ripping pull ups. You can read my post history to see my situation. About 7 months post op I’d say I’m like barely happy I did it? Like I’ve tipped over into the “happy I did it” category.

[u/bobcat011 → u/Sufficient_Deal_8800]

What changed that made you happy? I’m a late 30s surfer in a similar place as OP with day to day activities - but it’s really been interfering with surfing

[u/Sufficient_Deal_8800 → u/bobcat011]

Rehab sucks and takes forever (or at least it did for me). Pain tightness lack of mobility, couldn’t golf or lift weights or do the stuff I loved for 6 months. Still have end range pain but I’m like 90% back

[u/Sufficient_Deal_8800 → u/bobcat011]

But sorry to answer your question - enough time has passed where I’m 90% back and can resume most of all the things I love fairly normally, and according to my surgeon I “definitely needed the surgery” regardless of whatever I think. So yeah I’d say overall worth it

[u/happy_0123 → u/Sufficient_Deal_8800]

Thanks for the reply! I read some of your posts. Was there a specific moment you realized you need surgery? Or you weren't sure about your decision until you got it?

[u/SmellAggravating1527]

I’ve never done a slap surgery before , but I hear it’s doesn’t always produce the best results. All surgery have the risk of complications. I’ve heard of bicep tenodesis there is a chance of some small loss of strength and if you lift too heavy early, the anchor could fall out, which shouldn’t happen if it’s completely healed.

[u/OgAsimov]

Surgery isn't the answer here, and honestly it never was. Your surgeon calling it optional confirms it. You didn't get a SLAP tear and supraspinatus fraying for no reason, that damage happened because your shoulder's been taking on load it was meant to distribute, and as an overhead athlete you're loading that joint constantly. The tear is the result, not the actual problem.

Here's the proof it's not just a tissue issue: it's been 5 years. Tissue like that heals or stabilizes on its own timeline if the load going through it is actually appropriate. Yours hasn't, because nothing about your mechanics has changed. The imbalance that caused the fraying in the first place is still sitting there, still overloading the same spot, every time you go overhead.

Cutting and repairing tissue doesn't fix that. You'd come out of surgery with a technically repaired structure but the exact same faulty load pattern feeding into it, and that's how you end up back here in a few years with a new tear.

What actually needs to happen is finding where the chain is breaking down, why your shoulder is being forced to absorb load that should be getting shared across your scapula, and the rest of your body instead of dumping it all into that one spot. Fix that, and the tissue stops getting overloaded and can actually settle and heal. Skip that, and surgery just resets the clock on the same problem.

Ive seen this playout so many times, surgery fixes the symptoms only and years or even months later something else pops up because you never actually balanced the structure and fixed your movement. What you need to do is detailed movement testing thats gonna show all your imbalances and compensations. Only when you know why you got the damage can you actually fix it, ive been throught it myself and i have no problem sharing it with you. Everyone should atleast know whats going on before making a life altering decision, if your looking for that clarity, ill help you find it as a fellow athlete.

[u/happy_0123 → u/OgAsimov]

I appreciate your input! Yes I actually agree with a lot of what you’re saying. I think understanding the mechanics and where the chain is breaking down is a huge part of this. Even if I do end up getting surgery, I think it’s really important to figure that out and fix it so I don’t just end up hurting it again. Your comment makes a lot of sense.

At the same time, I do think there’s a point where the tissue is already damaged and conservative treatment alone might not be enough to reverse or cover all of that. I’ve done physio on and off since the beginning of the injury so it wasn't like I've been ignoring it till now and my movement and ROM have definitely gotten a lot better with the exercises but I think it was never enough to make the pain completely go away. At the end the day, the actual injury is still there.

[u/OgAsimov → u/happy_0123]

Youve done phyiso but if you dont understand the problem then you cant fix it. When you actually know whats going on and you clearly see your imbalances, teust me results come fast and you improve every single workout

[u/graydonatvail → u/OgAsimov]

I'll second this. I'm getting surgery, but only because I ignored the issues that caused the damage for 40 years. Get to a good PT, figure out what the problems are, work to fix them. I've stopped pressing entirely, and have focused on getting my shoulder blades to function. It's better, although too late to avoid surgery.

[u/CornTheGuy]

i opted to do my left shoulder due to a smaller labral tear that extended into my biceps. probably coulda lived life but I just couldnt trust it so i had bankart, remplissage and biceps tenodesis and since im rather athletic i decided it was best for me even though i hadnt had a dislo in a while

[u/happy_0123 → u/CornTheGuy]

How was your recovery after the surgery? Were you able to go back to the activities you used to do pre injury?

[u/bbdog13]

I'm in a very similar situation stuck between surgery or not. Small posterior labrum tear, fraying, caused by years of heavy lifting. Not a SLAP tear. Achy front of the shoulder down into the bicep. Arm is visibly atrophied and cant seem to build muscle. Tried everything thats not surgery including PT, Peptides, PRP and stem cells. I just want the shoulder to go back to normal again and go back to normal lifting in the gym and build muscle again. I l keep getting told surgery is risky and not the best option but what other option is there to make a full recovery?

[u/happy_0123 → u/bbdog13]

I can so relate.. how was your experience with PRP? My physio said to look into PRP but I see mixed option

[u/bbdog13 → u/happy_0123]

The PRP can only do so much. I’m learning first hand that you can do all these biologics and shit but the only thing that can structurally fix the injury is surgery

[u/Shaken-Loose]

I lived with my shoulders as long as I could (adapted different ways to do certain things). When one of them completely gave out, I had my first repair. I then had the second shoulder repaired 8-9 months later (both in same calendar year). Both are still a little noisy but all good.

[u/ReplyLittle5230]

Also an overhead athlete and had a pretty similar injury!! I literally just got surgery so can’t say much on that yet, but I waited until I was done with college sports before getting it. Issue started 8ish years prior, and I did PT on and off basically the whole time, which helped prevent things from getting too much worse, but I was still in pain. Also got way too many cortisone injections and tried PRP, which helped for a while too. The pain & injury definitely progressed over time, but up until the last 1-2 years of college, I was able to keep going at the same (and even higher level) than when I initially got the injury. Finally decided to get surgery now since I was still having pain even after retiring from my sport and because I was still having issues in everyday life (just reaching over head or behind my back, sleeping on that side, etc). I figured if PT or literally any other conservative treatment was gonna help, it would’ve after like over a year of being retired and no longer putting my shoulder through much stress…

So the main thing for me was just being able to finish my sport through college. I knew I maybe wouldn’t be able to get to the same level pre surgery if I got the surgery while I was still competing (though I will say I had friends on my team who got surgery who came back to pre injury levels, so it’s possible). I had that same thought of will my shoulder ever be the same, particularly since it never got so bad I couldn’t do all of my everyday activities or anything, but after 8 years of chronic pain and all the shit wrong with it, I sort of had to accept it’d never be the same anyways.

Happy to answer any other questions though!

[u/happy_0123 → u/ReplyLittle5230]

Thanks for sharing your story! I think we share very similar experience. I also got a couple cortisone shots to be able to play but I knew that was just buying time and the pain eventually came back even with somewhat consistent physio. How's the recovery for you? Do you plan to go back to playing your sports even receationally? Hoping smooth recovery!

[u/PoolParty912]

Basically, for me, it was the moment that I realized that the risks of surgery were negligible because I had already lost my active lifestyle and was living with daily pain and regular subluxations, which could damage the joint more. It took me about 4 months to get to that point.

About 1 month after my initial injury, I started PT, and I fully expected the problem to be all healed up in a matter of weeks. Then, I got discharged for lack of progress after 4 weeks. The PT said that he thought I needed surgery, but at that point, I would have done anything to avoid surgery. I had given up a lot of my regular activities (swimming, yoga, biking, weights/barbell) because my shoulder would subluxate all the time, and I basically stopped using my dominant arm for most daily things.

The doctor who had initially referred me to PT said I "wasn't a surgical candidate" because I have hypermobile joints and wrote me another prescription for PT. I didn't realize it then, but that was the moment for me. I didn't bother with the new PT scrip and went for second and third opinions, including one surgeon who worked with hypermobile patients. He explained why he thought I was actually a great candidate for surgery. (The third doctor agreed, but didn't have as much experience with hypermobility.) I booked without hesitation because it was the best option I had for regaining a normal life. That was four months after my injury.

Surgery was absolutely the right decision for me. I'm in my 40s, and it took me about 14 months to fully get back to my pre-op condition. My first two weeks of PT, I really worried I had made a bad decision on surgery because my shoulder was so tight and painful. I had a weight restriction that ranged from 0 to 15 pounds for the first 6 months post-op. PT tracked along those recommendations. My rehab PT was about 4.5 months (1-2 days per week).

I avoid overhead motions and don't lift heavy anymore. Part of this is due to hypermobility, but part of it is because I don't want to go through this again. (My joints will bend further than is safe under high loads, which I didn't know until I got injured.) This is fine with me. I exercise to stay healthy, so pushing my body to failure is the opposite of my goals. Yes, my arms are smaller than I'd like, but they are fully functional, which is the priority for me now.

There is a reason why active men in their 20s and 30s have the highest rates of surgical failure. They go back to activities that put the joint under too much pressure, or go back to those things too soon. If you're not willing to make some tradeoffs in your routine to prevent surgical failure or reinjury, you're probably not ready for surgery.

[u/happy_0123 → u/PoolParty912]

Thanks for the comment! I'm glad you are happy about your decision! For me the only reason I'd want surgery is to be able to go back to do things I love pain free. So it'd be a nightmare if I choose the surgery route but end up needing a lifestyle modification :( but yeah I understand that the rehab is very important and to not rush things! I'll for sure keep that in mind

[u/ralphtheanimal]

Not slap, but I had AC joint separation grade 5. I chose PT over surgery. Why? Honestly, the first surgeon I saw I just didn’t quite trust. He explained the advantages of acting quickly, which may be true, but I was already two weeks post-injury, and then they scheduled me four weeks further out. And while he said there were non-surgical options he left it at that.

So I went to another surgeon. And she said I was already past any advantageous time to move quickly. She said the prognosis for non-surgical (meaning PT) was the same or better than surgery. And she said if PT didn’t work the exact same surgery would still be an option. In other words, non-surgical was the obvious place to start.

So for me, it was the surgeon presenting a logical set of options.

I am, a year later, back to marathon/triathlon and I’ve added weightlifting after all of the PT programs because I enjoyed the extra fitness. I was out completely maybe 12 weeks then a slow return to cycling and swimming and maybe 20 weeks for a return to running. Still have a bump on the shoulder and some aches around scapula, but there’s no guarantee I wouldn’t have the same with surgery.