Shoulder Arthroscopy surgery

Training Q&A [Moderated]
1

Hi BBM,

To give some background - around 5 months ago I was warming up on bench press and on one of the reps felt a sudden “pop/click” in my right shoulder. At the start I had quite significant pain even when not training, and I took a bit of a break from pressing for a few weeks. Since then, i’ve been working with a physiotherapist every 1 to 2 weeks, and i’ve managed to make some progress. This is where I got to:

  • Close-grip bench of around 95% of the weight I was able to press prior to the injury with no pain
  • Comp bench with a regular grip around 90% of my previous weights with minimal pain.
  • OHP and Incline bench press around 80% of my previous weights with minimal pain.
    Though, even after 4-5 months, there are a few things i’ve made little to no progress in:
  • I can’t get into a low-bar squat position due to pain when my shoulder is stretched.
  • Dumbbell bench / overhead press hurts at the bottom portion of the lift due to the stretch on the shoulder.

I’ve been around this level of recovery from the injury for the last 1-2 months and my physiotherapist suggested that I go get an MRI scan and go to an shoulder specializing orthopedic surgeon that he works with regularly to check what’s causing the pain and if we’ve missed something in our analysis.
Sorry in advance for any mistranslations in the exact terminology, english isn’t my first language and this is being translated:
The orthopedic surgeon that I went to said that I have a partial SSP tear (though he said it’s very close to being a full tendon tear and most fibers have been torn), and he said that potentially the bicep tendon that is attached to the shoulder is also damaged, but he said that it’s hard to determine it with an MRI and that would be something that we would likely see in surgery. I was told that although surgery isn’t a necessity if I don’t plan on lifting weights, he did say that if I did choose to continue training over time this could result in more significant damage to the shoulder (though he said we’re likely not talking about the immediate future), and he recommended a shoulder arthroscopy to fix any damaged tendon.

I have a few questions about that:

  1. From what I know from following BBM for the last few years, surgery for a “small” injury is usually a last resort after trying to following the BBM pain protocol and working with the BBM rehab team and/or local physios. What are your thoughts about the claims that if I don’t get surgery it could lead to complications in my shoulder in the future? Given i’ve already been rehabing for a good few months, and first took the conservative approach and still haven’t seen a full recovery, should the surgery be something to seriously consider? I know that the last question is up to me to decide in the end, though i’d like to get some thoughts about what would be your approach in this situation.
  2. Question to Jordan - I remember seeing a few months ago that you’ve dislocated your shoulder after an accident. Did you end up having surgery to fix any damage that’s been done to the tendons in the area? If not, what are the reasons for that and do you feel confident that this won’t lead to problems in the future (in case you had a partial/full tendon tear along with the dislocated shoulder)?
  3. Does BBM have any resources such as articles / podcasts about this surgery and it’s recovery proccess? For example, when can I get back to lower-body training, when can I start one-sided training with my non-injured arm, when do I start light training with both arms, etc.
2

Hey Josh,

I think this is better suited for a consultation, as I don’t think we can answer this in enough detail for you to on the forum.

In general, at ~ 1 year of time there tend to be little differences in conservative vs surgical management for cuff tears. 5 months isn’t a particularly long time. There are unique cases and contexts that can respond better or worse. Also not sure why the PT recommended imaging.

I did not have any surgery to my shoulder and do not know if any tendons are “damaged”. Imaging findings in shoulders and many other joints don’t necessarily correlate with function or pain. I am very confident that this is unlikely to lead to bad outcomes in the future that I would otherwise avoid with surgery, though surgery is not typically advocated for shoulder dislocations that have been reduced.

We do not have any podcasts on rotator cuff surgery at this time. There are no guidelines for return to activity of the non surgerized side, but if it were me, I would be doing something days after the procedure. It might just be walking or light resistance training on machines, but I’d be doing something.

-Jordan

3

Hey Jordan,

Thanks for the reply. I’ll definitely consider a consultation before deciding on what to do next.

Just to make sure I understood it correctly - what you said means that after around a year since an injury the outcomes of consevaties vs surgical management are relatively similar? Does this mean that if a person was to have surgery soon after such injuries outcomes are usually better?

And in general, are there any cases that you would be in favour of surgery to repairs torn tendons or are you always in favour of conservative management of such injuries?

4

Josh,

Unfortunately, there are too many variables to say that shoulder surgery or conservative management is better or worse at any time point. I am not always in favor of conservative management for all injuries, shoulder or otherwise, but I don’t think surgery is always necessary either. Even for tendons that have abnormalities on imaging. There are few general rules here without more information, which makes them less generalized…

Just to make sure I understood it correctly - what you said means that after around a year since an injury the outcomes of consevaties vs surgical management are relatively similar?

In most, but not all cases, my interpretation of the literature is as stated: “In general, at ~ 1 year of time there tend to be little differences in conservative vs surgical management for cuff tears.”