Shoulder Pain: When You Need a Surgeon and When You Do Not

Most shoulder pain does not need a surgeon. The American Academy of Orthopaedic Surgeons puts surgery late in the order for the common shoulder problems, behind time, movement and graded loading. A short list of shoulder problems does need a surgical opinion quickly, and those come first here.

When does shoulder pain need a surgeon?

Book a surgical opinion soon if any of these apply, especially after a fall or a wrench.

• The arm drops when someone lifts it for you, or you cannot raise it at all.
• The shoulder has changed shape.
• Numbness or weakness spreads down the arm into the hand.
• The joint is hot and swollen and you have a fever.
• The pain began after a fall and a doctor has told you your bones are thin.

The first two suggest a tear or a break. The third points at a nerve. The fourth needs same day care, because a hot, swollen, feverish joint can be an infection, and that is treated as an emergency.

What shoulder pain usually does not need a surgeon?

Three of the most common shoulder complaints are managed without surgery in most people.

• Rotator cuff tendon pain with no full tear.
• Frozen shoulder, which doctors call adhesive capsulitis.
• Early shoulder arthritis.

Frozen shoulder is the clearest example. It hurts and it limits the arm for a long stretch. Published guidance describes it as a condition that eases over time with movement and pain control.

How does a doctor tell the difference?

The first visit is a conversation and an examination. The place the pain lands, the movement that brings it on, and the moment it started all narrow the list.

An X-ray shows bone. An MRI shows tendon, cartilage and muscle.

Most shoulders do not need an MRI at the first visit. A scan ordered too early often finds wear that is common in people with no pain at all.

What can you do in the meantime?

• Move the arm every day inside a range that does not spike the pain.
• Load it lightly and often instead of resting it completely.
• Use ice or heat, whichever one helps you move more.
• Write down what you can and cannot do each week, so any change is visible.

Complete rest is the common mistake. A shoulder that does not move gets stiff, and stiffness becomes its own problem to treat.

What we do at Towsen Clinic, and what we do not

Adrienne Towsen, MD, is a board certified orthopedic surgeon. The American Board of Orthopaedic Surgery certified her in 2006. She trained in orthopedic surgery at Allegheny General Hospital and finished a sports medicine fellowship at Thomas Jefferson University Hospital.

She no longer performs surgery. She told her patients so when the clinic opened: “I loved my years in orthopedic surgery, and I appreciate the trust you placed in me as your surgeon. My focus now is more about prevention and health optimization.”

So if your shoulder needs surgery, this is not the office that does it. The work here is the part on either side of that. It covers movement quality, graded loading, hormone and metabolic health, and lowering the odds of the next injury.

The towns we serve

The clinic is at 795 East Marshall Street, Suite 303 in West Chester. It is on the third floor of the North Hills Medical Building, next door to Chester County Hospital. Patients travel in from Exton, Malvern, Glen Mills, Wayne, King of Prussia and Newtown Square.

What to do next

If a surgeon is what you need, see one first. If the goal is fewer injuries and better movement over the next ten years, that is a different appointment. Our page on injury prevention and performance medicine in West Chester describes what it covers.

A first visit at Towsen Clinic is 60 to 90 minutes and costs $295. Our page on how the first visit works sets out the steps and what the labs cover.

Call (484) 803-5448 to book one.