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Shoulder Surgery Complications

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Reviewing internet sites for shoulder surgery information, I was surprised to see very little published about shoulder surgery complications. Despite this lack of information on complications, many patients still undergo shoulder surgery for minor problems like frayed tendons or small rotator cuff tears, removal of bone spurs, or “clean-up” (shoulder joint and rotator cuff debridement). If a patient considers shoulder surgery for these less severe problems, then one also has to consider the possible complications or side effects of that surgery. About 1 in 10 patients who undergo an operation for their rotator cuff tear will have a significant complication. In one study common complications included shoulder stiffness (frozen shoulder), failure of healing, infection, reflex sympathetic dystrophy, deep venous thrombosis (blood clot), and death. Another possible complication is re-tear of the shoulder rotator cuff tear once it’s been surgically repaired. Older patients tend to re-tear their rotator cuffs despite surgery. In one study, the re-tear rate for patients over 65 with full thickness rotator cuff tears was 42%. In addition in a different research study, bigger (massive) rotator cuff tears had a higher re-tear rate of 57% at 10 years out from surgery. Regrettably, this study also showed that in many of these patients, fatty atrophy of the rotator cuff increased with time (the muscle got weaker and replaced by fat). Type of shoulder surgery may also affect re-tear rate of the rotator cuff. For example, in this study, open repair (where the shoulder is opened with a more traditional large incision) had a 39% re-tear rate, whereas arthroscopic repair had lower rates (16-25%). However, a different study showed the opposite: re-tear rates in large tears were more with arthroscopic surgery and less with open surgery.  Patients with bigger rotator cuff tears where the tear was retracted (the two ends don’t connect anymore) tended to suffer from the complication of re-tear 52% of the time in one study. Patients with diabetes had outcomes from shoulder rotator cuff surgery that are less robust than their non-diabetic counterparts. One study showed the encouraging finding that waiting to repair the rotator cuff (within reason), didn’t seem to hurt the outcome of the shoulder surgery.

The upshot? Shoulder rotator cuff surgery can help patients who have more severe problems in their shoulder and any surgery has to be weighed against the possible complications. About 1 in 10 patients who have these surgeries will have a significant complication. A common complication is re-tear of the rotator cuff and these patients tend to be older with larger tears.

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