Shoulder Surgery Side Effects: Common Procedure Is Bad News

by Chris Centeno, MD /

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shoulder surgery side effects

Old shoulder surgery habits die hard, despite the side effects. This past week I posted the results of a study showing that adding in an acromioplasty surgery to a rotator cuff tear doesn’t help patients. One surgeon who loves the procedure protested that removing the stabilizing ligaments of this part of the shoulder is without side effects, and I responded that regrettably the body has no spare parts (i.e., removing ligaments is always a bad idea).

Now a new study seems to support my position as it shows that this procedure just places more stress on the rotator cuff. Why is this important? If you end up with shoulder rotator cuff surgery, you may forever have an unstable shoulder caused by the removal of these ligaments without your knowledge. So what are the shoulder surgery side effects of acromioplasty?

Why Are Ligaments Important?

First, a little background. Every joint in your body needs to make sure that its surfaces are aligned with millimeter precision while you move. To do this, your body uses two systems. The first system is made up of muscles that actively maintain that alignment. The second consists of ligaments, which act like duct tape to hold the joint passively together. Both systems have to work to allow normal and efficient movement. If you get rid of one of these systems, there will eventually be problems in the joint as the surfaces undergo too much wear and tear and arthritis sets in.

What Are These Important Shoulder Ligaments?

The shoulder, like every other part of the musculoskeletal system, depends on certain ligaments for stability. The ligaments in question are the onesshoulder AC joint ligaments that hold the acromioclavicular (AC) joint, located between the collar bone and shoulder blade, together. They are called the coracoclavicular (CC) and coracoacromial (CA) ligaments (see yellow highlighted ligaments to the right—click to enlarge).

What Is Acromioplasty?

The most common shoulder surgery performed in the U.S. today is a shoulder rotator cuff repair with acromioplasty. The surgery involves surgically sewing back together the torn rotator cuff, which makes up the active stability system for the shoulder. Since surgeons believe that in many patients the rotator cuff tear happened because of extra pressure placed on the muscle, they also usually cut the CA ligament to try and give the rotator cuff more breathing room. This procedure is called an acromioplasty.

Most patients have no idea that their rotator cuff repair involves cutting this important stabilizing ligament, as many years later when their shoulder arthritis brings them to our clinic, they are surprised to learn that their shoulder was destabilized at the time of surgery when this structure was cut.

New Research Shows Acromioplasty Is Bad News

The new study looked at what happens when surgeons cut this critical ligament. The researchers looked at nine shoulders of cadavers where the forces on various structures could be measured before and after the ligament was cut. As expected from our discussion above, when the ligament is no longer able to stabilize the shoulder, the muscles have to work harder. In this case, after the acromioplasty, they observed extra forces on the rotator cuff.

Given that most of these surgeries also involve repairing the rotator cuff, extra tugging on that muscle because the surgeon cuts a stabilizing muscle is not helpful. In addition, this likely explains why many of these patients get shoulder arthritis years later. After acromioplasty, the patient is left with an overloaded rotator cuff that tries to keep up with the extra stability demands but at some point can’t maintain stability, and eventually the joint suffers from the extra wear and tear.

Maybe adding the acromioplasty conveys some sort of other benefit? Nope. Recent research has shown that in the short run, adding acromioplasty doesn’t help the outcomes of the rotator cuff repair.

Old Habits Die Hard

If you’re scheduled for a rotator cuff repair or have already had one, it’s highly likely that an acromioplasty is planned or was already done. Don’t allow your shoulder to be destabilized because the surgeon is used to cutting this ligament! In addition, based on our experience, many rotator cuff tears don’t need surgery at all as they can be helped through a much less invasive and precise injection of the patient’s own stem cells.

The upshot? There are no spare parts! For decades orthopedic surgeons have been removing or cutting critical parts and pieces of the musculoskeletal system without much scientific justification or much information on the consequences of the surgery. As our research gets better and better, we’re seeing that these surgeries often do more harm than good—case in point is acromioplasty. So if your surgeon wants to cut your CA ligament, find another doctor!

To find out if you might be a candidate for a Regenexx stem cell procedure, complete our Regenexx Procedure Candidate Form online.

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8 thoughts on “Shoulder Surgery Side Effects: Common Procedure Is Bad News

  1. Anne

    Is that why I have a dent in my shoulder? I was surprised by this as I was unaware that my shoulder would not look the same following surgery.

    1. Regenexx Team Post author

      Anne,
      If you had a rotator cuff repair…it’s likely.

  2. Scott Lomas

    I had rotator cuff surgery in mid December, my supraspinatus tendon was torn about 80%, the acromioplasty procedure was also performed. I was told I would need shoulder replacement down the road. 4 weeks later I developed a blood clot in my lung from my surgery. I’m just now starting my rehab and I have a long road a head of me. I’m regretting my surgery big time! Is there any hope for me down the road, I’m 58 years young but getting older?

    1. Regenexx Team Post author

      Scott,
      I wish we could say we don’t hear these stories often. Given the acromioplasty, the biomechanics of the joint have been permanently changed. The problem is, the particular changes actually put greater strain on the rotator cuff, and make the joint unstable which then leads to arthritis. So while we can’t replace the missing parts, we can work with what’s there once you’re healed.

  3. Scott Lomas

    I’m extremely fearful of the prospect of a shoulder replacement. Reading my operative report and postoperative diagnoses I’m assuming that symptomatic acromioclavicular osteoarthritis and grade 4 chondromalacia of the humeral head and anteroinferior glenoid are the reasons for a future shoulder replacement. Knowing that there is a success and failure rate in all types of procedures, would the Regenexx stem cell procedure give me a chance to prevent shoulder replacement? Also, when would you consider me healed to consider me as a candidate for the procedure?

    1. Regenexx Team Post author

      Scott,
      We understand your concern and it’s well placed, as unfortunately in many cases patients are not advised of realistic outcomes and complications. It is true that all medical procedures have success and failure rates, which is one of the plethora of reasons conservative and non-invasive measures should be exhausted first. We treat many patients after a failed acromioplasty and while removing these ligaments makes our work harder, we’re always happy to take a look to see if we can help. I will inquire as to the time interval.

  4. Mark Merchant

    I have an upcoming appt. with the Regenexx clinic in Bradenton, FL. This past Wednesday I had a second opinion appt. with another orthopaedic surgeon in Atlanta. This physician is highly regarded and he and his team do all the ortho work for The Atlanta Braves.
    He examined my MRI of my left shoulder partial tear of my rotator cuff and was not adamant about performing surgery but did stress I will need six weeks before I could really go back to work as a professional comedy ventriloquist.
    I was honest and told him I was considering stem cell therapy and he told me there is no proof the injected stem cells act to repair the damage. Later that same morning I had a routine visit with my allergist and she went as far as to say; “Those stem cell guys are all a bunch of quacks.”
    From my conversations with Regenexx I have been told that your procedure has a remarkable success rate with shoulders.
    The cost of course is a concern but shoulder surgery is not cheap; however insurance will cover it, I would rather fork over substantial dough and AVOID surgery and hope the stem cells work.
    One of the physicians at the Denver clinic told me I needed to stop taking Nexium(for GERD) and stop low dose Lipitor as these affect the quality of the stem cell procedure.
    Comments?
    Mark Merchant

    1. Regenexx Team Post author

      Mark,
      The biggest problem with rotator cuff surgery is that it doesn’t work well. With surgery you are weakening something that tore because it didn’t have the necessary repair potential, and further weakening it by the muscle atrophy due to the long term bracing needed after surgery. http://www.regenexx.com/blog/rotator-cuff-surgery-retear-rates/ Giving the failing torn area what it needs to repair itself, without creating more trauma simply makes more sense. It’s not surprising that the Orthopedic Surgeon sees the situation differently; Orthopedic Surgery and Regenerative Interventional Orthopedics are two entirely different paradigms. http://www.regenexx.com/helping-another-shoulder-rotator-cuff-tear-heal/ http://www.regenexx.com/blog/rotator-cuff-surgery-alternative/ Unfortunately, to use their words, there are “quacks” out there in the stem cell field, but importantly, there are also orthopedic surgeons who have decided to offer stem cells without adequate training, knowledge and experience.
      It’s a very important decision, and understanding that all medical procedures (including surgery) have success and failure rates, you need to make the decision that works for you. Here are a few additional pages of articles on Rotator cuff surgery: http://www.regenexx.com/?s=rotator+cuff . http://www.regenexx.com/the-regenexx-procedures/shoulder-surgery-alternative/ But if you decide on surgery, make sure you get in writing that they won’t do an acromioplasty which has become a routine part of the surgery, as it creates lifelong shoulder instability!

Chris Centeno, MD

Regenexx Founder

Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications.
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