But I’ve already had physiotherapy…

I completely understand the frustration.

You feel as though there is something wrong with your shoulder. You’ve already seen a physiotherapist, you’ve diligently done all the exercises you’ve been given, but you’re still not getting better.

So you come to see a shoulder surgeon and what do they recommend?

You guessed it… physiotherapy.

The thing is, there’s physiotherapy — and there’s physiotherapy.

Sometimes it is about finding the right physiotherapy

You wouldn’t see a hip surgeon for a shoulder problem, and physiotherapy can be similar.

Physiotherapists train broadly, but as their careers develop some gain particular expertise in certain areas. Some work predominantly with sports injuries; others develop considerable experience managing shoulder problems, instability or rehabilitation following surgery.

That doesn’t mean the physiotherapy you’ve already had was wrong or that your previous physiotherapist wasn’t good. Sometimes it simply means that your particular shoulder problem needs a different approach, or someone with more specific experience of that condition.

Not everything painful needs surgery

One of the important parts of my job as a shoulder surgeon is actually recognising when surgery isn’t the answer.

Some shoulder problems can be extremely painful without there being a structural abnormality that I can simply fix with an operation. That can understandably be frustrating, particularly when you’ve had a scan and expected it to provide an explanation.

But a normal or relatively reassuring scan doesn’t mean that your pain isn’t real.

For example, posterior capsule tightness can cause remarkably sharp pain and catching in the shoulder. Patients sometimes describe feeling as though something is tearing or moving inside the joint, which can understandably be quite unnerving. Yet this isn’t necessarily a problem that needs an operation. Once it has been recognised, targeted shoulder physiotherapy can be very effective.

Sometimes timing matters too

Frozen shoulder is a good example.

Physiotherapy can be very useful, but the approach may need to change depending on the stage of the condition. Trying to push aggressively through a very painful, irritable shoulder can sometimes make things worse rather than better.

So simply saying “I’ve tried physiotherapy” doesn’t always tell me whether physiotherapy has genuinely failed. I want to understand what treatment you’ve had, what exercises you’ve been doing, how your shoulder responded and, most importantly, whether we are treating the right diagnosis.

So why am I sending you back to physio?

Because sometimes my role isn’t to operate.

It is to listen to what’s been happening, examine you, use imaging where it will genuinely help, work out what I think is causing your symptoms and then help you get to the right treatment.

Sometimes that treatment is surgery. Sometimes an injection can help settle things enough to allow rehabilitation to progress. And sometimes the most useful thing I can do is put you in the hands of a physiotherapist with the right expertise, with a clearer diagnosis and a more specific rehabilitation plan.

So if you’ve already had physiotherapy and I recommend physiotherapy again, it doesn’t mean we’re simply starting again.

Hopefully, this time we’re starting from a better understanding of what we’re actually trying to treat.