Private Shoulder Surgery: Costs, Recovery and the Rehab That Decides the Result

• Arthroscopic subacromial decompression. Keyhole removal of a bone spur and soft tissue from above the rotator cuff, done for impingement-type pain with an intact cuff.
• Rotator cuff repair. Reattaching a torn tendon to the bone, usually with anchors. Recovery is governed by the tendon healing to bone, which takes months.
• Stabilisation surgery. Repairing the labrum or capsule after recurrent dislocations, most often in younger people.
• Shoulder replacement, anatomic or reverse, for advanced arthritis or an irreparable cuff with arthritis.

The pain that leads people to a surgeon is often the same in the first three. Working out which structure is actually involved is what our article on physiotherapy for rotator cuff injury covers.

Subacromial decompression was for years one of the most frequently performed orthopaedic operations in the UK. The CSAW trial, published in The Lancet, tested it properly by randomising 313 patients with subacromial shoulder pain into three groups: decompression surgery, arthroscopy alone as a placebo procedure, and monitoring with no surgery.

Both surgical groups improved compared with no treatment, and the decompression group showed no meaningful advantage over the placebo arthroscopy. In other words, the improvement came from having a procedure rather than from removing the bone spur.

This has changed practice. UK guidance now steers strongly towards a properly structured exercise programme before any decompression is considered for impingement-type pain, and many surgeons have stopped offering it. It says nothing about rotator cuff repair, stabilisation or replacement, all of which have their own separate evidence.

A private quote is assembled from parts, and comparing two headline figures without knowing which parts they include is how people get caught out. The components are:

• The initial consultant appointment, and any follow-up appointment before the decision.
• Imaging, typically an ultrasound or MRI scan.
• Surgeon and anaesthetist fees.
• Hospital fees, which rise with an overnight stay. Cuff repairs and replacements are more likely to involve one than a keyhole procedure.
• Implants, which matter for replacements.
• Postoperative consultant reviews.
• Physiotherapy, and specifically how many sessions.

That last item deserves scrutiny for shoulders more than for most joints, because shoulder rehabilitation runs for months and a package that includes six sessions covers a small fraction of it. Ask for the number in writing, and ask what happens after it runs out.

The tendon has to heal onto bone, and that biology sets the pace regardless of how well you feel. A typical protocol runs:

• Weeks 0 to 6. Sling, with passive movement guided by a physiotherapist within limits the surgeon sets. Elbow, wrist and hand movement throughout, and gentle scapular work.
• Weeks 6 to 12. Sling comes off, active movement is rebuilt, and range is restored gradually. Strength work stays light.
• Months 3 to 6. Progressive strengthening of the cuff and the scapular muscles, then loaded work in useful positions.
• Months 6 to 12. Return to overhead sport, heavy lifting and manual work, on capacity rather than on a date.

Recent evidence has softened the traditional strict immobilisation. A systematic review and meta-analysis of early versus delayed rehabilitation after cuff repair found that earlier mobilisation improved shoulder flexion at six weeks, three months, six months and a year, without increasing the rate of re-tears. Protocols still vary by surgeon and by tear size, so follow the one you are given.

The most common problem after a cuff repair is stiffness. The shoulder tightens during the protected phase, stays that way once the sling comes off, and then takes months of work to reverse.

Two things reduce that risk. The first is doing the permitted passive movement diligently from the start, several short sessions a day rather than one long one. The second is keeping the elbow, wrist and neck moving, since a shoulder held rigidly in a sling for six weeks drags the whole upper quadrant into stiffness. Our article on neck pain from the shoulder covers that relationship.

If range is clearly behind schedule at the six to eight week mark, that is the moment to say so rather than waiting for the next consultant review.

What has shifted in clinic is who turns up and when. More people now arrive having been told that surgery for their impingement-type shoulder pain is off the table, holding a recommendation for exercise and no clear sense of what that means beyond a sheet of resistance band exercises. Uckfield Leisure Centre has a refurbished gym and a 25 metre pool, and both get used heavily by exactly this group, often with technique that keeps the shoulder irritated.

The clinical point is that "do exercises" and "load the rotator cuff and scapular muscles progressively for three months" are different prescriptions with different results. The CSAW findings only make sense as a change in practice if the exercise arm is done properly, which means resistance that increases over weeks, positions chosen so the painful arc is respected early and reclaimed later, and a plan for overhead work rather than avoidance of it. Freestyle swimming and overhead pressing are usually reachable again, in a specific order.

If your shoulder is stalled either side of an operation, an assessment will establish which stage it is actually at.

Should I have decompression surgery for impingement?
The CSAW trial found no benefit over placebo surgery. Current practice is a properly progressed exercise programme first, and a surgical opinion if that genuinely fails.

How long is the sling after a cuff repair?
Usually around six weeks, though this varies with the tear and the surgeon. Follow the protocol you were given rather than a general timeline.

When can I drive after shoulder surgery?
Once out of the sling and able to control the wheel and perform an emergency manoeuvre. That is typically six weeks or more after a repair. Confirm with your surgeon and check your insurer’s position.

Does a torn rotator cuff always need repairing?
No. Many partial and some full-thickness tears become symptom-free with strength work, particularly in older shoulders. Size, age, function and symptoms all feed the decision.

How many physiotherapy sessions will I need afterwards?
More than most surgical packages include. Shoulder rehabilitation is measured in months, so check the number in your package and plan for what follows it.