Rotator Cuff Surgery May Cause More Shoulder Pain Than Relief

Michael Greger M.D. FACLM · October 7, 2026 ·

The most common shoulder surgery provides no meaningful benefit over placebo sham surgery, yet it continues to put millions at risk.

Discuss

Transcript

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The fact that common shoulder surgeries appear to provide no important benefit compared to exercise, whose own effectiveness is under question, as I discussed in my last video, says something about the efficacy of surgery.

Millions of Americans go to their doctors seeking help for shoulder pain every year. About 70 percent present with the classic “painful arc,” a worsening of pain when lifting their arm to the side between about 60 and 120 degrees. For decades, this was considered a symptom caused by mechanical impingement of the rotator cuff tendons passing under the acromion, the bony projection of the shoulder blade at the top of the shoulder. To treat this “subacromial impingement syndrome,” an operation called subacromial decompression (S.A.D.) was developed more than 50 years ago. It has lived up to its acronym.

SAD quickly became one of the most commonly performed orthopedic surgeries. Then, studies started showing that it not only offered no benefit for pain or function over sham surgery, but it didn’t offer even clinically relevant improvements over no surgery at all, leaving little doubt that the surgery had little to offer. Carving away bone and other tissues to make more room for the tendons didn’t seem to make much of a difference. With the failure of the mechanistic rationale for the surgery, SIPS became SAPS. Subacromial impingement syndrome was renamed to the even fuzzier wastebasket term” subacromial pain syndrome. It’s also called rotator cuff tendinopathy or rotator cuff–related shoulder pain, all out of a recognition that a range of pathological conditions in multiple structures may contribute to it. Nevertheless, SAD subacromial decompression surgeries continued unabated years after it was first shown to be worse than useless.

By 2019, it was clear that surgery offered no important improvements in pain, function, or quality of life. Even surgery journal editorials started saying it should no longer be offered to patients, given that “almost all well informed patients would decline surgery,” considering there are only harms with no benefit. Serious harms, such as deep infections, blood clots in the lungs, nerve injury, and death, occur in less than 1 percent of SAD operations, though, ironically, frozen shoulders may result from slightly more than 1 percent of SAD surgeries. So, patients may go in with shoulder pain and come out with even more shoulder pain. If there are only harms, why do surgeons keep doing them to this day?

In a sidebar from my book How Not to Hurt entitled “Twisting the Knife,” I note how history is said to be “riddled with examples of excess exuberance in surgical innovation.” What better example than the Nobel Prize–winning lobotomy––brain surgery performed on tens of thousands of Americans for mental illness in the 1940s and 50s? With an ice pick-like instrument through the eye sockets, in ten minutes, even non-surgeons could cut through the brains of those rendered unconscious via electroconvulsive shock. A whole new meaning to the phrase “Let me pick your brain.” JFK’s sister, Rosemary Kennedy, was famously lobotomized for being an agitated teen, and ended up severely impaired and institutionalized for the rest of her life.

Excess exuberance is not limited to surgery. One reason given for not teaching the history of medicine is that it is said to be “so unrelievedly deplorable a story.” Remedies included fly specks scraped off walls, hippo fat, the urine of menstruating women, crocodile dung, owl blood, frog semen, “oil of skinned puppy,” and “moss scraped from the skull of a victim of violent death.” Or at least you hope it’s just skull moss. Dangerous practices like feeding people heavy metals or bloodletting continued for centuries before finally giving way to more evidence-based medicine. Here’s an example of the best medicine could offer King Charles II: “A pint of blood was extracted from his right arm, and a half pint from his left shoulder, followed by an emetic, two physics, and an enema comprising 15 substances; the royal head was then shaved and a blister raised; then a sneezing powder, more emetics and bleeding, soothing potions, a plaster of pitch and pigeon dung on his feet—obviously—potions containing 10 different substances, chiefly herbs, finally 40 drops of extract of human skull, and the application of bezoar stone; after which his majesty died.”

Even today, only 11 percent of 3,000 common medical treatments are considered to be proven to be beneficial, and the bulk of the rest of them— 50 percent—are classified as effectiveness unknown. (The remaining 39 percent of common treatments is split between 24 percent likely to be beneficial, 7 percent a toss-up, 5 percent unlikely to be beneficial, and 3 percent likely to be ineffective or harmful.) It has been said that there is no “alternative medicine.” There is only proven medicine supported by solid data or unproven medicine for which scientific evidence is lacking. Unfortunately, much of conventional medicine falls into the latter category.

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Sources

Acknowledgements

Motion graphics by Avo Media

Topics

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

The fact that common shoulder surgeries appear to provide no important benefit compared to exercise, whose own effectiveness is under question, as I discussed in my last video, says something about the efficacy of surgery.

Millions of Americans go to their doctors seeking help for shoulder pain every year. About 70 percent present with the classic “painful arc,” a worsening of pain when lifting their arm to the side between about 60 and 120 degrees. For decades, this was considered a symptom caused by mechanical impingement of the rotator cuff tendons passing under the acromion, the bony projection of the shoulder blade at the top of the shoulder. To treat this “subacromial impingement syndrome,” an operation called subacromial decompression (S.A.D.) was developed more than 50 years ago. It has lived up to its acronym.

SAD quickly became one of the most commonly performed orthopedic surgeries. Then, studies started showing that it not only offered no benefit for pain or function over sham surgery, but it didn’t offer even clinically relevant improvements over no surgery at all, leaving little doubt that the surgery had little to offer. Carving away bone and other tissues to make more room for the tendons didn’t seem to make much of a difference. With the failure of the mechanistic rationale for the surgery, SIPS became SAPS. Subacromial impingement syndrome was renamed to the even fuzzier wastebasket term” subacromial pain syndrome. It’s also called rotator cuff tendinopathy or rotator cuff–related shoulder pain, all out of a recognition that a range of pathological conditions in multiple structures may contribute to it. Nevertheless, SAD subacromial decompression surgeries continued unabated years after it was first shown to be worse than useless.

By 2019, it was clear that surgery offered no important improvements in pain, function, or quality of life. Even surgery journal editorials started saying it should no longer be offered to patients, given that “almost all well informed patients would decline surgery,” considering there are only harms with no benefit. Serious harms, such as deep infections, blood clots in the lungs, nerve injury, and death, occur in less than 1 percent of SAD operations, though, ironically, frozen shoulders may result from slightly more than 1 percent of SAD surgeries. So, patients may go in with shoulder pain and come out with even more shoulder pain. If there are only harms, why do surgeons keep doing them to this day?

In a sidebar from my book How Not to Hurt entitled “Twisting the Knife,” I note how history is said to be “riddled with examples of excess exuberance in surgical innovation.” What better example than the Nobel Prize–winning lobotomy––brain surgery performed on tens of thousands of Americans for mental illness in the 1940s and 50s? With an ice pick-like instrument through the eye sockets, in ten minutes, even non-surgeons could cut through the brains of those rendered unconscious via electroconvulsive shock. A whole new meaning to the phrase “Let me pick your brain.” JFK’s sister, Rosemary Kennedy, was famously lobotomized for being an agitated teen, and ended up severely impaired and institutionalized for the rest of her life.

Excess exuberance is not limited to surgery. One reason given for not teaching the history of medicine is that it is said to be “so unrelievedly deplorable a story.” Remedies included fly specks scraped off walls, hippo fat, the urine of menstruating women, crocodile dung, owl blood, frog semen, “oil of skinned puppy,” and “moss scraped from the skull of a victim of violent death.” Or at least you hope it’s just skull moss. Dangerous practices like feeding people heavy metals or bloodletting continued for centuries before finally giving way to more evidence-based medicine. Here’s an example of the best medicine could offer King Charles II: “A pint of blood was extracted from his right arm, and a half pint from his left shoulder, followed by an emetic, two physics, and an enema comprising 15 substances; the royal head was then shaved and a blister raised; then a sneezing powder, more emetics and bleeding, soothing potions, a plaster of pitch and pigeon dung on his feet—obviously—potions containing 10 different substances, chiefly herbs, finally 40 drops of extract of human skull, and the application of bezoar stone; after which his majesty died.”

Even today, only 11 percent of 3,000 common medical treatments are considered to be proven to be beneficial, and the bulk of the rest of them— 50 percent—are classified as effectiveness unknown. (The remaining 39 percent of common treatments is split between 24 percent likely to be beneficial, 7 percent a toss-up, 5 percent unlikely to be beneficial, and 3 percent likely to be ineffective or harmful.) It has been said that there is no “alternative medicine.” There is only proven medicine supported by solid data or unproven medicine for which scientific evidence is lacking. Unfortunately, much of conventional medicine falls into the latter category.

Please consider volunteering to help out on the site.

Motion graphics by Avo Media

Doctor's Note

So, with zero evidence backing up rotator cuff surgery, it became one of the most commonly performed procedures. As if that weren’t bad enough, the surgery continues to be performed on gullible patients even after it’s been found to be worse than useless.

Harm with no benefits.

How can shoulder surgery continue? Why? I answer that question, next.

This is the third video in a six-part series. If you missed the first two, see Steroid Injections for Shoulder Pain Relief May Do More Harm Than Good and Chiropractic Manipulation, Physical Therapy, and Exercise Therapy for Shoulder Pain Relief. Stay tuned for:

Check out my new book How Not to Hurt, available now for preorders. (All proceeds received from my book are donated directly to charity.)

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