Medically reviewed by Dr. Santiago Echeverri, FMH Orthopaedic Surgery
It’s been months. Reaching for something on a high shelf, putting on a jacket, sleeping on that side—every time, the shoulder reminds you. The scan mentioned worn tendons and maybe a small bone spur. Surgery has come up.
Before you decide, there’s something you deserve to know. It was published in December 2025, and it’s rather surprising.
What some Finnish researchers set out to test
To find out whether an operation really works, you have to compare it to something. A Finnish team compared shoulder surgery to… placebo shoulder surgery.
Here’s how. They took 210 people aged 35 to 65 who’d had shoulder pain for more than three months and split them into three groups at random. The first got the real operation. The second went into the theater and was put under; the surgeon looked inside the shoulder—and then closed up without doing anything else. The third group wasn’t operated on at all: they did a program of exercises.
Nobody—not the patients, not the doctors assessing the results—knew who had received the real operation and who had received the placebo procedure. And they followed everyone for ten years.
The result: no difference. Not between the real and placebo procedure, and not between surgery and exercise. All three groups were substantially better. None was better than the others.
Can one study really settle this?
No—and that’s exactly why the picture is convincing: it isn’t just one.
A large British study had done the same thing a few years earlier, with 313 patients across 32 hospitals. Same conclusion: the operation did no better than the placebo procedure.
When researchers later pooled nine studies and over a thousand patients, the verdict was clear and solid: no real benefit from this operation for pain, movement, or quality of life. At the same time, roughly 6 people in every 1,000 experienced a serious complication.
None of which means operated patients don’t get better. They do. But the improvement seems to come from everything around the operation—time passing, the attention received, the rehabilitation that follows—rather than from the surgery itself.
“But my scan shows a tear”
This is where it really matters, and there’s one number that puts a lot of things in perspective.
A Swedish study followed people on a waiting list for shoulder surgery for ten years. At the start, about a quarter had a tear in the tendons of the painful shoulder. Ten years later, more than half did.
So far, no surprise. But the researchers also looked at the other shoulder—the one that had never hurt. At the start, 3% had a tear. Ten years later: one in two.
One shoulder in two, completely pain-free, with a tear inside it.
Tendons wear with the years, the way skin wrinkles. It’s common, it’s often completely silent, and seeing a tear on a scan doesn’t prove it’s what’s causing your pain.
So what does work?
In that same Swedish study, two approaches were compared in these people awaiting surgery.
The first group did targeted exercises: strengthening precisely the tendons that surround the shoulder joint and the muscles that steady the shoulder blade, with resistance that increased week by week. The second group simply moved the shoulder around in all directions, with no load.
After ten years, 35% of the first group had ended up having surgery, compared with 65% of the second. Nearly double. And those who hadn’t been operated on had better shoulders than those who had.
The important word is targeted. Moving your shoulder isn’t enough. It has to work against resistance, targeting the right muscles, a little more each week.
Do you need a lot of appointments?
An important point is worth noting here, because the findings may be different from what you’d expect.
The largest study ever done on this followed 708 British patients. It compared a supervised exercise program over several sessions to… one single session of good advice from a physiotherapist. After a year, the results were the same.
What that tells us: it isn’t the number of appointments that counts. It’s that the right work actually happens—that you know what to do and how to progress gradually and that you do it.
That same study also looked at cortisone injections. They gave real relief at around two months, especially for people in the most pain. But at one year, there was no difference from people who’d had none. An injection can provide temporary relief, allowing you to start moving when pain is preventing you from doing so. But it doesn’t replace the rehabilitation itself.
Professional support remains valuable when pain makes it impossible to judge how far to push, when you plateau, or when you’re compensating without noticing. But most of the benefit comes from the work you do yourself.
And when is surgery genuinely the answer?
None of this says shoulders are never operated on.
These studies looked at one specific profile: pain that’s been there for months, with no recent injury. Other situations deserve a prompt surgical opinion:
- a tear that happened during a fall or a clear accident, especially in someone younger or active;
- a real loss of strength, or not being able to lift the arm at all under your own power;
- a shoulder that dislocates repeatedly;
- or a well-conducted strengthening program of sufficient duration that hasn’t worked.
This is your decision, with your doctor. These findings aren’t here to make it for you—they’re here to help you have that conversation with a clear understanding of the potential benefits and limitations.
Four questions to ask your doctor
- Does my pain look like long-term wear or like a tear from an accident? The reasoning isn’t the same.
- Have I genuinely tried targeted strengthening—not just movement without resistance?
- What is my shoulder strength today, in numbers, and how is it changing?
- If I have surgery, what do I gain over simply continuing to strengthen?
How we work at Dr.E
Our center is medically supervised by Dr. Santiago Echeverri, FMH orthopaedic surgeon. This allows the need for shoulder surgery to be assessed objectively—neither systematically for nor against it—and surgery to be considered when it genuinely is the right option.
The pathway starts with a measurement: your strength and your mobility, in numbers. Strengthening then happens on machines built for the shoulder, which let you work only in the range where you don’t have pain, with a load that increases gradually. Then we measure again to check that your strength and mobility are genuinely improving, rather than relying on how the shoulder feels on a particular day.
Treatment is covered by health insurance with a physiotherapy prescription from your family doctor or specialist. Get in touch for an assessment.
Frequently asked questions
Is shoulder surgery worth having?
For pain that’s been there for months with no recent injury, the studies comparing it to a placebo procedure find no added benefit—not over the placebo procedure, and not over exercise. It’s a different question for a tear caused by an accident.
Does a tendon tear always need repairing?
No. Age-related tears are very common and often painless: in one ten-year study, one in two shoulders that had never hurt had one. A tear from a fall, especially with loss of strength, is a different matter and warrants prompt advice.
How long before strengthening works?
Expect eight to twelve weeks. Tendons respond slowly—that’s the normal pace, not a sign it isn’t working.
Are cortisone injections useful?
They do genuinely help at around two months, especially if you’re in a lot of pain. But at one year they make no difference compared with not having one. They can provide enough temporary pain relief to help you start moving, but they don’t replace rehabilitation.
Can you strengthen a shoulder that hurts?
Yes, if it’s properly dosed. By staying in the range where you have no pain, with controlled resistance that increases gradually, the muscles work without irritating the joint.
This article gives general information and does not replace your doctor’s advice.
Sources: 10-year follow-up of the FIMPACT trial (surgery versus placebo surgery), BMJ, December 2025 · CSAW trial, The Lancet, 2018 · systematic review of subacromial decompression, British Journal of Sports Medicine, 2019 · 10-year follow-up of a trial comparing targeted versus unloaded exercise, 2024 · GRASP trial, The Lancet, 2021.
