Understanding Shoulder Pain: Do You Need Surgery?
Shoulder pain is one of the most common musculoskeletal complaints, with nearly 70% of adults experiencing it at some point in life (Luime et al., 2004). But here’s the catch: pain and structural damage don’t always match up. Some men have MRI scans that look like a grenade went off in their shoulder yet feel fine. Others show little or no damage on imaging but are crippled by pain.
Pain Without Damage
Multiple studies show that rotator cuff “tears,” tendinopathy, and labral fraying are often found in pain-free individuals. A landmark MRI study revealed that over 50% of adults over age 60 have rotator cuff tears, most of them completely asymptomatic (Yamamoto et al., 2010; Tempelhof et al., 1999). Similarly, labral “damage” can show up in healthy athletes with no pain (Schwartzberg et al., 2016).
This tells us pain isn’t just about tissue. It’s about sensitivity, load tolerance, and the brain’s perception of threat (Moseley et al., 2012).
Damage Without Pain
On the flip side, you’ll meet plenty of men whose MRI looks pristine but who still struggle to press, sleep on their side, or throw a ball. Pain is influenced by more than structure: inflammation, neural sensitization, stress, and even poor sleep can all amplify symptoms (Haack et al., 2020).
The Rotator Cuff & Labrum — Quick Primer
Rotator cuff: Four muscles (supraspinatus, infraspinatus, teres minor, subscapularis) that stabilize the ball-and-socket joint. They’re often labeled as “torn” on imaging, but degeneration is part of aging, much like wrinkles in your skin (Tempelhof et al., 1999).
Labrum: A rim of cartilage that deepens the socket. Labral fraying or tears show up on scans in both painful and pain-free athletes (Schwartzberg et al., 2016).
Surgery vs. Conservative Care
For decades, the reflex answer to pain was surgery: “Clean up the tear, smooth the bone, cut out the damage.” But the research doesn’t support this for most men.
Rotator cuff surgery: Randomized controlled trials show no clear long-term benefit of surgery over structured physical therapy for many cuff tears (Kukkonen et al., 2014). (does not mean ALL tears).
Labral surgery: Similar story—arthroscopic repairs often don’t outperform conservative rehab in restoring pain-free function (Schrøder et al., 2017).
Best approach today: Progressive loading, building tolerance, and strengthening the cuff and surrounding muscles often achieve equal or better outcomes than going under the knife (Littlewood et al., 2015).
That said, surgery still has a place. For certain older populations with acute full-thickness tears, high-level athletes, or men experiencing severe pain or complete loss of function after conservative treatment fails, surgical intervention can be necessary and life-changing. There are many cases where surgery IS the only option, but this is not ALWAYS the case.
The Takeaway
Shoulder pain doesn’t always mean damage, and damage doesn’t always mean pain. The modern approach? Test, load, adapt. Instead of rushing into surgery, build capacity.
In fact, over the last 15 years I’ve worked with many men who were told they “needed” shoulder surgery. After 3–6 solid months of conservative treatment—focused on progressive loading, pain education, and lifestyle changes—not only did they avoid surgery, but their shoulders ended up stronger and more mobile than they had been in years.
If you are dealing with shoulder pain, there’s a video inside The Brotherhood that will guide you through a few simple movements to help rebuild your shoulder and start loading it the right way.
References
Luime JJ, et al. Prevalence and incidence of shoulder pain in the general population. Scand J Rheumatol. 2004. PMID: 15461292.
Yamamoto A, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010. PMID: 20554454.
Tempelhof S, et al. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999. PMID: 10471998.
Schwartzberg R, et al. High prevalence of labral tears in asymptomatic shoulders. J Shoulder Elbow Surg. 2016. PMID: 26776925.
Moseley GL, et al. Pain and the brain: Unraveling the complex interaction. J Orthop Sports Phys Ther. 2012. PMID: 22814461.
Haack M, et al. Sleep deficiency and chronic pain. J Pain. 2020. PMID: 32553740.
Kukkonen J, et al. Treatment of non-traumatic rotator cuff tears: RCT. Bone Joint J. 2014. PMID: 24788504.
Schrøder CP, et al. Surgery vs. physiotherapy for SLAP tears. Br J Sports Med. 2017. PMID: 27999150.
Littlewood C, et al. Exercise for rotator cuff tendinopathy: Systematic review. Br J Sports Med. 2015. PMID: 25105447.
