Private shoulder specialist

In my clinical experience, arthroscopy fits when symptoms match a mechanical problem we can address arthroscopically, or after a structured conservative trial without functional gain. For diffuse pain without a clear mechanical driver, I prioritize targeted rehab and load management before surgery.

The goal is function, not only tear size on imaging. If strength is acceptable, motion is reasonable, and symptoms are controlled, a monitored conservative pathway can be appropriate. With progressive weakness, night pain, or major functional loss, we discuss surgery with transparent expectations and rehab requirements.

I weigh dislocation episodes, structural findings, age, and activity demands. Recurrent instability with relevant structural pathology—or instability despite good rehab—often leads to a stabilization discussion. Rare episodes with objective improvement on a plan may avoid surgery with strict return‑to‑load rules.

The intent is to treat the mechanical source (e.g., stiffness patterns, selected tendon/labrum issues, locking symptoms). In advanced wear or chronic inflammatory pain patterns, zero pain is not always a realistic promise; expectations should be aligned preoperatively.

I select based on tissue diagnosis, symptom duration, and whether there is a mechanical problem that injections cannot replace. PRP can help selected soft‑tissue inflammatory patterns as part of a movement plan—not as a substitute for needed surgery when mechanics require it.

Symmetric strength benchmarks, controlled scapular mechanics, graded load tolerance without ROM loss, and pain that stays within agreed thresholds. In my practice, returning too early to heavy rotational load is a common driver of recurrent symptoms.