Quick answer: For elective shoulder or elbow surgery, a second opinion is a reasonable, common, and respected step, and good surgeons welcome it. Second opinions frequently refine or change the diagnosis [1], and many shoulder problems that look surgical on an MRI can be treated without surgery [2, 3, 4]. A second opinion is especially valuable before complex surgery, revision surgery, or any operation recommended before you've tried appropriate nonsurgical treatment.
Why Second Opinions Matter
Diagnoses evolve when a fresh set of eyes looks at the problem. In a study of patients referred to a major academic center, the final diagnosis matched the referring diagnosis exactly in only 12% of cases. In 66% it was refined or better defined, and in 21% it was distinctly different [1].
Surgical recommendations can also differ. A review of second opinions in spine surgery found that about half of second opinions disagreed with the first, and most of those disagreements recommended nonsurgical care instead [5]. Shoulder-specific data are more limited, but the principle is the same: complex musculoskeletal decisions involve judgment, and reasonable surgeons can differ.
An MRI Finding Is Not the Same as a Surgical Problem
Shoulder MRIs and ultrasounds often show findings that aren't causing symptoms:
- In people with no shoulder pain at all, MRI showed rotator cuff tears in 34% overall, and in 54% of those over 60 [2].
- In an ultrasound study of 411 people without symptoms, rotator cuff tears were found in 23% overall, and in about half of those over 80 [3].
This is why treatment decisions should be based on your symptoms, exam, and goals, not on the scan alone [2].
Some Common Shoulder Surgeries Have Effective Alternatives
Evidence has reshaped how surgeons approach several common problems:
- Atraumatic rotator cuff tears: In a multicenter study, about 75% of patients treated with a structured physical therapy program avoided surgery over two years [4].
- Shoulder impingement: In a large placebo-controlled trial, arthroscopic decompression surgery offered no meaningful benefit over a placebo arthroscopy for patients with intact rotator cuff tendons [6].
That doesn't mean surgery is wrong for you. Many patients clearly benefit from surgery. It does mean it's worth making sure the recommendation fits your situation.
When a Second Opinion Is Especially Worthwhile
- Surgery has been recommended before you've tried physical therapy or other appropriate nonsurgical care
- The proposed operation is complex, such as shoulder replacement, revision surgery, or stabilization with bone grafting
- You've had a prior surgery that didn't work, and another operation is being considered
- The diagnosis is uncertain, or your symptoms don't match the imaging
- You're receiving conflicting advice, or simply don't feel your questions were answered
How to Get the Most From a Second Opinion
Bring your records:
- The actual images (a disc or electronic image link), not just the radiology report
- Operative notes from any prior surgery
- Physical therapy notes and a list of injections or other treatments you've tried
- A list of your medications and medical conditions
Ask focused questions:
- What do you think is causing my symptoms?
- What are my nonsurgical options, and have I given them a fair trial?
- If surgery makes sense, which operation, and why that one?
- How often do you perform this procedure? Higher-volume surgeons have been shown to have lower complication rates for procedures such as shoulder replacement [7].
- What does recovery realistically look like for someone like me?
Choosing Who to See
Look for a surgeon with fellowship training and regular experience in your specific problem. You can verify board certification through the American Board of Orthopaedic Surgery [8] and search for surgeons through the AAOS "Find an Orthopaedist" directory [9]. See also How to Choose an Orthopedic Surgeon in New York.
Frequently Asked Questions
Will my first surgeon be offended?
Experienced surgeons expect patients to seek second opinions for elective surgery, especially major procedures. It's a normal part of informed decision-making.
Does insurance cover a second opinion?
Many plans do, but coverage varies. Check with your insurer before your visit.
What if the two opinions disagree?
Ask each surgeon to explain their reasoning, and consider which plan best fits your goals and tolerance for risk. In some cases, a third opinion or a trial of nonsurgical treatment first can help clarify the decision.
Can a second opinion be done remotely?
Sometimes. A records-and-imaging review can be helpful, but an in-person exam is usually important for shoulder and elbow problems.
Request a Second Opinion
Dr. Tej Joshi provides second opinions for shoulder and elbow conditions, including rotator cuff tears, shoulder replacement, instability, and revision surgery, at NYU Langone offices in Manhattan, Lake Success, and Bay Ridge, Brooklyn. Book a consultation.
References
- Van Such M, Lohr R, Beckman T, Naessens JM. Extent of diagnostic agreement among medical referrals. J Eval Clin Pract. 2017;23(4):870-874. PubMed 28374457 · doi:10.1111/jep.12747
- Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77(1):10-15. PubMed 7822341 · doi:10.2106/00004623-199501000-00002
- Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8(4):296-299. PubMed 10471998 · doi:10.1016/s1058-2746(99)90148-9
- Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013;22(10):1371-1379. PubMed 23540577 · doi:10.1016/j.jse.2013.01.026
- Gattas S, Fote GM, Brown NJ, et al. Second opinion in spine surgery: a scoping review. Surg Neurol Int. 2021;12:436. PubMed 34513199 · doi:10.25259/SNI_399_2021
- Beard DJ, Rees JL, Cook JA, et al. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet. 2018;391(10118):329-338. PubMed 29169668 · doi:10.1016/S0140-6736(17)32457-1
- Jain N, Pietrobon R, Hocker S, et al. The relationship between surgeon and hospital volume and outcomes for shoulder arthroplasty. J Bone Joint Surg Am. 2004;86(3):496-505. PubMed 14996874 · doi:10.2106/00004623-200403000-00006
- American Board of Orthopaedic Surgery. Verify Certification. abos.org
- American Academy of Orthopaedic Surgeons. Find an Orthopaedist. aaos.org