Should I Get a Second Opinion Before Shoulder Surgery?

Short answer: If the surgery is planned rather than an emergency, a second opinion is almost always reasonable. It is especially worth getting when the diagnosis is unclear, when you have not tried nonsurgical care, or when you have been told your shoulder cannot be fixed. Second opinions are routine in medicine, Medicare Part B covers them for non-emergency surgery, and patients in Southern Oregon and Northern California can get one without leaving home.

Why does a second opinion matter so much in shoulder surgery?

A shoulder MRI is very good at finding things. The harder job is deciding which of those things is causing your pain. In a well-known study in the Journal of Bone and Joint Surgery, MRI showed a rotator cuff tear in 34 percent of people with no shoulder symptoms at all, and in 54 percent of those over 60. A tear on a report is not, by itself, a reason to operate.

How the images are read also varies. When musculoskeletal radiologists at an academic center re-read more than 2,300 outside CT and MRI scans, they found a clinically important difference, one likely to change treatment, in 26.2 percent of them. Across medicine more broadly, a Mayo Clinic study of referred patients found the final diagnosis was distinctly different from the referring diagnosis in 21 percent of cases.

None of this means your first doctor got it wrong. It means shoulder decisions benefit from a second experienced look, especially before an operation that comes with months of rehab.

What should a good second opinion answer?

A useful second opinion leaves you with clear answers to a few specific questions, not a vague sense that surgery is or isn't a good idea. By the end of the visit or review, you should know:

• Whether the finding on your MRI actually explains your symptoms and your exam.
• Whether surgery is needed now, may be needed later, or is unlikely to help.
• If surgery is recommended, which procedure, and why that one over the alternatives.
• What recovery realistically involves, including sling time and time away from work.
• What is likely to happen if you wait, and whether waiting could close off any options.

If you leave without those answers, ask for them directly. A surgeon who is confident in the recommendation should be able to explain it in plain language.

Signs you should get a second opinion

• You were told your rotator cuff tear is irreparable, or that a replacement is your only option. With modern arthroscopic techniques, many massive tears can still be repaired or improved. See Told You Have a Massive or Irreparable Rotator Cuff Tear?
• Surgery was recommended before you tried therapy or other nonsurgical care, and there was no injury or sudden weakness that made it urgent.
• The explanation of your diagnosis did not match what you feel, or different providers have told you different things.
• You are facing a revision, meaning another operation on a shoulder that has already had surgery.
• Your surgeon performs only a few of the specific procedure you need each year. Experience matters, and our post on whether surgeon experience affects outcomes covers the research.
• You simply don't feel confident. That is reason enough.

Will my surgeon be offended?

Good surgeons expect it. Asking for a second opinion is normal practice, and very few physicians object. You don't owe anyone an explanation or an apology. Ask the office for copies of your imaging (the actual images, not only the written report), your visit notes, and any operative reports.

Does insurance cover a second opinion?

Medicare Part B covers a second opinion for medically necessary surgery that is not an emergency, and it also covers a third opinion if the first two disagree. Your usual coinsurance applies. Most commercial plans cover a specialist consultation as well, and in most cases you do not need a referral to see us. Our remote MRI review is a separate flat-fee service of $250.

How to prepare for a second opinion

• The MRI and X-ray images themselves, on a disc or through a sharing link. A report alone leaves out too much.
• Notes from the doctor who recommended surgery, including the exact procedure proposed.
• A list of what you have already tried, with the dates of any injections.
• Operative reports if that shoulder has had surgery before.
• Your goals, written down: the activities you want back and how much time you can take off work.

Our guide on choosing a shoulder surgeon lists the questions worth asking any surgeon, including us.

Getting a second opinion in Southern Oregon and Northern California

Our main office is in Medford at 2780 E. Barnett Rd, Suite 200, and we also see patients in Grants Pass. For people in Klamath Falls, Roseburg, Ashland, and Northern California towns such as Yreka, Mount Shasta, Redding, and Crescent City, Medford is often already a familiar trip for specialty care.

If the drive is hard for you, there are ways to start without making it:

• MRI review. Upload your MRI, and Dr. Denard personally reviews it and records a narrated video of what he sees, typically within 48 hours. See how the MRI review works.
• Telehealth visit. A video consultation lets us go over your history and images and talk through options face to face.
• Destination surgery. If surgery makes sense and you choose to have it here, most traveling patients come in the day before for an office visit, have surgery the next day, and follow up by phone and video. Medford's airport (MFR) has direct flights from Seattle, San Francisco, Los Angeles, Phoenix, Denver, Las Vegas and Salt Lake City. Read more about traveling for shoulder surgery.

What a second opinion from our team looks like

Shoulders are all we do. Our surgeons have performed more than 10,000 surgeries, and more than 95 percent of our patients go home the same day. Dr. Patrick Denard has been voted one of the top 20 shoulder surgeons in North America and is the most widely published shoulder specialist in Oregon. In 2021, Expertscape ranked him #2 for rotator cuff repair expertise based on his published research.

Just as important, a second opinion here is not a sales pitch for surgery. Most of the people we see are treated without an operation. Sometimes the most useful thing we can tell you is that you don't need surgery yet, or that a smaller procedure will do the job.

When to see a shoulder specialist

• You have been advised to have non-emergency shoulder surgery and have not had a specialist opinion.
• You suddenly cannot lift your arm after a fall or a lift, which can signal an acute tear that is best evaluated promptly.
• Shoulder pain has been waking you at night for more than a few weeks.
• Your shoulder has dislocated.
• A previous shoulder surgery has not given you the result you expected.

Get your second opinion

You can start today from anywhere. Order a remote MRI review for $250 and receive Dr. Denard's narrated video explanation, typically within 48 hours. If you would like to be seen in Medford or Grants Pass, request an appointment or call 541-608-2595.

Frequently asked questions

Is it rude to get a second opinion before shoulder surgery?

No. Second opinions are a normal part of medicine, and very few surgeons object. Ask for copies of your images, visit notes, and any operative reports so the second surgeon can see everything the first one saw.

Does Medicare pay for a second opinion before shoulder surgery?

Yes. Medicare Part B covers a second opinion for medically necessary surgery that is not an emergency, and a third opinion if the first two disagree. Your usual coinsurance applies. Most private plans also cover specialist consultations.

Can I get a second opinion on my shoulder MRI online?

Yes. With the Oregon Shoulder Institute MRI review, you upload your MRI and Dr. Patrick Denard personally reviews it and sends a narrated video explanation with treatment guidance, typically within 48 hours, for $250.

Do I need a referral for a second opinion at Oregon Shoulder Institute?

In most cases, no referral is needed. You can request an appointment in Medford or Grants Pass, book a telehealth visit, or order a remote MRI review directly.

What if the second opinion disagrees with the first?

Ask each surgeon to explain what they see on your images and exam and why they recommend their plan. Choose the explanation that best matches your symptoms. If you are still unsure, Medicare and many insurers cover a third opinion.

References

1. 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. PMID 7822341.
2. Chalian M, Del Grande F, Thakkar RS, et al. Second-opinion subspecialty consultations in musculoskeletal radiology. AJR Am J Roentgenol. 2016;206(6):1217-1221. PMID 27058462.
3. 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. PMID 28374457.
4. Centers for Medicare and Medicaid Services. Second surgical opinions. medicare.gov/coverage/second-surgical-opinions

This article is for education and is not a substitute for an exam.