A Second Opinion Before Shoulder Surgery:
Interview with Dr. Raymond Carroll
If you have been diagnosed with a shoulder injury or disorder and told by a physician that you need surgery, you may want to get a second opinion. A comprehensive exam and diagnosis from a shoulder specialist is the best way to ensure an optimal outcome for your shoulder.
We interviewed Dr. Raymond Carroll, a shoulder surgery specialist at Cary Orthopaedics, to get his advice on when to seek a second opinion for a shoulder condition. Here’s what Dr. Carroll had to say:
Q: Why should I seek a second opinion on my shoulder diagnosis?
Dr. Carroll: The primary benefit of seeking a second medical opinion on a shoulder diagnosis is to avoid the risk of undergoing the wrong treatment, especially if it involves surgery. In a worst-case scenario, having the wrong shoulder surgery or surgery that isn’t necessary can exacerbate your original condition. Even if your treatment protocol calls for physical therapy or other non-invasive treatment, you don’t want to waste valuable time and/or money with a misdiagnosis.
Q: What factors should I consider when deciding to seek a second opinion?
Dr. Carroll: Once you receive an initial diagnosis for your shoulder pain, seek a second opinion if any of the following situations apply:
- A doctor has told you that surgery is the only option without explaining why non-surgical treatments won’t work.
- The doctor has not thoroughly explained the rationale for surgery, how it will benefit you, and the degree of improvement you can expect.
- The doctor recommends open surgery when minimally invasive or arthroscopic shoulder surgery may be a better option for you.
- You’ve already had surgery that was not successful or developed a complication, and the doctor is now recommending additional surgery.
- You feel at all uncomfortable with the doctor’s diagnosis and/or treatment recommendations.
- You do not feel confident in the doctor or their ability to deliver the outcome you desire.
- You feel that you and the doctor have conflicting personalities and desire to avoid conflict during what can often be a stressful time.
Q: What if I offend the doctor who gave the initial diagnosis?
Dr. Carroll: You might feel a little uncomfortable getting a second opinion once you’ve already seen a doctor but seeking a second surgical opinion is a common practice in medicine. A surgeon who is confident in their abilities will have no problem with you seeking another opinion.
I often recommend for my patients to seek an additional opinion for any unusual condition or controversial treatment option. In my experience, the more confident a patient is in their diagnosis and treatment, the better experience they have with surgery and subsequent rehabilitation. And, remember, just because you are seeking a second opinion does not mean you are under any obligation to proceed with treatment from that doctor.
Q: How is a second opinion useful after a failed shoulder surgery?
Dr. Carroll: When a patient develops a complication after surgery or has an unanticipated, negative outcome, both the patient and the surgeon can become frustrated and disillusioned. However, complications can and will occur independent of the surgeon’s skill or experience. In fact, some patients are at higher risk of complication or failure due to other medical problems. In this setting, a second opinion can help you, the patient, understand the complication or failure while maintaining a positive outlook about the overall prognosis. Most complications or unanticipated outcomes can be additionally treated with good success. In rare instances, the presurgical diagnosis may have been incorrect, or the complication or unanticipated outcome was due to issues with technique. Either way, a second opinion with a shoulder specialist who can critically review your pre-surgical records and surgical treatment can help you get back on track to your desired outcome.
Q: How do I choose a doctor for a second opinion?
Dr. Carroll: Look for an orthopedic surgeon who has completed a fellowship in shoulder surgery at a reputable institution and who specializes in shoulder surgery. You should not hesitate to ask your orthopaedic surgeon or primary care physician who they would recommend for a second opinion. Seeking a recommendation from family or friends who have had a good experience with shoulder surgery is also a good idea.
Q: How should I prepare for my appointment with a second opinion shoulder specialist?
Dr. Carroll: A quality second opinion should include a comprehensive, in-person clinical evaluation, so be prepared. Make sure you have your complete orthopaedic records and operative notes, as well as previous diagnostic scans (MRIs, X-rays or CT scans) ready to show your second opinion doctor. In fact, it is often better to deliver these items prior to your appointment to facilitate the subsequent appointment. The doctor’s office can usually obtain these records for you if you sign a medical records release form in advance of your appointment.
Make a list of any information you wish to convey to the doctor as well as questions to ask. This may include:
- Getting clarification on the original diagnosis and treatment plan
- Understanding if/why surgery is needed
- Inquiring about alternatives to surgery
- Asking about the surgeon’s experience with your specific injury
- Understanding the near-term recovery process and expected long-term outcomes
Q: In the case of a rotator cuff tear, is surgery always the only option?
Dr. Carroll: The treatment of rotator cuff tears, both operative and nonoperative, has been studied extensively. Based on MRI studies of the shoulder that were performed in the last century, it is well known that the majority of people will develop some type of rotator cuff tear over the course of their lifetime assuming an average lifespan. Many people who are found to have a rotator cuff tear may not need surgery or any other treatment. However, there are patients who develop a painful shoulder condition or have an injury that results in a rotator cuff tear. In this setting, surgery may be the best option for treating the rotator cuff tear.
In practice, most patients who develop a painful shoulder condition are treated without surgery initially. Physical therapy is the most commonly recommended treatment for painful shoulder conditions. Patients who continue to experience shoulder pain despite therapy will often be directed to have an MRI scan or other imaging to evaluate for a rotator cuff tear. Studies have shown that this population of patients who have a rotator cuff tear do well with surgical treatment.
Q: What if the second doctor also recommends surgery?
Dr. Carroll: In some cases, surgery may be the best option. Even if the second doctor agrees with the treating doctor and recommends surgery, getting a second opinion is never a waste of time. Having the same diagnosis from two physicians will give you peace of mind knowing you’re on the right track to treat your shoulder condition.
For a second opinion on your shoulder diagnosis or treatment, schedule an appointment with Dr. Raymond Carroll, board-certified orthopaedic surgeon and shoulder specialist. Dr. Carroll is a founding member of the Association of Clinical Elbow and Shoulder Surgeons and an associate member of the American Shoulder and Elbow Surgeons. He completed the Neer Shoulder fellowship in New York, NY, in 2002 and has been practicing shoulder surgery since that time.