Cost of Rotator Cuff Surgery

In today’s challenging economic environment,  many people have to foot the bill for some of their own costs of procedures and treatment.  Many times it’s difficult to follow the dollar in medicine.  Recently some researchers have put together an interesting cost analysis of rotator cuff repair, and I think it’s important for patients to know about the actual cost of the surgery prior to going in.  Keep in mind that a cost of the surgery in this study which was performed through Columbia University in New York did analyze the cost of the surgery and all the associated costs and then the six month follow-up costs that included some rehab.  Keep in mind it did not include any of the doctor visits and attend said physical therapy prior to the surgery.  In any case, the total cost of a rotator cuff repair averaged $12,464, a figure driven largely by physician’s fees which were on average $2,392, operating room costs average $3001, and a total per diem hospital cost average $2,122.  The remainder of the costs were largely physical therapy.  Again, sometimes the cost of medicine is difficult for people to track down.  The other costs that this study did not take into account is wages lost.  Keep in mind every, there of course, the hospital days, there’s a few days after the surgery where most people are unable to go to work, and there’s all the missed time from work in regards to the physical therapy appointments.

Comments

[Robert]

I just had rotator cuff surgery (with a couple of other minor procedures once he got in), the surgeon was at for only about 75 minutes, it was an outpatient procedure and I was on my way home by 3pm. I recently got the bill that said before any inusrance adjustments were made that the cost of the surgery was in excess of $45k, can that even be possible?? I had a cuff repair, I just don't get it. . . .

[Dr. Mike]

Sounds a bit on the high side. In defense of your doctor he probably only made about 1/15th of the bill. Perhaps you could ask your insurance company if your procedure is out of the norm.

[Kim Williams]

My boyfriend had rotator cuff surgery on June 4th 07, he has been doing all the therapy involved and is now up to four hours five days a week called work conditioning as he is in construction. He is told his range is good but he is in constant pain, has trouble sleeping and still can't do many of the everyday things. He 's miserable and this is effecting his whole life, is this normal, everyone tells him he's coming along but he cannot take the 24/7 pain. Thank you.

[Dr. Mike]

SOMETHING IS WRONG! He should be doing much better. The fact that the shoulder is getting better range of motion with no improvement in his pain is concerning. He could have a problem with the nerves coming out of his neck that supply the shoulder. You need to go to his next appointment with him. Some guys (particularly the tough construction guys) absolutely freeze up in the doctors office as they feel any complaining is unmanly. While this is great for the doctor staying on time with his schedule, it is not helping your boyfriend. If you feel like you have been blown off by the doctor I would transfer care. I would find the nearest board certified orthopedic surgeon fellowship trained in shoulder surgery. Maybe the best way to find that doc is to just call the large orthopedic groups around and ask if they have one. Good luck.

[Preston Gundelach]

I was in a car accident in September in which I had to hold the steering wheel straight while I went over a camaro at 45mph. I have had extreme shoulder pain ever since. I have been to a Orthopedic witha no contrast MRI, he says no loss of stength and the MRI conclude nothig is wrong. I am still in Pain, Should I see someone else or just go to physical therapy as my first doctor suggested?

[Preston Gundelach]

I also forgot to mention that he also gave me an injection, and upon that injection the pain was terrible for about six days, then it subsided to a dull roar for about a month, and now the pain is back to about what it was after the accident. The cost for the visit was almost $800.00 plus the MRI which was $1496.00. At these prices it would seem I could find some relief for my pain. I also work construction, or I should say I used to. Any help would be greatly appreciated.

[Dr. Mike]

Terrible pain and "normal MRI"

I would suggest a few things. First just ask for a copy of the MRI report (interpretation and not the films). This will confirm it actually has an interpretation of normal. Sometimes doctors will say normal, when actually they mean there is no obvious surgical correction to your problem. This is in no way a slam on your doctor, it is just how we think sometimes.

I would go to physical therapy. A lot of these guys are really good and they think about body mechanics all day. Also bring that copy of the MRI report to your physical therapist just to get a little more input. They will love your for bringing it in for their insight and it may direct how they do their PT. If PT is not helping after 4-6 visits then you need to go back to your doctor or find another.
Good luck.

[Michele]

I had rotator cuff surgery about 12 weeks ago. Had a full thickness tear of the the superspinatis, tore the bicep tendon and had a cyst removed during open surgery. I have been going to therpy since week 2. First it was passive movement only until the 6th week. Now it's active ROM but still no weight. The pain is tolerable but sleeping is still tough. The therpist is concerned about my external rotation, which is slow to come around. I have almost full range all other ways with minor pain. I also am facing achilles surgery soon. Is this normal and will I be able to use the crutches since I wont be able to bear wight on my foot for 6 weeks?

[Dr. Mike]

Michele,

The thought of you using crutches makes me weak in the knees. I my opinion the added weight on the arms, the force of which is transmitted up to your shouder, I think will trash the repair of the supraspinatus tendon.
If you absolutely need the achilles surgery I would start having your doctors lobby hard with the insurance for and electric scooter or wheelchair.
As far as the external rotation being a little behind, I would not worry too much about it yet. You mentioned that you had open surgery rather then arthroscopic. This takes longer to recover from and is likely why you are lagging behind some of the published data that references recovery from arthroscopic repairs.
Good luck. Write if you have more questions.

[Michele]

I have been doing some homework on the scooter/wheelchair thought. A friend of mine's daughter worked with her college football team as part of her sportds trainer program. She gave me a web site to go to for an option to crutches. it is called a knee walker. There are several different types. The weight is put on the knee instead of the shoulders. It looks like a little scooter. Think that would work?

[John]

i had a partital tear of my supraspinatus rotator cuff and labrum tear, along with a cyst and an impingement. i had surgery sept 24th 2007 and i am still in extreme pain, i dont have the same ROM as before and ive lost a lot of strength in the arm. also if i raise my arm above my head my fingers get a tingly feeling in them. my surgeron didnt seem to listen to me when i told him how i was feeling by saying everything is normal. i sleep maybe 3hrs a night i cant work ive thought about suicide cause i cant take it anymore. it was a work related injury and ive since lost my job so the BWC is not paying for anymore medical treaments. i would really like to know what is wrong with my shoulder and what i can do to fix it.

[Dr. Mike]

John,
Chronic pain is a brutal and horrible thing. It can cause depression. You sound depressed and should seek care for this. Do not worry about the cost of care. Go to a doctor, go to the er, talk to a friend. Do something if the suicidal thoughts are still there.
Regarding the shoulder and your current lack of insurance. Basically I would recommend my ace in the hole approach. Jump rope with the 3/4 pound jump rope from lifeline fitness. This is the perfect exercise for the RC. At least 400 jumps daily and do it fast. Also use the nighttime immobilizer shoulder device sold at teterop.com. If that does not help after about a week then get back to your surgeon.

Good luck and God bless.

[Paula]

My brother has no insurance and has been told he has a rotator cuff tear by a chiropractor. If he could come up with the $ for MRI is it the only way to diagnose him for sure? Do ortho Dr.'s ever work on sliding scale, discounts or pro bono?
He has been in pain for a couple of months, can't sleep & when he does it is only for a couple of hours before he wakes up from the pain. He can't get medicaid to help and we don't know what to do or how to help him. How would we ask a Dr. about cutting his/her fees? Thanks

[Dr. Mike]

Paula,
Don't blow that $1200 bucks on an MRI. I can tell you right now what it will say "extensive inflammation in the distribution of the supraspinatus, partial non full thickness tear at the musculotendinous junction. Also some inflammation and swelling along the proximal aspect of long head of the biceps"
JUST BECAUSE THERE IS A TEAR DOES NOT MEAN THAT HE HAS TO HAVE SURGERY.

Also stop spending the money on the chiropractor, he doesn't have back pain. Have him jump rope until his arms fall off and have him go to teterop.com and get the nighttime shoulder immobilizer. If that does not work have him go to the free clinic and get a referral to physical therapy.

[Kim Williams]

I wrote you on January 27th of this year about my construction worker boyfriend who had rotator cuff surgery and was still in a great deal of pain months later. Well, he did get another MRI and both his doctor and the Workerman's comp doctor agreed it warranted scoping him again. On April 15th they went in and cleaned out the joint and cut away some scar tissue, after almost two weeks he returned to therapy. For a little while he said he was feeling better but now we are back to where we were before with severe pain in shoulder and now bicep. This is just sucking the life out of him as he can't sleep more than 2-3 hours without waking up in pain. He cannot fathom living like this too much longer having to rely on pain meds and sleeping pills. The doctor says the first surgery healed fine and it looks good though his muscle is kind of thin. Right now he has the best range of motion he has had since surgery but it doesn't do him any good if all he does is sit on the couch in pain. He wants to get back to work and is worried that Workman's comp is going to push him way before he is ready. Do you have any more suggestions? Thank you very much.

[Kim Williams]

I also forgot, he has bruising on his shoulder and bicep which isn't from the surgery.

[Dr. Mike]

This is a tough situation and I am far from the facts. One thought that I have is that he may be putting more pressure on the rotator cuff while he is sitting. Make sure he is not keeping the elbow on an armrest of a chair. Keep working with his doctors. They want him to get better almost as bad as he does. Good luck.

[manuela]

I had shoulder surgery back in 1999.
I did well till April first when I fell in one of the major grocery store.
The orthopedic suggested and xray and then an MRI which showed a rotar cuff tear that require surgery. I asked about physical therapy and he said that wouldn't fix the tear. I suggested a second opinion and he said that was okay, but any other doctor would see the same.
I am scared and I really would prefer NOT to have surgery. He said that if I wait later I might not be able to do it and I can the recovery will be much longer.

[Dr. Mike]

Manuela,
The devil is in the details as we like to say. Many, many, many rotator cuff tears can be rehabilitated with physical therapy. However, some tears are so large that it is pointless to try to rehab.

Getting a second opinion is, I think a good idea. I would get your MRI films and consult with a local physical medicine and rehab (pmr) doctor and get their advice.

Good luck.

[cathy]

I had surgery on Feb.28, 08 it was decompression for a bone spur in left shoulder. The pain I was having before the surgery is back and coming on more each day.
The pain is across my shoulder and up the side of my neck; I can’t move my arm while I’m in this severe pain. Been back to the doctor and told him of this and was told to wait 12 weeks then see how it is. Went back after 12 weeks and was given a anti-inflammatory and told to come back in 6 weeks and if I am still having the pain they will go back to the cortisone shots.
The pain is coming twice a day and I am on the edge of giving up. Please any ideas would be greatly appreciated.

[Dr. Mike]

Cathy,
I hate to say this but sometimes I do need to do a physical exam before I can say much of anything intelligent about the case.

That being said let me give you a few thoughts. First pain that shoots across the shoulder and goes up into the neck is frequently trapezius spasm.

The other thought is that the pain all along has been more from the neck then from the shoulder. If that is suspected by your doctor he will order an electromyelogram.

Good luck.

[Cathy]

Dr.Mike,
Thank you, Thank you! I went on the net and looked up trapezius spasm and there was a picture of the the same spot where my pain is.
I am so glad you emailed back because after talking to my doctors today they were going to send me for a nerve block.
Thank you for giving me other idea's to look at that they could'nt.
Will update you at a later date.

[Linzi]

I've had 'twinges' in my shoulder for over a year, but no major ROM issues, then last October (07) I was in a car accident. I don't remember gripping the wheel or anything, rather throwing my arms up in front of my face because I was hit from behind and slammed into the car in front. Since December I've had major ROM issues, so much so that I can barely move my arm, even though I've not tried to stop using it.
Even though I'm not working I paid to have an MRI and the results were " Supraspinatus tendinopathy with partial-thickness bursal surface tearing thru approx two-thirds of the tendon width of the mid and distal anterior tendon.
Now I have an appointment scheduled with an ortho surgeon/specialist. Does this mean I might have to have surgery? Could the tear be the result of the car accident?

[gavin]

I dislocated my shoulder 8 yrs ago, and it clearly was a repeat risk, feels like it could always go and sleeping on it is tough.
I play golf and it feels strong but most movements with it begin and end with a twinge (almost electric shock like) pain. This is a new development which came about after over did the reande of motion with it during an exercise. should I get an MRI, should I live with it or seek surgery ?
I just want to see if its best tackled early or left to see how it develops ?

[Dr. Mike]

Gavin,

I do not think your current problems have a lot to do with your previous dislocation. I think an intelligent approach would be to do the best things for rotator cuff tendonitis and see if it gets better. Rotator cuff problems are teh most common cause of shoulder pain. If you do not get better in a month then go see a doctor.

The best things to do for rc tendonitis are to jump rope like a madman. Also because you are having pain at night I would go to teterop.com and get your hands on a nighttime shoulder immobilizer. If that does not work then go to your doctor.