Shoulder arthroscopy in Turkey

Subacromial decompression, the operation that shaves bone and soft tissue to make room under the acromion, was for years the standard answer to shoulder impingement. Then a placebo controlled trial compared it against a sham arthroscopy in which the surgeon looked inside and removed nothing. Decompression gave no greater benefit than the placebo operation, and both surgical groups were better than no treatment by an amount the researchers judged not clinically important.

In England the operation is now restricted under an evidence based interventions programme and offered only in defined circumstances. That does not mean nobody should ever have it. It means that if a clinic proposes decompression for shoulder pain without first exhausting a proper physiotherapy programme, you are entitled to ask why, and to expect an answer that engages with this evidence rather than dismissing it.

• Rotator cuff repair

  Reattaching a torn tendon to bone. A recognised operation for a symptomatic tear, though many degenerative tears are managed without surgery. The result depends heavily on the rehabilitation that follows.

• Labral repair or stabilisation

  For a shoulder that dislocates or for a torn labrum in a younger, active person. Ask how many dislocations you have had, because that changes the recommendation.

• Capsular release

  For a frozen shoulder that has not settled. Most frozen shoulders improve over time without surgery, which is why the timing of this decision matters.

• Decompression for impingement

  The operation the placebo trial questioned. Ask what physiotherapy you have completed, and what specifically the surgery is expected to change.

For the wider orthopaedic offering, see orthopedics in Turkey.

1. 1

   Assessment before imaging

   Examination first: which movements hurt, which are weak, what the shoulder does under load. A scan is read against that rather than instead of it, because scans of shoulders without pain often show tears too.
2. 2

   Anaesthetic

   A general anaesthetic, often with a nerve block that numbs the arm for the first hours. Ask what the block covers and when it wears off, because the pain arrives when it does.
3. 3

   Positioning and access

   You are positioned upright or on your side. Small incisions admit the camera and instruments, and the joint is filled with fluid to open the working space.
4. 4

   Looking before repairing

   The surgeon sees the actual state of the tendon, labrum and capsule, which sometimes differs from the scan. Agree in advance what you consent to if the findings differ.
5. 5

   The repair

   Anchors and sutures for a cuff or labral tear, release for a stiff capsule, or removal of inflamed tissue. Ask which of these is planned for you specifically.
6. 6

   Sling and first instructions

   Most people go home the same day or the next, in a sling, with a written rehabilitation protocol and a date to begin physiotherapy.

• Which procedure is performed. A cuff repair with anchors costs differently from a diagnostic arthroscopy or a capsular release.
• How many anchors are used. Implants are a real part of the cost in cuff and labral repair, and the number depends on the tear.
• Hospital time and anaesthetic. Day case or overnight, and whether a nerve block is included.
• Imaging and pre-operative assessment. Whether new imaging and blood tests are covered.
• Physiotherapy sessions included. Some packages include the first sessions before you fly home. Most of the rehabilitation is still yours to arrange.

The clinic list on this page shows each clinic's current price with a note on what it includes. For instalments, see payment plans. For other joints and orthopaedic care, see orthopedics in Turkey.

• Ask how much of their practice is shoulders. Shoulder surgery is a subspecialty. A general orthopaedic list is not the same thing.
• Ask them to talk you out of it. A surgeon who can describe who should not have this operation, and why, is assessing you.
• Ask what they do if the findings differ from the scan. And agree the limits of your consent before you are asleep.
• Ask about re-tear and revision. How often, how it is detected, and what a second operation would involve.
• Ask who runs your rehabilitation. And whether they will correspond with a physiotherapist in your own country.