Shoulder Arthroscopy and Replacement
As an FCA-authorised expert broker that has helped arrange over 800,000 policies, WeCovr provides this guide to shoulder procedures and private medical insurance in the UK. We explain the options available, from keyhole surgery to full joint replacement, and clarify how health cover can give you faster access to treatment.
WeCovr explains shoulder procedures and PMI coverage
Shoulder pain is one of the most common reasons people visit their GP in the UK. From a nagging ache to a sharp, debilitating pain, shoulder problems can severely impact your quality of life, affecting everything from work to sleep.
When simple treatments like rest and physiotherapy don't work, your doctor might suggest surgery. The two most common procedures are shoulder arthroscopy and shoulder replacement.
This comprehensive guide will walk you through:
- The basics of your shoulder joint and what can go wrong.
- A detailed look at arthroscopy and replacement procedures.
- The difference between seeking treatment on the NHS versus going private.
- How Private Medical Insurance (PMI) covers these treatments, including the crucial rules around pre-existing and chronic conditions.
- What to expect during recovery and how to keep your shoulders healthy.
Understanding Your Shoulder: A Quick Anatomy Lesson
To understand what goes wrong, it helps to know how the shoulder works. Think of it as a remarkable piece of natural engineering.
Your shoulder is the most mobile joint in your body, allowing you to lift, reach, and rotate your arm. This incredible range of motion comes from its unique structure:
- The Ball and Socket: The top of your arm bone (humerus) is shaped like a ball, which fits into a shallow socket (glenoid) on your shoulder blade (scapula).
- The Rotator Cuff: This is not a single part but a group of four muscles and their tendons. They wrap around the "ball" of the joint, keeping it centred in the socket and controlling movement and rotation. Rotator cuff tears are a very common injury.
- The Labrum: A rim of soft cartilage that lines the socket, making it deeper and more stable, almost like a rubber seal.
- The Bursa: A small, fluid-filled sac that acts as a cushion, reducing friction between the rotator cuff tendons and the bone above them (the acromion).
Because it’s so mobile, the shoulder is also prone to instability and injury.
Common Shoulder Problems That May Lead to Surgery
While some shoulder pain resolves with simple measures, certain conditions often require surgical intervention. These are typically classed as acute conditions – illnesses or injuries that are sudden, unexpected, and curable. This is the type of condition that private medical insurance is designed to cover.
Here are some common acute shoulder problems:
- Rotator Cuff Tears: The tendons of the rotator cuff can be torn due to a sudden injury (like a fall) or from gradual wear and tear over time. This causes pain, weakness, and a limited range of motion.
- Shoulder Impingement Syndrome: This occurs when the space between the rotator cuff and the bone on top of your shoulder (acromion) narrows. As you lift your arm, the acromion can rub on, or "impinge," the tendons and bursa, causing irritation and pain. Sometimes a surgeon needs to remove a small piece of bone to create more space.
- Shoulder Instability (Dislocation): This happens when the head of the upper arm bone is forced out of the shoulder socket. Once it has happened, it can become a recurring problem that may require surgery to tighten the ligaments and repair the labrum.
- Frozen Shoulder (Adhesive Capsulitis): The connective tissue surrounding the shoulder joint becomes thick, stiff, and inflamed. This severely restricts movement and can be very painful. While it can resolve on its own, this can take years, and some cases benefit from a surgical procedure to manipulate or release the stiff tissue.
- SLAP Tears (Superior Labrum Anterior and Posterior): This is a specific tear of the labrum, often seen in athletes who perform overhead motions (like tennis players or swimmers) or following a traumatic injury.
Crucial Point: Chronic vs. Acute Conditions A chronic condition is a health problem that is long-lasting and requires ongoing management, like osteoarthritis or rheumatoid arthritis. Standard UK private health cover does not cover chronic conditions. PMI is designed for acute conditions that can be resolved with a single course of treatment. We'll explore how this applies to shoulder replacements later.
What is Shoulder Arthroscopy? The "Keyhole" Surgery
Shoulder arthroscopy is a minimally invasive surgical technique that allows a surgeon to look inside your shoulder joint, diagnose the problem, and perform repairs through tiny incisions.
How does it work?
- Small Incisions: The surgeon makes two or three small cuts (about the size of a keyhole) around your shoulder.
- The Arthroscope: A thin tube containing a light and a high-definition camera (the arthroscope) is inserted through one incision. This sends a live video feed to a monitor, giving the surgeon a clear view of the inside of your joint.
- Surgical Instruments: Miniature surgical instruments are inserted through the other incisions to perform the necessary repairs, such as trimming damaged tissue, reattaching a torn tendon, or removing a bone spur.
Arthroscopy is commonly used to treat rotator cuff tears, impingement syndrome, labral tears, and shoulder instability.
| Feature | Shoulder Arthroscopy (Keyhole) | Traditional Open Surgery |
|---|---|---|
| Incisions | 2–3 small cuts (less than 1cm each) | One large incision (5–10cm) |
| Hospital Stay | Usually a day case (you go home the same day) | Often requires an overnight stay or longer |
| Pain Level | Generally less post-operative pain | More pain and need for pain medication |
| Recovery Time | Faster initial recovery and return to daily activities | Slower recovery, longer period of immobilisation |
| Scarring | Minimal scarring | A more significant, visible scar |
What is a Shoulder Replacement? (Arthroplasty)
For some conditions, the damage to the shoulder joint is too severe for a simple repair. In these cases, a shoulder replacement (also known as shoulder arthroplasty) may be the best option to relieve pain and restore function.
This major operation involves removing the damaged parts of the shoulder joint and replacing them with artificial components, called a prosthesis. The prosthesis is typically made of a medical-grade metal ball and a durable plastic socket.
The primary reason for shoulder replacement is severe osteoarthritis, where the protective cartilage on the ends of your bones has worn down completely. Other reasons include severe fractures, rheumatoid arthritis, or a massive, irreparable rotator cuff tear.
There are three main types of shoulder replacement:
- Total Shoulder Replacement: The most common type. The surgeon replaces both the "ball" (humeral head) and the "socket" (glenoid) with artificial parts. This is the gold standard for patients with osteoarthritis but an intact rotator cuff.
- Partial Shoulder Replacement (Hemiarthroplasty): Only the "ball" part of the joint is replaced. This is often used for certain types of severe shoulder fractures or in younger patients with arthritis limited to the humeral head.
- Reverse Total Shoulder Replacement: This innovative procedure is designed for people with severe arthritis and a badly damaged rotator cuff. The surgeon reverses the position of the ball and socket – attaching the artificial ball to the shoulder blade and the socket to the top of the arm bone. This allows other muscles (the deltoid) to take over the work of the torn rotator cuff to lift the arm.
The Patient Journey: NHS vs. Private Treatment
If you need shoulder surgery in the UK, you have two main pathways: the NHS or private treatment. Your choice will significantly affect your experience, particularly the waiting times.
The NHS Pathway
- GP Visit: You visit your GP with shoulder pain.
- Initial Treatment: Your GP will likely recommend conservative treatments like painkillers, anti-inflammatories, and a referral for physiotherapy.
- Referral to Specialist: If your condition doesn't improve, your GP will refer you to an NHS orthopaedic specialist.
- Waiting for Consultation: You will be placed on a waiting list to see the specialist. According to the latest NHS England data (2024/2025), the median wait for a first outpatient appointment in Trauma & Orthopaedics can be several months.
- Diagnostics: The specialist will examine you and likely order diagnostic tests like an X-ray or MRI scan. There can be another wait for these scans.
- Surgical Decision: If surgery is deemed necessary, you are placed on the surgical waiting list.
- Waiting for Surgery: This is often the longest wait. The target for non-urgent, consultant-led treatment is 18 weeks from referral, but in reality, many patients wait much longer. For orthopaedics, waits of over a year are not uncommon.
The Private Pathway (with or without PMI)
- GP Referral: You still typically need a GP referral to see a private specialist. Some insurers now offer digital GP services that can provide this quickly.
- Choosing Your Specialist: You can choose which consultant you want to see, often based on their specialism or reputation.
- Fast Consultation: You can usually book a consultation within days or a week or two.
- Rapid Diagnostics: MRI scans and other tests are often done on the same day as your consultation or within a few days.
- Quick Treatment: Once a diagnosis is made and surgery is recommended, it can typically be scheduled within a few weeks at a time and hospital convenient for you.
NHS vs. Private Treatment for Shoulder Surgery: A Comparison
| Aspect | NHS Treatment | Private Treatment (using PMI) |
|---|---|---|
| Referral Time | Weeks to months to see a specialist | Days to a week or two |
| Waiting for Surgery | Months, sometimes over a year | Typically 2–6 weeks |
| Choice of Surgeon | You see the surgeon on duty | You choose your consultant |
| Choice of Hospital | Limited to local NHS hospitals | Wide choice from a national hospital list |
| Accommodation | A ward with several other patients | A private, en-suite room |
| Post-op Physio | Often group sessions with limited availability | Quicker access to one-on-one physiotherapy |
| Cost | Free at the point of use | Paid for by your PMI provider (minus your excess) |
Private Medical Insurance (PMI) and Shoulder Surgery Explained
This is where things can get confusing, but the rules are straightforward if you remember the core purpose of PMI.
The Golden Rule of PMI: Private medical insurance is designed to cover the diagnosis and treatment of new, acute medical conditions that arise after your policy has started.
1. Pre-existing Conditions Are Excluded
This is the most critical point to understand. If you have sought medical advice, experienced symptoms, or received treatment for a shoulder problem before you took out your PMI policy, that condition will be considered "pre-existing" and will not be covered.
There are two main ways insurers handle this:
- Full Medical Underwriting (FMU): You declare your entire medical history on an application form. The insurer will review it and explicitly state any conditions (e.g., "any condition relating to the right shoulder") that are excluded from your cover. It's clear from day one.
- Moratorium Underwriting (Mori): You don't declare your medical history upfront. Instead, the policy automatically excludes any condition you've had in the 5 years before the policy start date. However, if you go for a set period (usually 2 years) without any symptoms, treatment, or advice for that condition after your policy starts, the insurer may then cover it in the future.
Example: David has had a grumbling pain in his left shoulder for a year and saw his GP about it. He then buys a PMI policy with moratorium underwriting. A year later, the pain worsens, and he is diagnosed with a rotator cuff tear. His PMI provider will likely decline the claim because it's a pre-existing condition.
2. Acute vs. Chronic Conditions
As mentioned, PMI covers acute conditions. Osteoarthritis is the most common reason for a shoulder replacement, and it is a chronic condition. So, how can a shoulder replacement ever be covered?
This is a key nuance: while PMI will not cover the day-to-day management of chronic arthritis (e.g., pain medication, routine consultations), many insurers will cover the one-off surgical procedure to resolve the issue. The joint replacement is seen as a definitive treatment to return you to the state of health you were in before the condition became debilitating.
The coverage depends on:
- When the condition was first diagnosed: If you were diagnosed with shoulder arthritis before your policy started, it's a pre-existing condition and will not be covered.
- The insurer's specific terms: Most leading UK PMI providers, including Bupa, AXA Health, and Vitality, may cover joint replacement for osteoarthritis that develops after you join, provided it meets their criteria for surgery.
An expert PMI broker like WeCovr can help you understand the subtle differences in how each insurer treats conditions like osteoarthritis, ensuring you get the policy that best suits your potential future needs.
3. The Claims Process for Shoulder Surgery
If you develop a new shoulder problem after your policy starts, the process is simple:
- Visit Your GP: Get an initial diagnosis and an open referral letter to see a specialist.
- Contact Your Insurer: Call your PMI provider's claims line to get your claim pre-authorised. They will check your cover and give you an authorisation number.
- Book Your Appointment: You can now book your consultation with a specialist from your insurer's approved list.
- Treatment Authorisation: After your consultation, if the specialist recommends surgery, they will provide a medical code for the procedure. You (or the consultant's secretary) pass this to your insurer to get the surgery itself authorised.
- Receive Treatment: You have your surgery in a private hospital. The bills are sent directly to your insurer. You only pay the excess that you chose when you bought your policy.
Choosing the Right PMI Policy for Your Needs
Not all private medical insurance UK policies are the same. When considering cover for potential issues like shoulder surgery, here are the key features to look at:
| Policy Feature | What it Means & Why it Matters for Shoulder Surgery |
|---|---|
| Outpatient Cover | Covers consultations and diagnostic tests (like MRI scans) that don't require a hospital bed. A shoulder diagnosis almost always requires an MRI. A low outpatient limit (£500) might not be enough, while a full cover option ensures all diagnostics are paid for. |
| Hospital List | Insurers have different lists of approved hospitals, often tiered by cost. Ensure the list includes high-quality hospitals near you with renowned orthopaedic departments. |
| Excess | The amount you agree to pay towards any claim. A higher excess (£500 or £1,000) will lower your monthly premium, but you'll have to pay it if you have surgery. A £250 excess is a popular, balanced choice. |
| Post-operative Therapies | Crucial for a successful recovery. Check how many physiotherapy sessions are included after surgery. Comprehensive policies often have better physiotherapy cover. |
| No Claims Discount | Many policies offer a discount on your renewal premium for every year you don't claim. This can make cover more affordable over the long term. |
The Cost of Private Shoulder Surgery in the UK
If you were to pay for the treatment yourself (self-funding), the costs can be substantial. This is why PMI is such a valuable investment.
Here are some estimated costs for private shoulder treatment in the UK (2025):
| Service / Procedure | Estimated Private Cost (Range) |
|---|---|
| Initial Orthopaedic Consultation | £250 – £350 |
| MRI Scan (one shoulder) | £400 – £800 |
| Shoulder Arthroscopy (e.g., rotator cuff repair) | £5,000 – £8,500 |
| Total Shoulder Replacement | £12,000 – £16,000 |
Note: These are guide prices and vary significantly based on the surgeon, hospital, and specific city (e.g., London is typically more expensive).
With a PMI policy, these costs are covered by your insurer, leaving you to pay only your chosen excess.
Recovery and Rehabilitation: Life After Surgery
Surgery is only the first step. A structured rehabilitation programme, led by a physiotherapist, is essential for a good outcome.
- After Arthroscopy: You will likely wear a sling for 2-6 weeks to protect the repair. Physiotherapy starts soon after surgery, beginning with gentle passive motion and progressing to active exercises and strengthening over several months. Full recovery can take 4-6 months.
- After Shoulder Replacement: Recovery is longer and more intensive. You will be in a sling for 4-6 weeks. The focus of physiotherapy is on restoring a safe range of motion and gradually building strength. It can take up to a year to achieve the maximum benefit from the surgery.
Wellness Tips for a Better Recovery
- Nutrition: Eat a protein-rich diet to help your tissues repair. Foods high in Vitamin C and Zinc can also aid healing.
- Sleep: Your body does most of its healing while you sleep. Ensure you are comfortable and getting plenty of rest. You may need to sleep propped up on pillows for a while.
- Follow Advice: Adhere strictly to your surgeon's and physiotherapist's instructions. Doing too much too soon is the most common reason for a poor outcome.
To support your overall health, every WeCovr customer gets complimentary access to CalorieHero, our AI-powered calorie and nutrition tracking app. Maintaining a healthy weight reduces stress on all your joints, including your shoulders.
Lifestyle and Prevention: Keeping Your Shoulders Healthy
You can take steps to reduce your risk of shoulder injuries:
- Maintain Good Posture: Slouching at a desk puts your shoulders in a compromised, forward position. Sit up straight and take regular breaks.
- Warm-Up Properly: Before playing sports or lifting weights, always perform a thorough warm-up with dynamic stretches.
- Strengthen Supporting Muscles: Focus on exercises that strengthen the muscles of your upper back and rotator cuff to create a stable, balanced shoulder.
- Don't Push Through Pain: If something hurts, stop. Pain is your body's signal that something is wrong.
At WeCovr, we believe in a holistic approach to health. That's why clients who purchase PMI or Life Insurance with us can also benefit from discounts on other types of cover, helping you protect your health and your finances all in one place.
Will my PMI cover a shoulder replacement for osteoarthritis?
What is the difference between moratorium and full medical underwriting for a shoulder condition?
Does private health insurance cover physiotherapy after my shoulder operation?
Take the Next Step with WeCovr
Navigating the world of private medical insurance can be complex, especially when considering specific future health needs. As an independent, FCA-authorised broker with high customer satisfaction ratings, WeCovr is here to provide clear, expert guidance.
We compare policies from all leading UK providers to find the right cover for your needs and budget, at no extra cost to you.
Why private medical insurance and how does it work?
What is Private Medical Insurance?
Private medical insurance (PMI) is a type of health insurance that provides access to private healthcare services in the UK. It covers the cost of private medical treatment, allowing you to bypass NHS waiting lists and receive faster, more convenient care.How does it work?
Private medical insurance works by paying for your private healthcare costs. When you need treatment, you can choose to go private and your insurance will cover the costs, subject to your policy terms and conditions. This can include:• Private consultations with specialists
• Private hospital treatment and surgery
• Diagnostic tests and scans
• Physiotherapy and rehabilitation
• Mental health treatment
Your premium depends on factors like your age, health, occupation, and the level of cover you choose. Most policies offer different levels of cover, from basic to comprehensive, allowing you to tailor the policy to your needs and budget.
Questions to ask yourself regarding private medical insurance
Just ask yourself:👉 Are you concerned about NHS waiting times for treatment?
👉 Would you prefer to choose your own consultant and hospital?
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Many people don't realise that private medical insurance is more affordable than they think, especially when you consider the value of faster treatment and better facilities. A great insurance policy can provide peace of mind and ensure you receive the care you need when you need it.
Benefits offered by private medical insurance
Private medical insurance provides numerous benefits that can significantly improve your healthcare experience and outcomes:Faster Access to Treatment
One of the biggest advantages is avoiding NHS waiting lists. While the NHS provides excellent care, waiting times can be lengthy. With private medical insurance, you can often receive treatment within days or weeks rather than months.
Choice of Consultant and Hospital
You can choose your preferred consultant and hospital, giving you more control over your healthcare journey. This is particularly important for complex treatments where you want a specific specialist.
Better Facilities and Accommodation
Private hospitals typically offer superior facilities, including private rooms, better food, and more comfortable surroundings. This can make your recovery more pleasant and potentially faster.
Advanced Treatments
Private medical insurance often covers treatments and medications not available on the NHS, giving you access to the latest medical advances and technologies.
Mental Health Support
Many policies include comprehensive mental health coverage, providing faster access to therapy and psychiatric care when needed.
Tax Benefits for Business Owners
If you're self-employed or a business owner, private medical insurance premiums can be tax-deductible, making it a cost-effective way to protect your health and your business.
Peace of Mind
Knowing you have access to private healthcare when you need it provides invaluable peace of mind, especially for those with ongoing health conditions or concerns about NHS capacity.
Private medical insurance is particularly valuable for those who want to take control of their healthcare journey and ensure they receive the best possible treatment when they need it most.
Important Fact!
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Why is it important to get private medical insurance early?
👉 Many people are very thankful that they had their private medical insurance cover in place before running into some serious health issues. Private medical insurance is as important as life insurance for protecting your family's finances.👉 We insure our cars, houses, and even our phones! Yet our health is the most precious thing we have.
Easily one of the most important insurance purchases an individual or family can make in their lifetime, the decision to buy private medical insurance can be made much simpler with the help of FCA-authorised advisers. They are the specialists who do the searching and analysis helping people choose between various types of private medical insurance policies available in the market, including different levels of cover and policy types most suitable to the client's individual circumstances.
It certainly won't do any harm if you speak with one of our experienced insurance experts who are passionate about advising people on financial matters related to private medical insurance and are keen to provide you with a free consultation.
You can discuss with them in detail what affordable private medical insurance plan for the necessary peace of mind they would recommend! WeCovr works with some of the best advisers in the market.
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