Informed Consent in Shoulder and Elbow Surgery

Puru Sadh; Antonio Almeda-Lopez; Benjamin Hershfeld; Dan Monessa; Brandon Klein; Randy M Cohn; Adam D Bitterman

doi:10.7759/cureus.92584

Informed Consent in Shoulder and Elbow Surgery

Cureus. 2025 Sep 17;17(9):e92584. doi: 10.7759/cureus.92584. eCollection 2025 Sep.

Authors

Puru Sadh¹, Antonio Almeda-Lopez², Benjamin Hershfeld^{3

4

1}, Dan Monessa^{3

4

1}, Brandon Klein⁵, Randy M Cohn^{3

6

1}, Adam D Bitterman^{3

4

1}

Affiliations

¹ Department of Orthopaedic Surgery, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, USA.
² Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, USA.
³ Department of Orthopaedic Surgery, Northwell Health, New Hyde Park, USA.
⁴ Department of Orthopaedic Surgery, Northwell Health Huntington Hospital, Huntington, USA.
⁵ Department of Orthopaedic Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
⁶ Department of Orthopaedic Surgery, Long Island Jewish Valley Stream, Valley Stream, USA.

Abstract

Informed consent is essential for patient autonomy and shared decision-making but remains inconsistent in orthopaedic surgery. Shoulder and elbow procedures present unique challenges, with complex functional outcomes, diverse patient demographics, and high medicolegal exposure. Despite the clinical and legal importance of informed consent, evidence describing current practices in this subspecialty is limited. This review aimed to synthesize the literature on consent in shoulder and elbow surgery, identify barriers to effective communication, and highlight strategies to improve patient understanding and engagement. Peer-reviewed literature was identified through searches of PubMed, Web of Science, and Scopus from database inception through September 11, 2025. Eligible studies addressed informed consent in shoulder and elbow surgery, including consent quality, patient comprehension, expectations, communication interventions, or medicolegal outcomes. Studies not directly addressing informed consent in this context were excluded. Findings reveal limited quantitative data on consent quality, despite high malpractice rates and frequent citation of inadequate consent in litigation. Key barriers include low health literacy, language discordance, insufficient physician training, and time constraints. Patient expectations vary by occupation, gender, and age, emphasizing the need for individualized consent discussions. Proposed solutions emphasize multifaceted, patient-centered approaches: the teach-back method to confirm comprehension, plain-language explanations supported by visual aids, structured resident training to improve communication, timely access to professional interpreter services, and greater workforce diversity to strengthen rapport. Future research should focus on validating specialty-specific consent frameworks, integrating digital adjuncts such as videos or surgery-specific forms, and adopting quantitative outcome measures to evaluate effectiveness. System-wide implementation of these strategies could enhance autonomy, build trust, reduce medicolegal risk, and improve outcomes in shoulder and elbow surgery.

Keywords: elbow surgery; informed consent; malpractice; medicolegal; patient autonomy; shoulder surgery; upper extremity.

Publication types

Review