Patients' preoperative expectations of shoulder surgery affect both the decision to proceed with surgery and how patients assess outcomes of surgery. Our goals were to identify patients' expectations of shoulder surgery, to develop and test a patient-derived shoulder surgery expectations survey, and to determine the prevalence of major expectations by diagnosis. An initial sample of 409 patients (mean age, 51 +/- 17 years; 58% men) with diverse shoulder diagnoses were asked open-ended questions preoperatively about their expectations of shoulder surgery. Their responses were grouped into 38 categories including the following: pain relief, increasing range of motion, improving the ability to wash and dress, returning to sports, improving the ability to interact and care for others, and for the shoulder to be back to the way it was before shoulder symptoms started. Expectations varied by demographic characteristics, diagnosis, and functional status measured by the L'Insalata Shoulder Rating Questionnaire and the Short Form 36. The most frequently cited categories were then assembled into closed-format questions to form a draft survey. A second sample of 100 patients with diverse shoulder diagnoses completed the draft survey on 2 separate occasions to establish test-retest reliability. Items retained to form the final survey were frequently cited, represented clinically relevant or potentially unrealistic expectations, and had concordance levels of 0.40 to 0.83 measured by the kappa statistic (71% had kappa >or= 0.60). The final 17-item Hospital for Special Surgery Shoulder Surgery Expectations Survey requires less than 5 minutes to complete. This patient-derived, self-administered survey has several possible uses in daily clinical practice, such as providing a way to learn about the patient's perspectives, providing the orthopaedist with a template to guide a formal discussion about realistic and unrealistic goals, and providing a prospective record that can be used jointly by the orthopaedist and patient postoperatively to assess the outcome of surgery.