I Have A Rotator Cuff Tear

Do I Need Surgery?

I can’t tell you the amount of times I’ve had someone come in and tell me they’ve been told they have a rotator cuff tear, and they are dreading the surgery.  Well, I’m here today with good news, just because you have a rotator cuff tear, it doesn’t mean you are bound for the OR. Believe it or not some amount of tearing can be normal in your rotator cuff as you age, this is simply a product of using it over time, and is very normal.

Studies have actually been done on people with no shoulder pain at all, so they all thought they were in a pretty good position, and actually 23% of them had a tear in their rotator cuff, but they were completely asymptomatic.  Now if one of those people suddenly gets some pain in their shoulder, and they get an MRI, and a tear is found, it can be very easy to blame their pain on that tear, but remember that predated the pain, so that doesn’t make sense.  The key here is to determine what changed. Their body was compensating for that, and now it isn’t. This is where we, as physical therapists get to shine, we get to watch you move, see what we can improve, strengthen, or “clean up”, and then hopefully return you to a state where your body can compensate again.

How is that possible?  MAGIC!! Nope, I wish it was that much fun, and/or that simple, but it isn’t.  Your rotator cuff’s primary job is to “dynamically stabilize your shoulder joint”.  Which in simple terms means that it needs to allow your shoulder a lot of motion while still being in a controlled environment.  Your body is an impressive machine and built with a lot of redundancy, and your rotator cuff is no different, there are multiple muscles that make up your cuff, and we can improve the function of the non torn ones, and help the cuff then be able to provide you with both the motion and stability you need to have a pain free shoulder.  

So, what should you do? Do you need an MRI? Do you need surgery? The course of action we always recommend is to start with PT, why? Well we are physical therapists, so that seems natural.  Seriously, though, physical therapists are great at evaluating the way you are moving, and creating a plan to improve it. Also if you aren’t seeing results, you can then go for the orthopedist, and MRI route.  The worst you would have done is strengthen your shoulder.

Now, don’t get me wrong, some people do end up needing surgery, but definitely not everyone, and I have not seen any numbers on this, but I would venture to guess that those individuals who do end up needing surgery are in the minority.  

The moral of the story is, you can have a rotator cuff tear without any symptoms, and therefore if you develop symptoms you can’t always blame them on the tear, often times we can get you stronger so the symptoms can go away, and you won’t need an operation.