Rotator cuff tears are now seen as age-related changes when viewed on an MRI. Also, studies have shown no significant correlation between size of rotator cuff tears and pain levels. It seems logical that one would think if their rotator cuff is torn, then it should be surgically repaired. After all, it can’t fix itself right?
Rotator cuff repairs have a high likelihood of retearing early in the rehab process regardless of how fast or slow one is pushed into their range of motion. The likelihood of a retear post-surgically is increased with the larger pre-op tears, but the rates aren’t good for any size of a tear.
Not only that, but there are many other complications with this procedure, such as post-op adhesive capsulitis (“frozen shoulder”), chronic pain, and long-term disability to name a few. Now, I’m not saying that it is absolutely wrong to get a rotator cuff repair...but you should be very cautious going into this procedure. You will want to try conservative methods first, such as working on your mobility, strength, stability, and naturally getting your pain levels down so you can tolerate activities at home, work, and the gym. But hey, does physical therapy actually work for someone with a torn rotator cuff? I mean...it’s still torn right?
Let’s see what the evidence says!
This study analyzed people with chronic (> 3 months) full-thickness rotator cuff tears (present on MRI). Each person participated in a 3-month home-based rehab program and then it was determined whether they were successful or failed. Those who failed were then recommended to go get the surgery. The examiners followed up with each person 1 year, 2 years, and 5 years afterwards to see what happened in the long-term.
I’m not going to go into detail on everything in the study (click here to read the article), but here’s the information we all want to know…
“The results also show that at 5 years, operative and nonoperative outcomes are not significantly different from each other.”
Would you really want to subject yourself to anesthesia, high levels of pain, the inability to use your arm for months, and a long road to recovery just to get to the same results you could get from a few months of PT? This study used a 3-month home-based program. Now, what if you went to see a PT for hour long sessions with an individualized plan to address your specific needs. You could develop a relationship with someone who can get you feeling better and moving better, while at the same time avoiding the thousands of dollars for X-rays, MRIs, surgery, and medications.
Surgical repair of the rotator cuff can be a great thing, when it is necessary. Don’t settle for this option at first, though. Try the conservative route. And I mean really give it a try (not just one or two sessions). It’s likely that you will get just as much with PT as you would with surgery, but you would get there faster and you won’t go through a long period of disability.
If you have specific questions about your shoulder, shoot me an email at email@example.com to see what the best steps are for you to take. You won’t regret it.
Corey Hall, PT, DPT