Does a Rotator Cuff Tear Require Surgery?

by Dr. Troy Vander Molen, PT, DPT

Shoulder pain is a common problem. If you have experienced shoulder pain, you are most certainly not alone. Shoulder pain is the third most common reason people seek care from us at our five physical therapy clinics, and it is estimated that 70% of the population will experience shoulder pain at some point in their lifetime.

Rotator cuff problems are the most common reason for shoulder pain, and these problems can range from simple inflammation to a rotator cuff tear.

The rotator cuff is a group of four muscles that originate from the shoulder blade. The tendons of these muscles come together to form a “cuff” around the shoulder, which is a ball and socket joint. Though it is known as the rotator cuff, which is appropriate because these muscles help to create shoulder rotation motions, its most common and important function is to properly position the large ball on the small socket of the shoulder.

If you experience rotator cuff problems, you are most likely to feel the pain when you are reaching. It is during this function that the rotator cuff may have difficulty controlling the position of the ball on the socket, which can result in pressure on sensitive tissues, causing pain on the front of the shoulder and radiating down the outside of your upper arm.

Many of you are likely to have dealt with this problem, and some of you have probably underwent diagnostic testing. If you are in the group of people who have been found to have a rotator cuff tear, it can be a scary experience.

Can a rotator cuff tear heal on its own? That’s a good question. If the tear is minor, healing can occur. However, if the tear has advanced, this tissue is unlikely to fully repair itself spontaneously.

So, does that mean that I must have rotator cuff surgery? The answer to that question is an emphatic “no!” A research study published in the January 2014 edition of the Bone and Joint Journal analyzed the results obtained by 167 subjects with nontraumatic (i.e. gradual wear and tear) rotator cuff tears, and the authors found that physical therapy alone produces results equal to those produced by both arthroscopic surgery and open surgical repair. In fact, the researchers indicated that “conservative treatment should be considered the primary treatment for this condition.”

Another thing to keep in mind is that finding a problem with an MRI can be misleading. These types of diagnostic tests are very sensitive but not very specific, which means that an MRI may be showing you something that is not even related to your current complaints.

Let me give you some details about what I mean about that:

• A study by Tempelhof et al (1999) revealed that 23% of people with pain-free shoulders had a rotator cuff tear. Newer research indicates that 35-40% of healthy people – people with no shoulder pain – have rotator cuff tears, and this number rises to 2/3 of people age 70 and above.
• Recent research indicates that more than 1/3 of people who undergo a successful rotator cuff surgery still have a rotator cuff tear. 16% still have partial tears and 20% still have complete tears.

Why get a surgery to fix something that many pain-free people also have? The goal is to improve the movement and reduce the pain – to feel better and function better – not fix the rotator cuff, and this can occur without going under the knife.

If you are one of the many dealing with shoulder pain, it is important to seek the help of a competent physical therapist who understands pain management, manual therapy, appropriate education and exercise interventions, and the functional role of the shoulder complex. Using modalities to rid the shoulder of pain may be helpful, but that focus alone is not complete. To feel better and function better, your shoulder specialist must understand the entire functional chain including the shoulder, the shoulder blade, the thoracic spine and even the hips.

Suffer with pain no more! Get the answers you need to correct the real problem, and stop spending loads of money on things that won’t provide any benefit. We invite you to call our office at (866)-588-0230 and schedule a FREE INJURY SCREEN to find out if your shoulder can benefit from the expertise we offer. We’d love to help you get results, save money, and experience a great 2018 free of shoulder pain!

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