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So You Tore Your Rotator Cuff and “Need Surgery”… Wait, Not So Fast!


Your shoulder hurts. You may not know what caused the pain. Or you may have recently “tweaked” it trying to do some sort of lifting, jerking, or pulling movement. Maybe you fell and your shoulder does not feel right.


Then you see a medical professional who diagnoses you as having a rotator cuff tear. What are your options?


It seems to me that a lot of people think that the only way to resolve their pain, weakness and limitations due to a rotator cuff tear is to have surgery. But did you know that physical therapy can help up to 80% of people with a diagnosed rotator cuff tear (1)?


“How can this be? If your rotator cuff muscle is torn, then don’t you need to fix it?”


Not necessarily. Rotator cuff tears are very common in people over 60 years old – at any given moment, up to 40% of people have rotator cuff tears (2-3). This does not always mean every one of these people need a surgery.


Also, having a rotator cuff tear does not always mean your pain is coming from that tendon/muscle. In a study by Mall et. al in 2010, 195 people without pain were diagnosed with a rotator cuff tear. Only 23% of them developed symptoms over a 2-year time frame (4). This shows some evidence that rotator cuff tears can just be a “normal” part of getting older (research is still developing on this topic though).


On that note, there are excellent research studies that show us that conservative care (aka physical therapy) of rotator cuff tears should at least be attempted prior to surgery (1).


There are a few exceptions though. See the picture here:

Adapted from Edwards et al. (1)


At this point in time in 2021, this article as well as other research provides an excellent resource & starting point for healthcare professionals to make decisions on how to manage a client’s care with a rotator cuff tear. Of course, every year we are learning how to refine who is most appropriate for surgery vs who is most appropriate for physical therapy/conservative care. As you can imagine, medicine is always evolving, and we get better as time goes on.


“Why does rehab work with people with rotator cuff tears? Will it work for me?”


You’ll have to consult a physical therapist and/or physician to determine the best course of action for you. However, rehab works for several reasons:


1. It helps strengthen the whole shoulder complex. It takes a lot more than 1 (or even 2) rotator cuff tears to stop your shoulder complex from doing its job. The shoulder complex involves muscles and joints from your rib cage, scapula, clavicle, and spine that all support each other. Rehab works because your care will address strengthening all of those muscles as a whole to help your arm function.


2. It helps you learn how to manage your pain and temporarily avoid painful motions. Once your pain calms down, we work together to progress your arms ability to be able to do everything again.


3. It helps you regain your range of motion with your shoulder and shoulder complex without aggravating your pain. You will regain motion to improve your reaching ability and feel better with these tasks.


So physical therapy does not “fix” your rotator cuff tear, but does it really need to be “fixed”?


Try physical therapy first. You may just notice your pain reduces, you feel stronger, you have better range of motion and you may end up being able to function without limitations and avoid surgery all together.


Dr. Dan Physical Therapy would be happy to discuss if mobile or virtual physical therapy is right for you with your pain or injury and for your recovery. Dr. Dan treats people of all ages with all different types of injuries and pains from muscle strains, joint sprains, spine pain, shoulder pain, knee or hip pain, elbow and hand pain and much more! Give us a call today to set up your Free Discovery Visit at 618-520-2312 or click here to book online! We would be happy to serve you.




References

1. Edwards P, Ebert J, Joss B, Bhabra G, Ackland T, Wang A. EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE. Int J Sports Phys Ther. 2016;11(2):279-301.

2. Smith KL, Harryman DT 2nd, Antoniou J, Campbell B, Sidles JA, Matsen FA 3rd. A prospective, multipractice study of shoulder function and health status in patients with documented rotator cuff tears. J Shoulder Elbow Surg. 2000;9(5):395-402. doi:10.1067/mse.2000.108962

3. Gartsman GM, Brinker MR, Khan M, Karahan M. Self-assessment of general health status in patients with five common shoulder conditions. J Shoulder Elbow Surg. 1998;7(3):228-237. doi:10.1016/s1058-2746(98)90050-7

4. Mall NA, Kim HM, Keener JD, et al. Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables. J Bone Joint Surg Am. 2010;92(16):2623-2633. doi:10.2106/JBJS.I.00506


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