Rotator cuff tears are one of the most common reasons why people have shoulder pain. But there are many people who have rotator cuff tears and have no pain. Many rotator cuff tears can be treated without surgery and result in a painless, well functioning shoulder. Some of you may have persistent pain despite medications, injections and physical therapy. Therefore, some of you may wish to consider rotator cuff surgery. This post will help address many of the key questions you should have about rotator cuff tears and whether or not you should think about having shoulder surgery. More than ever it is important that you have a good understanding about rotator cuff tears.
The rotator cuff is made up of 4 muscles which control how well your shoulder works. If a tear in the rotator cuff is large enough it can affect how well the shoulder will function. Most rotator cuff tears are actually due to degeneration of your tendons. Some tears may occur because you were injured… such as a fall, or sports injury.
Let’s review…
5 Facts You Must Know About Rotator Cuff Tears:
- The most common cause of a rotator cuff tear is degeneration. That means your tissue simply wore out over time. These tears can become larger with time, but that is not always the case. Many degenerative tears are very small. Many patients with degenerative tears can avoid surgery. Take home message: Inquire about your type of tear. If you have a small degenerative tear, a discussion about surgery should only occur after you have failed a proper non-surgical treatment regimen. Recent advances have enabled us to repair rotator cuff degeneration and degenerative rotator cuff tears with a biological patch.
- Trauma or injuries can cause rotator cuff tears. If you have fallen on your side, and now you find that you can not move your arm due to pain and weakness, you have likely suffered a large traumatic tear of the rotator cuff. Traumatic tears are treated differently then degenerative tears. In this case, you had a normal tendon which tore because of a traumatic event. These injuries are typically treated with surgery to repair the rotator cuff. Take home message. If you fell and now have significant weakness… do not wait too long before seeing an Orthopedist. If your tear is large, it will retract and turn to fat. It is better to treat these sooner rather than later.
- Retraction and Atrophy. Muscles in our body are under tension. Like a rubber band stretched between two fingers. If a tendon is torn on one end, it will start to retract or pullback towards the other end. If you have a large tear, then your rotator cuff tear can retract significantly. If it has retracted more than 3 centimeters the repair might be difficult to perform and your result might suffer, or degrade with time. When a muscle is not functioning well, it will turn to fat. Our body is cruel! If you have had a tear for a while, then there is a chance that the muscle has turned to fat.. and is NOT capable of working like a muscle. Unfortunately, once a muscle has turned to fat, it can not turn back into muscle. Take home messages: Talk to your doctor. Is your tear retracted? How far? Ask how that will affect your ultimate result. Do you have fat replacement of the muscle? How much? If it is significant, you may not be happy with the result of an attempted repair.
- Just because something is torn, does not mean it needs to be fixed. I see far too many second opinions where people had an MRI, were diagnosed with a small tear and told that they need surgery. The reason given for the need for surgery was simply because something was torn. That’s simply not true. Many people are living with tears of their rotator cuff and do not even know they have one. Just because something is torn does not mean it needs to be fixed. Take home message. If you have not had trauma or a serious injury and you are diagnosed with a small tear and have not been offered non-surgical treatment options it’s time to see a second opinion.
- Be treated like a person… not an MRI finding. All people are not created equal. All tears are not created equal. When determining what the proper treatment option is for you, your surgeon must take into account the type of tear you have, your story, your goals, your current quality of life and whether or not those goals are achievable given your exam, and your MRI findings. Take home message: Not all tears require surgery. Not all tears can be repaired. What are your goals? They matter! Are they achievable — with or without surgery? Don’t be afraid to ask questions.
Rotator cuff tears : Because you likely have more questions… see these articles for more information.
Click here to read more on the causes of rotator cuff tears.
Click here to read more about the function Rotator Cuff.
Paula Ernst
Thank you so much for this informative site and for addressing more than just the disease but quality of life etc. I have been diagnosed thru MRI with a large totator cuff tear…I saw an orthopedic surgeon who recommended surgery sooner rather than later (this after I had PT for about 4 months with some benefit but not significantly better). I got a second opinion from a physiatrist (sp?) at a Pain and Spine center that specializes in PRP and stem cell therapies….he was not also a surgeon but recommended we start with a non-steroidal anti-inflammatory injection. My range of motion was still quite good according to him (I can raise my arm up almost straight beside my head) even tho the MRI showed a significant tear…..he said he liked to treat functionality rather than just an MRI…. I’m going to get the injection as it seems pretty non-invasive and he said that could be all I need with continued PT. I am very hopeful…but would have felt better if he were also a surgeon. Your thoughts….and should I get yet another opinion from a surgeon… Thank you so much for your time and expertise. Paula
Jay Garbarino
I had a fall 10 weeks ago. I will be getting an MRI once approved. I am curious about what the time frameis for a large tear retracting and turning to fat.
Howard J. Luks, MD
You should be ok.
shawna
hello. great article. thank you for all the good info. for me, it is too late. i had probably long time with degenerative tearing, then one push of a piece of furniture and i hear the ripping sound. sadly, i did see several doctors, and they all recommended surgery but with just a five minute or less visit, nothing really EVER explaining what would happen if i didnt, only that i would be back when i couldnt stand the pain, but they allllll gave me cortisone injections…so i never did get to the level of pain, just finally a got a doc that cared enuf to take new mrs 2 years after and then tell me in detail, what was really going on. i am 53, working waitress, healthy non smoker, non drinker…active mother of 5 with two fully torn and retracted shoulder rc. left, massive tear supra, large tear infra, large tear bicep and out of medial groove. r, large tear supra, sml tear infra. and a few other things. doc says i have only a 50 % chance of successful surgery and if i were older he would recommend a total replacement. IS THIS IT?? THIS IS ALL THERE IS?? NO OTHER OPTION???? it feels incredible to me!!!!! yes, my shoulder hurt like a son of a gun, and yes, i have very limited rom, which ive grown accustomed to over the past 2 years…*T-Rex”!! and no, i cannot live lie this without injections to kill the major part of the pain….so that’s it??? i have to risk being worse? or not working at all? i just seems so crazy…and why are there soooooooooooo many??? it’s like Asian manicurists….one on every corner! what is going on? HELP…i dont want this surgery!!!!!! but how can i live like this for another ???? years??? nite time is so bad that if a surgeon walked into my room in the middle of the nite, I would let him cut me…but….in the day, i cope. i am scared to death of this surgery!!!!! what did they do before all these surgeries???
Geoffrey Cope
Dear Sir
I have just had an ultrasound the results are a small Tare the pain i get is mostly down the arm into the elbow is this common. I can move the arm up down and around with out pain and have no problem sleeping. I’m going to see orphopedic doctor next week to see what can be done. I don’t want surgery my age is 68 and was up to this happening a lawn green bowler ie out doors. When I was at work 8 years ago my job was lifting most of the day and have no problem with my arm. I must point out 3 years ago I feel of a ladder smashed this arm on to a concret post had pain for a few weeks nothing since.
best regards Geoff
Howard J. Luks, MD
Physical therapy sounds like a great option … we typically do not chase small tears. Most can be safely watched.
Fiona Seamer
Dears Dr,
I fell in my kitchen 4th May & dislocated my shoulder. I had an MRI for Mother’s Day revealing I had bruised(fractured) my humerus head, HAGL off the bone and suprasprinatus rotator cuff. Pain from the fracture has now gone and physio I have an anterior lift of 140 degrees and oblique lift of 80 degrees. Still pain and weakness with the RC & my Orthopedic surgeon is recommending surgery. I’m 48 and want to be able to swim overran again and have no pain. Can I achieve this without surgery or not? How long do I have to make my decision for my muscle to turn to fat?
Howard J. Luks, MD
it depends on many variables… Unfortunately I can’t say without seeing you and your scans.