The rotator cuff is a series of four small muscles that control your shoulder. Tears in the rotator cuff are very very common. It turns out that using the term “tear” really isn’t very accurate. Most rotator cuff tears are degenerative. That means your tissue simply wore out – it didn’t tear. It’s a sad fact of life: many people have rotator cuff tears and do not even know it. Many of you have shoulder pain and your MRI revealed a degenerative rotator cuff tear. Why do some “tears” hurt while other do not? We do not know the answer to that question.
Just because something is torn does not mean that it always needs to be fixed. In many cases your shoulder pain will respond to non-surgical measures such as injections, supplements, support sleeves or braces, a shoulder pillow to sleep with, medications and physical therapy. For those of you with traumatic tears following a significant injury or fall (not picking up a box, etc) then surgery is the recommended treatment. However, the vast majority of rotator cuff tears are degenerative or atraumatic.
The American Academy of Orthopedic Surgery put forth a series of guidelines on how to manage patients with rotator cuff tears. It shows that there is very little evidence in the scientific literature to support surgery as the initial treatment option of degenerative, atraumatic rotator cuff tears. They published a guideline for surgeons and it reveals that we do not really know how to manage these degenerative tears. The issue is that some tears will grow larger, yet many will not. Many will respond to physical therapy, yet some may not. More importantly, most research shows that the integrity of your rotator cuff… does NOT correlate with whether or not you have shoulder pain. That means that you may have had rotator cuff surgery, feel great, but if we image your shoulder we find that the rotator cuff tear did not heal. Confusing isn’t it? That’s why you can get four opinions on how to manage your rotator cuff tear and receive many different opinions.
A recent study out of Finland showed no benefit to choosing surgery over physical therapy in the management of patients with small rotator cuff tears.
Your take home message:
IF you have a degenerative tear of your rotator cuff, and did not suffer a significant injury, then it is likely safe and prudent to consider physical therapy as your primary treatment.
Patti VanScoy
Hi – I have read your blog with great interest. I am a 56 year old female with shoulder pain in my non-dominant shoulder. I have a decent amount of arthritis in other parts of my body, but I am not sure what exactly is going on with my shoulder. Although I did not have an acute injury, I do tend to exert myself beyond what is practical for a woman my age (landscaping work, moving docks in and out of water, etc.). After two months of chronic pain, I mentioned the situation to my doctor during a routine physical. I asked if he could refer me to PT, as I have great faith in the benefits from past experience with other issues. The problem is, after six weeks of therapy, I see no improvement. I actually may even be feeling a little worse. I am certain that I have degenerative changes, and probably multiple small tears much like my right shoulder. However, I wonder if maybe something else is going on. My pain is most evident whilst pulling blankets up over and across my body while lying on my right side, or trying to switch from laying on my right side to my left. Also, swinging a car door closed behind me while walking away has proven excruciating. A few other tweaking moments have occurred, but overall I experience a fairly constant dull ache. And, my bicep muscle seems to always feel tender and “knotted” in several places. Do these symptoms seem to indicate a specific malady to you? I suppose obtaining an MRI would be most helpful at this point, but I was just curious about your opinion based on my symptoms, and the fact that Physical Therapy has not been helpful. Also, I do take about 300mg of Tramadol each day for arthritis pain, and I would tend to think that would help the pain in my shoulder – maybe it has! Maybe I would be even worse off without it.
Cheryl Callahan Slippy
HI Dr. Luks
Thank you for making all this information available!!! I just had an MRI done and have found out that I have a bone spur and a rotator cuff tear. I have really no reason for it other than possibly from lifting weights. I t had been hurting for a while but original x-ray didn’t show anything. I’m now looking into therapy versus surgery as my Dr. has recommended. I’m still confused how therapy will help but will definitely look into it. I happen to remember your name as you were friends in high school with my sister!! Yours was the first sight I clicked on and couldn’t believe it!! Thanks again for all the wonderful info!!
Howard J. Luks, MD
Too funny… tell Carolyn I say hi :-)
PT is usually the way to go with most small degenerative rotator cuff tears. They are very common at our age :-( But thankfully most people do not have pain. If PT, etc does not improve your quality of life then surgery is a consideration.
Be well !
HL
Lynn Welsh
Hi Dr. Luks, My doctor is recommending surgery for my left shoulder , after my MRI showed a 10 by 11-mm complete tear of the supraspinatus at the insertion with proximal tendinopathy . There is also a 5-mm cyst at the humeral head, diffuse capsular thickening and degenerative tear of the superior labrum with bicep tendinopathy. I am a 59 year old female and am experiencing pain (mostly at night ) in my left bicep. I have pretty good range of motion but the pain is waking me up at night. My shoulder has been achy for a couple of years already, did PT last year, but things seem to be getting worse. Is it time for surgery? I really appreciate any advice and your posts are invaluable.
Howard J. Luks, MD
HI Lynn… I’m glad the posts are helping you. I can not guide you though… that’s between you and your doc.
Good luck !
Rob
I fell playing indoor soccer and have a near complete full thickness tear of my supraspinatus tendon (90%). I am 43, very active with a physical job (lifting, heavy work, repetitive work). I am otherwise fit and strong and want to regain full strength and ROM in my shoulder. Is it worth trying PT or is surgery indicated considering this was caused by a traumatic event? Have to wait 3 weeks to see a surgeon, on ‘light duties’ at work and taking pain killers and anti-inflammatories to get by in the meantime.
Howard J. Luks, MD
As I write about in other posts, if you have an acute (recent), traumatic rotator cuff tear, it seems that the best option is to fix it.
Shruti
Hi Doc,
I have read all your articles on rotator cuff tear treatment. Really impressed by your advise to each and everyone on the comment section.
My MIL is 64 year old and been suffering from rotator cuff tear. She doesn’t remember of any incident that might have caused this tear but it is guess that is a result of aging. The below is the description from her MRI scan. Could you please have a look at it and let me know if is it possible to go for physiotherapy.
“Mild supraspinatus tendinosis with small 3mm partial tear of the anterior fibres. Synovial thickening in the rotator internal – suggestive of adhesive capsulitis. subacromial-subdeltoid bursitis ”
Thanks in advance for the help.
Shruti
Howard J. Luks, MD
No doubt .. PT should benefit her. Those are not concerning tears. The adhesive capsulitis or frozen shoulder needs to be addressed with PT.