Surgery or Therapy for Rotator Cuff Tears?

More and more research is beginning to be done in order to determine if having a common orthopedic surgery is more effective than a more conservative approach (physical therapy) in the long term. Most of these studies have looked at surgeries for low back pain, knee pain, and shoulder pain. [...]

More and more research is beginning to be done in order to determine if having a common orthopedic surgery is more effective than a more conservative approach (physical therapy) in the long term. Most of these studies have looked at surgeries for low back pain, knee pain, and shoulder pain.

In this blog, I want to share a recent published paper from the Journal of Disability and Rehabilitation which reviewed 3 different studies that compared the 1 year outcome of having surgery for a rotator cuff (muscles of the shoulder) tear to treating the shoulder pain with physical therapy. It is a common belief that when an MRI done on the shoulder shows that there is a tear in the rotator cuff, surgery is indicated. However, we are finding that the older we get, the more likely it is that an MRI will show a tear in the rotator cuff-and these studies are done on people without complaints of shoulder pain! So, given the fact that a large percentage of people without pain, have a rotator cuff tear and do not know it, does this mean it needs to be surgically repaired to get out of pain and improve function?

In the current study by Ryosa and colleagues, outcomes for pain and function of the shoulder at 1 year where compared for individuals who had their rotator cuff tear surgically repaired and those that underwent a bout of physical therapy. They found that at 1 year our from the start of their care, there was no clinically meaningful difference between the two groups. This means that any difference in improvement noted between the two groups were not big enough for the patients to notice.

They concluded that there is limited evidence that surgery is NOT more effective in treating a rotator cuff tear than conservative treatment alone. Furthermore, they stated that since physical therapy is less prone to complications and less expensive than surgery, a conservative approach is advocated as the initial treatment modality for rotator cuff tears.

Now, you may be thinking that since the outcomes are the same, why not just get it “fixed” and have the surgery. Well, there are a few things to consider here. First, long-term, studies are showing that you may not be better off getting it “fixed” and that the shoulder pain you are having may not be all related to the tear itself. Secondly, recovery from a rotator cuff repair surgery is no simple process. It is a painful procedure, there is an extended period of time where you will not be able to use your arm and hence will likely have to take time away from work, daily activities, and the activities that you enjoy. Also, there will still be a very extensive, prolonged period of physical therapy to restore your shoulder motion, strength, and function. Most surgeons will tell you that full recovery from a surgery will take 6 months to a year. Lastly, even with a surgery, there is no guarantee that your shoulder will be better off than it was before the surgery and that is a heck of a recovery to go through if you could have gotten the same or better results with a few sessions of physical therapy and follow through with exercises for your shoulder.

Now, I am not saying that rotator cuff surgery should never be done. There are times when this might be needed. However, it should not be the first step in the treatment of a rotator cuff tear.

As always, feel free to contact me by email at bob@promotiongb.com with any questions.

Thanks for reading.

​Bob