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Dr. Arnan Sisson, PT / Sept 28, 2022
Have you been diagnosed with a rotator cuff tear and told you need surgery?
We’ve seen a lot of people with rotator cuff tears and they are extremely common, even normal, for people over the age of 65, even someone in their 20’s. It’s something that a lot of people have, even people without pain. The real problem is that when you get an MRI, they are going to find something, and there is a great chance that you’ll have a more invasive procedure.
Just because you have a rotator cuff tear, does not mean it’s actually completely torn. Being diagnosed with a tear as the cause of your pain does not even tell me, your physical therapist, what is truly the problem. See, the “tear” is just the symptom and what we see on the MRI. MRI’s are very sensitive and pick up every little feature. It’s like someone saying, there’s a wrinkle on your face when you smile, that’s why you are unhappy. It’s not really congruent.
There are cases where the rotator cuff is actually completely torn away from its anchor on your bone and those usually occur during a traumatic event, but not always, and not all traumatic events cause rotator cuff tears. They are so normal; I would absolutely expect to find one on your healthy shoulder if we gave you an MRI and you were over the age of 30.
There are research studies of major league baseball pitchers, who at the time had no pain or symptoms, and were throwing 90 miles an hour. The results of the MRI showed that over 90% had rotator cuff tears on the imaging results.
Yes, there is a chance you may actually need surgery, but before you make your final decision and even when you know you are ready for surgery, you should see a physical therapist first to get a full body exam and help you prepare your body for the surgery. Sometimes, depending on your activities and lifestyle, the surgery is still elective or can be delayed.
Most people who have been diagnosed with a rotator cuff tear imagine that the whole thing has been completely ripped off, or it’s just hanging by a thread, ready to shred apart. That’s not really the way it works. Even with a partial tear, people go years if not the rest of their life without needing a surgery or further medical intervention. If it is a true and complete rotator cuff tear, you are not going to have functional movement with your arm. You’re not going to be able to lift your arm overhead because the muscle is fully torn.
We have seen plenty of patients who have a complete tear, who do not have pain and helped them recover without surgery.
Deciding on whether you should get rotator cuff repair surgery should not just be about reducing your pain, because even without pain people have “arthritis,” “bone spurs,” a “torn labrum” and a “rotator cuff tear.” The decision should be based on the amount of movement you have, how recent the tear/injury was, your activity level and your desire to work consistently through rehab for 6-12 months after the surgery.
So, don’t be worried if someone says you have a tear. I had a patient tell me he was told his shoulder was “shredded.” What good does that do?
When you are told you have a torn rotator cuff and have shoulder pain, we have to look at at least three areas. We have to look at your neck, your upper back and your shoulder itself. Those three areas really work together when it comes to movement. To find a resolution, we have to look at all three, because you may just have a rotator cuff tear that’s been there for years, when it’s your upper back or neck that’s causing the pain you are feeling.
A lot of our patients have been to other places where they just got their shoulder looked at. They said therapy didn’t help them at all for that reason. In that case, it’s probably something in the back or neck. That’s the problem. Many people don’t have time to look at your whole body and help you get back to the activities that are most important to you. That’s why we’re here!
Remember, physical therapy is not just for your post-surgical rehab and recovery. We can actually help you reduce your pain and symptoms and prevent a surgery that will take you months to recover from. We can get you back to your favorite workouts, playing with the grandkids, or just feeling great with reaching in cabinets again.