Physical Therapy Versus Surgery for Rotator Cuff Tears

Painful shoulder conditions may need physical therapy to help return to normal.
Physical Therapy can help if you have shoulder pain.. Stockbyte/Getty Images

Research has shown that if you have a rotator cuff tear, treatment with physical therapy may be just as effective as surgery.

If you have shoulder pain, you may benefit from the skilled services of a physical therapist to help you regain normal shoulder range of motion (ROM), strength, and function. Your PT will likely conduct an initial evaluation and perform special tests for your shoulder to determine the cause of your pain and to get you started on the correct treatment.

There are many different causes of shoulder pain. These may include:

A visit to your doctor may be in order if your shoulder pain is persistent so you can get an accurate diagnosis of your condition.

If you have a rotator cuff tear that your doctor suspects is causing your shoulder pain, he or she may suggest various treatments. Some patients with a rotator cuff tear attempt conservative treatment - like physical therapy - while others undergo a surgical procedure called a rotator cuff repair to treat their condition.

So if you have a rotator cuff tear, is is better to opt for surgery or to treat your problem with physical therapy?

What Does the Research Show?

Researchers from Finland studied 173 people age 55 and older with non-traumatic rotator cuff tears. Each study participant was randomly assigned to a group of either physical therapy for their shoulder or surgery plus PT for their condition.

They found that a significant number of people with rotator cuff tears were treated successfully with conservative measures, including physical therapy. There was no difference between groups 12 months after intervention. They concluded that "conservative treatment should be considered as the primary method of treatment for this condition."

One important caveat about the study is that it only included patients with a specific type of rotator cuff tear in the supraspinatus muscle, which is one of the 4 rotator cuff muscles. Does that mean if you have a tear in a different muscle that you shouldn't try physical therapy? No. It simply means that the results of this study may not apply to your specific condition. Your doctor should examine your shoulder and determine the functional loss that may require a surgical intervention to correct. Attempting PT for your shoulder is usually a good idea before considering surgery.

So what does this mean for you? For starters, if you have shoulder pain due to a rotator cuff tear, you should consider visiting your physical therapist to treat it conservatively. (If your doctor does not refer you the physical therapy, you may be able to attend via direct access.)

What is the Rotator Cuff?

The rotator cuff is a group of 4 muscles that arise from your shoulder blade and then wrap around your upper arm.

When you lift your arm, the muscles contract to help stabilize your arm in your shoulder socket. You can think of your rotator cuff muscles as dynamic stabilizers that support your shoulder.

What Happens When Your Rotator Cuff is Torn?

When you suffer a rotator cuff tear, one or more of the muscles that support your shoulder may not work properly. This may cause symptoms like:

  • Shoulder pain
  • Loss of ROM
  • Decreased strength and mobility around your shoulder
  • Decreased stability when lifting your arm overhead.

Here's the kicker though: not everyone with a rotator cuff tear experiences pain or loss of motion and strength. And not everyone with shoulder pain has a rotator cuff tear. So the diagnosis of rotator cuff tear is merely an anatomical finding that cannot be used to predict your need for surgery or not. So, if you have shoulder pain due to a rotator cuff tear, checking in with your PT may be in order to get an idea of how your shoulder is moving and functioning.

Physical Therapy for Rotator Cuff Tears

When you visit a physical therapist for treatment of your rotator cuff tear, you can expect to engage in active exercises designed to help improve the way your shoulder moves and functions. Exercises may include:

Your therapist may also choose to use various treatments and modalities to help decrease your pain and improve the way your rotator cuff works. These may include:

Working hard in physical therapy is important; your shoulder won't get stronger overnight. If you consistently work to keep your shoulder moving and to keep your rotator cuff strong, you can possibly overcome a rotator cuff tear and get back to your normal activity.

Kukkonen, J. etal. Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. Bone Joint J. 96(B1). Jan, 2014. (Abstract available online.)

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