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decision pointShould I have rotator cuff surgery?

Rotator cuff disorders may be treated nonsurgically, with rest and rehabilitation, or with surgery. Consider the following when making your decision.

  • You may be able to stop and reverse early stages of rotator cuff damage with nonsurgical treatment, which includes rest, ice and heat applications, anti-inflammatory medications, and physical therapy. But symptoms that persist for more than 6 months are unlikely to get better without surgery.
  • You may want to consider surgery if you have torn your rotator cuff in a sudden injury and the tear is causing weakness. But surgery cannot completely reverse problems that occur with degeneration (wear and tear over the years) of the rotator cuff.
  • Whether you choose surgery or nonsurgical treatment, you will need rehabilitation and physical therapy.

What is the rotator cuff?

The rotator cuff is a group of four tendons and their related muscles that stabilize the shoulder joint and enable you to raise and rotate your arm. The shoulder is a ball-and-socket joint with three main bones: the upper arm bone (humerus), the collarbone (clavicle), and the shoulder blade (scapula). These bones are held together by muscles (the supraspinatus, infraspinatus, subscapularis, and teres minor), tendons that attach these muscles to the humerus, ligaments, and the joint capsule. The rotator cuff helps keep the arm bone seated into the socket of the shoulder blade.

What are rotator cuff disorders?

The rotator cuff tendons are a common source of shoulder problems. The tendons and tissues around them can become irritated, damaged, or weak because of normal wear and tear over the years, particularly through overuse and repetition of overhead arm movements. This age-related degenerative process can cause one or more tendons to rub against the bones (impingement). Impingement also can be caused by irregularly shaped shoulder bones.

Rotator cuff disorders include inflammation of the tendons (tendinitis) or the bursa (bursitis), a calcium buildup in the tendons, or partial or complete tears of the tendon. Partial tears are not uncommon when the rotator cuff is already damaged, scarred, or weakened. A complete rotator cuff tear in a person with an otherwise healthy shoulder is most often caused by a forceful injury.

Many people with shoulder problems feel as though their shoulder is weak. If weakness is related to pain, you can probably use your arm and shoulder, but it is uncomfortable. True weakness means that you are unable to use your shoulder normally because of decreased strength, not just because of pain. For example, you may be unable to raise your arm, no matter how hard you try. This kind of weakness may be caused by a tear in one of the shoulder tendons.

Without any treatment-either physical therapy or surgery-rotator cuff disorders may get worse. Over time, you may have more pain and lose range of motion and strength in your shoulder, making it harder to do your daily activities.

When is nonsurgical treatment used to treat rotator cuff disorders?

Shoulder pain has many different causes and can be related to something other than a rotator cuff disorder, such as problems in the upper back and neck. Shoulder pain alone without weakness or limited range of motion is not a reason to have surgery. Early stages of rotator cuff damage are usually reversible with nonsurgical treatment, which includes:

  • Resting, although gentle movement of the shoulder is recommended. Prolonged immobilization (holding the shoulder still), such as with slings or braces, may cause the shoulder joint to become stiff (frozen shoulder).
  • Alternating applications of cold and heat.
  • Taking nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Avoiding positions and activities that hurt your shoulder.

After a period of rest and gentle activity, many people can relieve their pain and restore strength and flexibility in weakened and stiff shoulders by following a physical therapy program. These programs include exercises to:

  • Stretch tight shoulder tissues.
  • Strengthen the muscles that move the shoulder.
  • Allow you to do daily activities without putting excess strain on your shoulder.

Surgery may not be warranted if:

  • Your shoulder problem gets better with physical therapy and exercise.
  • You have torn rotator cuff tendons but are not bothered by pain, weakness, or stiffness.
  • You are able to continue your daily activities.
  • You are not willing or able to complete the physical therapy program required after surgery.
  • You have other health problems that may make surgery too dangerous as compared to the expected gain.

When is physical therapy used to treat rotator cuff disorders?

Physical therapy is sometimes needed before surgery to help determine the cause of your shoulder problem and whether surgery may be appropriate. While strengthening a muscle that is attached to a torn tendon is unlikely to be beneficial, strengthening the surrounding muscles may allow your shoulder to compensate for a rotator cuff tendon tear. If your shoulder gets better with physical therapy, you may not need surgery. If you do have rotator cuff surgery, you will need to commit to and complete a physical therapy program after surgery.

  • If your shoulder joint capsule or tendons are tight, physical therapy can help improve your range of motion and allow your shoulder to move more smoothly.
  • Physical therapy may strengthen the muscles that move your arm and shoulder.
  • Physical therapy helps you learn how to lift and carry objects and do other activities with your unaffected muscle groups. This puts less stress on your irritated rotator cuff tendons.

Most exercise programs can be done easily on your own at home after a health professional or physical therapist has trained you. There is generally no risk to trying physical therapy for several weeks to see if it helps, especially if you have had shoulder problems for some time.

For more information, see:

Rotator cuff problems: Exercises you can do at home (with your health professional's approval).

When is surgery used to treat rotator cuff disorders?

If you are young and your tendon tissue is strong and healthy, surgery may be a good treatment choice. Your doctor may also recommend surgery if there is a good chance that your tear will get worse over time.

There are two types of surgery for rotator cuff disorders:

  • Subacromial smoothing removes scar tissue and damaged tendon, bursa, and debris from the joint (debridement). The surgeon may also remove small amounts of bone from the underside of the acromion and the acromioclavicular joint (acromioplasty). Subacromial smoothing usually is effective in relieving pain.
  • Rotator cuff repair usually starts with debridement. The repair then involves sewing the torn tendon or tendons together, and reattaching them to the arm bone. Rotator cuff repair improves strength and movement.

Surgery may be a good choice for you if both of the following are true:

  • You have severe shoulder weakness.
  • These symptoms have not improved after a period of nonsurgical treatment, including a well-designed physical rehabilitation program.

Sudden tears, such as from a major sports injury or auto accident, often are best treated with early surgery. Very large rotator cuff tears [those larger than 2in.] and tears that affect more than one of the four rotator cuff tendons sometimes cannot be repaired, especially if they are long-standing. But surgery may help relieve pain by removing damaged tissue from the joint (subacromial smoothing).

What are the risks of rotator cuff surgery?

If your rotator cuff tendons are very weak and frayed, surgical repair will not be as effective in holding the tendon together.

Even after surgery, you may be advised to avoid lifting heavy objects, doing overhead work, and returning to sports or activities that require over-the-head movement of the arm or throwing movements.

Shoulder surgery may relieve some pain and weakness and make it easier to move your shoulder, but it may not restore full strength to your shoulder, especially if you have a severe tear in the tendons or if your tendons are weak.

You may continue to have pain, which may require more physical therapy or, sometimes, more surgery to relieve it.

Surgery poses risks of infection, persistent pain, slow healing followed by stiffness, and a potential need for more surgery. In addition, all surgeries pose some risks, such as irregular heart rhythms (arrhythmias), changes in blood pressure, and heart attack.

Surgery will not be a substitute for physical therapy. In fact, a good physical therapy program is necessary for a full recovery after surgery.

For more information, see the topic Rotator Cuff Disorders.

Your choices are:

  • Try nonsurgical treatment, including physical therapy.
  • Have surgery followed by physical therapy.

The decision about whether to have rotator cuff surgery takes into account your personal feelings and the medical facts.

Deciding about rotator cuff surgery
Reasons to have rotator cuff surgery Reasons not to have rotator cuff surgery
  • You experienced immediate pain, felt a tearing sensation, and/or heard a popping sound in your shoulder during an activity or accident.
  • You have severe shoulder weakness.
  • Your symptoms have not improved after a period of nonsurgical treatment, even though you participated fully in a well-designed physical rehabilitation program.

Are there other reasons you might want to have rotator cuff surgery?

  • Your shoulder problem gets better with physical therapy and exercise.
  • You have torn a rotator cuff tendon but are not bothered by symptoms such as pain, weakness, or stiffness.
  • You are not willing or able to complete the physical therapy program required after surgery.

Are there other reasons you might not want to have rotator cuff surgery?

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about rotator cuff surgery. Discuss the worksheet with your health professional.

Circle the answer that best applies to you.

I can't seem to raise my arm very high, and sometimes I'm in pain, especially when I'm trying to sleep. Yes No Unsure
My doctor tells me I have a tear in my rotator cuff, but it doesn't seem to be bothering me. Yes No NA*
I have off-and-on pain in my shoulder, but I'm not sure surgery will fix that. Yes No Unsure
For a month now, I've been doing daily exercises followed by icing my shoulder, and I think it's helping. Yes No NA
I felt something tear while I was playing a game last week, and now I can hardly lift my arm. Yes No NA
I don't feel up to committing to a lengthy physical therapy program. Yes No Unsure
I've been noticing weakness in my arm for a few years now, but I don't think it is getting worse. Yes No NA
When I move my arm a certain way, it hurts a lot, and physical therapy isn't helping that much. Yes No Unsure
I've been taking NSAIDs and icing or heating my shoulder regularly, and the pain seems to be under control. Yes No Unsure
My shoulder has been stiff and sore for some time, but I retired last year and I don't think I'll need to do any repetitious arm movements now. Yes No NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

 

 

 

 

 

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have rotator cuff surgery.

Check the box below that represents your overall impression about your decision.

Leaning toward having rotator cuff surgery

 

Leaning toward NOT having rotator cuff surgery

         

Other Works Consulted

  • Devinney DS, et al. (2005). Surgery of shoulder arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp. 995–1015. Philadelphia: Lippincott Williams and Wilkins.

  • Husni EM, Donohue JP (2005). Painful shoulder and reflex sympathetic dystrophy syndrome. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 2, pp. 2133–2151. Philadelphia: Lippincott Williams and Wilkins.

  • Krishnan SG, Hawkins RJ (2003). Rotator cuff and impingement lesions in adult and adolescent athletes. In JC DeLee, D Drez Jr., eds., DeLee and Drez's Orthopaedic Sports Medicine, Principles and Practice, 2nd ed., vol. 1, pp. 1065–1095. Philadelphia: W.B. Saunders.

  • Speed C, Hazleman B (2005). Shoulder pain. Clinical Evidence (13):1555–1571.

Author Amy Fackler, MA
Editor Renée Spengler, RN, BSN
Associate Editor Lila Havens
Primary Medical Reviewer William M. Green, MD - Emergency Medicine
Specialist Medical Reviewer Kevin L. Smith, MD - Orthopedic Surgery
Last Updated January 7, 2010

WebMD Medical Reference from Healthwise

Last Updated: January 07, 2010
This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

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