Internist Questions Rotator Cuff Injuries

Rotator cuff tear

I have a tear in my left rotator cuff. Why is my doctor sending me to PT rather than just fixing it?

16 Answers

Follow your doctor recommendation if after PT no improvement you might see an orthopedic doctor
PT works well in many patients and is safer than operating, this was good advice
Good question. Unless you have a complete and disabling tear, PT is always the best option. It is far better to strengthen the rotator cuff muscles and tendons and other supporting muscles, than to undergo surgery. In many cases, PT is all that a patient needs and they recover completely. Surgery, remember, carries risks, such as a bleeding, infection, poor healing, worse pain, having to undergo additional surgery, anesthetic complications, and even death. Afterwards, there is a 8-12 week recovery time, including 2 or more weeks in a sling, and progressive PT. Avoiding surgery, whenever possible, is always your best option.
Attempting conservative PT first is a much better option than surgical intervention. It's all relative to the extent of the tear, but many times, you can recover from a rotator cuff tear with a few months of therapy. If PT works, saved yourself many months of pain and rehab, which is what you can usually expect after having surgery. Also, you saved your insurance company tens of thousands of dollars.

If PT doesn't work initially, then you just spent 4-8 weeks strengthening your shoulder, preparing it for recovery. If you went into surgery weak and flabby, you'd have a much tougher time recovering properly.
Having not seen the imaging it’s difficult to be sure but unless there is a complete tear of the rotator cuff the standard of care is physical therapy.
There is nothing to fix if it is a minor tear. The muscle regenerates itself. Only bigger tears are repaired. Then it also depends on your insurance how they authorize etc.
In unusual circumstances, you want surgery before physical therapy. Often, in a period of 6 weeks, or thereabouts, rotator cuff injuries can be vastly better with therapy and no surgery. Most of the time, if it really requires surgery, you can figure it'll be about 6 months or more before you're back to normal.
There are a lot of factors that are used to determine the best course of treatment for a torn rotator cuff. The rotator cuff is actually a complex of the tendons of four different muscles, so it's not clear from your question exactly which tendon is torn. And it's also important to know whether the tendon is partly or completely torn. A partially torn tendon might do just fine with rehabilitation. We also consider goals of the patient: the plans for a high-performing athlete will be different than a retired businessperson. Another factor to consider is your overall health and wellbeing. Rotator cuff surgery is not easy and the recovery is difficult; are you ready and able? If we can get back to full function and pain free with just rehab, then why not give that a try?
Many rotator cuff tears can be managed nonoperatively by preserving the strength and range of motion while allowing the torn fibers to heal. Surgery for this should be reserved for those who do not achieve symptom relief after working with a good physical therapist.
It depends on the MRI findings. If there is a full thickness tear, you will need surgery. If there is partial rotator cuff tear, it can be fixed with physical therapy.
Most rotator cuff tears get better with PT and don't need surgery, they can usually tell in a few sessions if it will improve or not.
Physical therapy will strengthen the muscles surrounding the shoulder joint which in the end, will improve overall joint mobility. Moreover, the techniques used in physical therapy including massage, heat and iontopheresis, will decrease the inflammation around the torn tendons, which ultimately reduce the pain you may be experiencing.
Also, the size of the tear dictates whether surgical intervention is required promptly or not. There are patients that can recover from a rotator cuff tear with PT and anti- inflammatory medications alone. Repair is inevitable if the tear is large enough.
Many times, rotator cuff tears can be managed and treated without needing surgery. Strengthening the remaining rotator cuff muscles and the other surrounding musculature can often help individuals function normally.
many studies show that PT can heal the tear without requiring the use of surgery; please undergo evaluation by a board certified orthopedist to help determine a course of action
Surgery is the main treatment for rotator cuff tears, non-surgical rotator cuff treatments may include physical therapy, anti-inflammatory medications, and steroiod injections. The purpose of this treatment is to reduce inflammation and strengthen the uninjured muscles around the shoulder to compensate for the torn muscles.

Sayyed Farhan Ali Jaffri

Rotator cuff tear is a common shoulder injury.

The initial treatment may be conservative. I.e. Use of ice , anti
inflammatory medications and home exercise plan ( to avoid frozen shoulder )

Physical therapy is very useful in improving range of motion and restoring
strength to the injured shoulder.

Steroid injection provides additional benefit.

If all conservative measures fail to

Improve the condition , surgery may be considered.

The degree and the severity of the shoulder damage is a good indicator to
determine whether to consider conservative or aggressive measures ( ie
surgery )

Your Doctor will be able to evaluate and determine the best treatment
approach to your shoulder condition.

Please directly communicate with your physician and express your concerns
and questions clearly.

I hope the above information was helpful.

Hessam Noralahi M.D