Rotator cuff injury: conservative management or surgery?

As a physical therapist in beautiful Bellingham, Washington, we are blessed to be surrounded with lakes and mountains that make it an outdoor paradise.  Since so many Bellingham residents are physically active, I also see my share of clients with shoulder pain and injuries, including rotator cuff injuries, shoulder bursitis, arm pain, frozen shoulder,  and shoulder tendinitis.

A question that arises frequently is whether or not a torn rotator cuff should be surgically repaired.  Many factors will play into the ultimate decision: age of the patient, overall health status, partial or full rotator cuff tear, time needed for rehabilitation.

Let’s look closer at some of these variables: 

Age of the patient: As we age, the common tendency of the rotator cuff is to become weak, stretched, hypovascular (poor blood supply) and possibly torn already as a result of fraying over the years.  Many surgeons have told me the rotator cuff in the elderly looks similar to tissue paper, making a surgical repair not possible.  In many of my elderly patients, conservative management is the only choice.

Overall health:  In patients with compromised cardiac function, surgery may not be a viable reason for additional health reasons. 

Partial or full thickness tears:  As the name implies, a partial tear indicates that the muscle is not torn all the way through and conservative rehab may be a stronger choice.  A full tear of the muscle leaves no chance of spontaneous reattachment without surgical intervention.  If you do have a full  thickness tear and choose not to have it repaired, then expect to have residual strength deficiencies . The residual arm weakness may not be an issue for your particular lifestyle or you may learn to live with it.

Time needed for rehabilitation:  Many patients do not realize that you will probably be in a sling for 4-6 weeks after surgery and will not be allowed to use your arm except for passive range of motion exercises.  For many clients that have other obligations (child care, work duties, etc) this may not be an option and they may try a more conservative approach (assuming no full thickness tear of the rotator cuff)

Many factors must be considered when surgery is an option.  The more information you have, the greater capacity for making a sound decision.  Good luck!

Ed Deboo, Physical Therapist

Bellingham, Washington