Rotator Cuff: Surgery or Physical Therapy?

Rotator Cuff: Surgery or Physical Therapy?

The rotator cuff is a group of muscles and tendons that surround the shoulder and hold the arm in place. Damage to the rotator cuff is a common source of shoulder pain. When it comes to fixing that pain, both physical therapy (PT) and surgery plus PT have been known to restore function and comfort to the shoulder. How do we know which approach is right for us?

Recently, Ian Lo of the University of Calgary led a study to answer this question. His team followed 76 patients with un-complicated, partial thickness rotator cuff tears. All patients received PT and treatments from their doctors. The researchers categorized PT as a success if patients did not go to surgery for the 4.4-year observation period.

The biggest predictor of PT success was whether the tear was traumatic or atraumatic. Chronic pains that came on slowly without any unusual reason for injury had an 84% success rate with PT. Compare that to the 16% success rate when the tear was from a single, obvious traumatic injury. While PT proved successful with general rotator cuff tears, most of that success came from atraumatic tears.

Does this mean we can opt out of therapeutic exercise if we have a traumatic shoulder injury? No. Physical therapy is still needed after the surgery. Regardless of which treatment option is selected – physical therapy only or surgery plus PT – early treatment can help speed the healing process.

Specific exercises, under the supervision of a physical therapist, can strengthen the shoulder and the surrounding muscles gradually regaining shoulder function. In the event surgery is still required, the time spent in PT positively impacts the postsurgical outcomes.

Source: Lo IK, Denkers MR, More KD, Nelson AA, Thornton GM, Boorman RS. Partial-thickness rotator cuff tears: clinical and imaging outcomes and prognostic factors of successful nonoperative treatment. Open Access Journal of Sports Med. 2018; 9: 191. doi:10.2147/OAJSM.S153236

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