People assume that a full-thickness rotator cuff always needs to be repaired surgically. How else could it possibly heal the injury they say?
You should not have rotator cuff surgery if you have close to full range motion and close to normal strength.
If you have full strength, range of motion, and pain, this does not mean that you are a good candidate for surgery.
In the rest of this article, I will expand on this a bit and share with you a story about a patient that I’ve been working with who had a left RTC surgery done.
Why should you not have RTC surgery?
I have a patient who recently had their left shoulder, done. He had a full-thickness supraspinatus tear and the surgeon recommended that he get it repaired as it would ‘only get worse,’ if he didn’t get it taken care of (we’ll discuss why this isn’t true, later).
So, he gets the surgery done, and on the first session, he comes in and shares with me that they MRI’d his right shoulder and that one also has a full-thickness tear that will require repair.
I asked him if he could lift his arm up on his right side and he proceeded to lift it through all range of motion, relatively pain-free, with full strength and full range.
I was shocked and astonished that the recommendation had been to perform surgery on this perfectly fine, functioning shoulder.
I want to reiterate this; you should NOT have RTC (rotator cuff) surgery if you have full range of motion and strength, UNLESS, you’ve gone through 6 months of conservative management (exercise, physical therapy, etc), and the pain is now unbearable.
If it were me, knowing the data, I would wait an entire year, working on different exercises before I decided to go get the procedure done, assuming it wasn’t completely debilitating.
Will surgery make all the pain go away?
You might assume that if they go and do surgery that this will just ‘cut’ all the pain away.
This is, unfortunately, not reality.
You will likely have pain after surgery, as is normal with surgical procedures, and then depending on you, you could still have discomfort after your rehabilitation is complete.
This is really hard to predict as everyone responds differently to surgery and then subsequent treatment.
I caution anyone who is getting surgery for pain to think again and consider alternatives, as oftentimes they end up just as frustrated after the surgery as before.
Again, this is not all the time. If you have weakness, pain, reduced function and range of motion, then you’ll likely have a great recovery from surgery as it’s likely indicated. This is the case with many different common conditions.
Can surgery help with severe weakness and range of motion loss?
As discussed above, surgery can help with severe weakness and range of motion loss. Initially, after surgery, your shoulder will be very stiff and sore.
This will gradually loosen up over the course of 3 months and ideally, you have regained a full range of motion in all directions between 3-6 months. Sometimes this can take longer but that’s the general time frame that I see with clients.
What does the research say about rotator cuff surgery outcomes?
Boorman Et al. (2018) demonstrated that after five years, patients with full-thickness rotator cuff tears who received surgery or did not receive surgery had the same outcome and return to function.
One conclusion to make is that it doesn’t matter if you get the surgery done or not, however I would argue that on an individual basis it does matter.
If you are lacking significant strength and range of motion, you’ve gone through 6 months of physical therapy and are no better, then you are likely going to benefit from the surgery.
On the flip side, if you are full range of motion and strength, and it’s mainly painful, and you haven’t done any therapy and then you get the surgery done, well, you’ll likely have the same outcome regardless.
It’s a tricky discussion of who should have a procedure done vs. who should not as there is so much individual variability.
Is it okay to not get it repaired?
It is okay to not get it repaired. If you have full range of motion, strength, and pain is managed and under control, there is no reason to get the surgery.
If it doesn’t get repaired are you at future risk of worsening symptoms?
Symptoms are not at risk of worsening if you don’t get it repaired.
This is a common question that I’m asked.
You might assume that if there is a tear, how could it possibly heal or not be at risk of getting worse if you don’t surgically reattach it?
As I’ve discussed before in another article about rotator cuff surgery, damage does not always mean there will be pain. Our body is highly adaptable.
- If you have full range of motion, minimal strength loss, and tolerable pain, you should not get the surgery
- If you’ve gone through physical therapy and you still have significant range of motion loss, strength loss, and intolerable pain, then getting the surgery is reasonable and will likely help.