Rotator Cuff Problems: Should I Have Surgery?

The rotator cuff is a group of four tendons and muscles in the shoulder. The rotator cuff keeps your shoulder stable and allows you to raise and twist your arm.

The shoulder is a 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, tendons, and ligaments. The rotator cuff helps keep the arm bone in the socket of the shoulder blade.

The rotator cuff tendons are a common source of shoulder problems. Over time, normal wear and tear can damage or weaken the tendons. That's even more true if the tendons are overused or if you do repeated overhead arm movements. This age-related wear and tear can cause one or more tendons to rub against the bones. This rubbing is called impingement. It also can be caused by irregularly shaped shoulder bones.

Rotator cuff disorders include:

• Inflammation of the tendons (tendinitis) or the bursa (bursitis).
• Calcium buildup in the tendons.
• Partial or complete tears of the rotator cuff tendons . Partial tears are common when the rotator cuff is already damaged or weakened. A complete rotator cuff tear in someone with an otherwise healthy shoulder is often caused by a forceful injury, such as during sports or a car accident.

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

There are two types of surgery for rotator cuff disorders. They help improve strength and movement, and they also relieve pain.

• Subacromial smoothing. This removes scar tissue; irregularly shaped bone; and damaged tendon, bursa, and debris from the joint (debridement).
• Rotator cuff repair. This usually starts with debridement. The repair then involves sewing the torn tendon or tendons together and reattaching them to the arm bone.

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

• Shoulder pain or weakness limits your ability to do your daily activities, to be active, and to sleep well.
• 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 car accident, often are best treated with early surgery. Some kinds of tears (such as very large tears) can't be fixed, especially if you have had them for a long time. But surgery can help relieve pain by removing damaged tissue from the joint.

If your rotator cuff tendons are very weak and frayed, surgery won't work well in holding the tendon together.

After surgery, you may need to:

• Avoid lifting heavy objects.
• Avoid doing overhead work.
• Avoid sports or activities that require throwing or over-the-head movement of your arm.

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. This is even more true if you have a severe tear in the tendons or if your tendons are weak.

You may still have pain. You may need more physical therapy or even another surgery to relieve it.

Surgery poses risks of infection, pain that won't go away, and slow healing followed by stiffness. Also, all surgeries pose some risks, such as irregular heart rhythms (arrhythmias), changes in blood pressure, and heart attack.

Surgery isn't a substitute for physical therapy. You need to complete a physical therapy program to have a full recovery after surgery.

Other things besides rotator cuff problems-such as problems in the upper back-can cause shoulder pain. Shoulder pain alone without weakness or limited movement isn't a reason to have surgery.

You may be able to reverse the early stages of rotator cuff damage without surgery, by:

• Resting, although gentle movement of the shoulder is advised. Holding your shoulder still for long periods, such as with slings or braces, may cause shoulder stiffness or even a frozen shoulder.
• Using ice packs, followed by moist heat on the shoulder.
• Taking anti-inflammatory medicines. Be safe with medicines. Read and follow all instructions on the label.
• Avoiding positions and activities that hurt your shoulder.

After you try rest and gentle movement, physical therapy may help relieve your pain and restore strength and flexibility in weak and stiff shoulders. Physical therapy includes exercises to:

• Stretch tight shoulders.
• Strengthen the muscles that move the shoulder.
• Help you do daily activities without putting too much strain on your shoulder.

You may not need surgery if:

• Your shoulder gets better with physical therapy.
• You have a torn rotator cuff but you are not in pain.
• You can do your daily activities.
• You don't want to do the physical therapy program required after surgery.
• You have other health problems that may make surgery too dangerous.

Physical therapy is sometimes used to find out the cause of a shoulder problem and to see if surgery will help. Exercises can help strengthen the muscles around a torn tendon and make up for the weakness there. If your shoulder gets better with physical therapy, you may not need surgery. Whether you choose surgery or not, you will need rehabilitation and physical therapy.

• 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 using the muscle groups that aren't hurt. This puts less stress on your injured rotator cuff tendons.

Most exercise programs can be done easily on your own at home after you've learned how to do them. In most cases, you can try these exercises for several weeks to see if they help, especially if you have had shoulder problems for some time.

Your doctor may recommend rotator cuff surgery if:

• You are young and your tendon tissue is strong and healthy.
• There is a good chance that your tear will get worse over time.
• You had a forceful injury to your shoulder, such as during an activity or car accident.
• You have severe shoulder pain or weakness.
• You have not gotten better after 3 to 6 months of other treatment and physical therapy.