Is Surgery Needed to Treat a Rotator Cuff Tear?

Is rotator cuff surgery always necessary to treat a tear? The quick answer is no. One must distinguish a full-thickness tear from a partial-thickness tear before arriving at a more accurate decision. Full-thickness tears typically result in a patient unable to lift his/her arm and is associated with significant weakness during muscle testing; partial-thickness tears, on the other hand, vary in their presentation and may require an MRI study (see below).

Clinical evaluation is necessary in ruling in or ruling out a tear and more importantly, as to whether or not surgery is absolutely indicated. A thorough review of the patient's history is necessary to begin shedding some light on the prognosis. The examination performed by a physician (usually, orthopedist or sports medicine) or physical therapist provides valuable information about the patient's movement restrictions and limitations via range of motion testing, special clinical tests, and muscle/joint testing.

Is an MRI necessary? In some cases, yes. Partial-thickness tears, determined by clinical examination, may warrant the need for an MRI study, especially if the patient's signs and symptoms do not improve after a few weeks of physical therapy. Again, a good clinical examination will usually reveal the severity of a tear based on the functional limitations and impairments noted. If I see a patient for a diagnosis of "rotator cuff tear", and the patient is able to perform movements and tests without restriction, I usually tell the patient to rehab (or "prehab") the shoulder, and if the symptoms don't dramatically improve in 2-3 weeks, then I'll go ahead and refer the patient to the appropriate physician for further testing.

Can a rotator cuff tear "heal" on its own? Again, it depends on the size the tear. Full-thickness tears will not heal on their own. Partial thickness tears may scar down with time.
Gender, age, activity level, lifestyle, occupation, and diet are all factors that can influence general tissue healing and post-surgery recovery.

Winterizing your shoulder: preparing your shoulder for the spring season

So, you're an athlete who specializes in playing overhead sports (baseball, tennis, lax, softball, etc) and you've finished fall ball, itching for the spring season to come sooner than later. How exactly do you keep your shoulder safe and sound?

Work on Your Posture! Huh? What does posture have anything to with the shoulder? It has EVERYTHING to do with keeping your shoulders working at its best. Practicing good posture while incorporating seated rows, bent over rows, and scap retraction exercises may be helpful in keeping the coast clear of potential shoulder injuries.

Back to Basics- You may THINK you know everything there is to pitching, serving, shooting, and throwing a ball, but now is a GREAT time to get some seasoned eyes on your form and technique to make sure you're recruiting the right muscles for your sport's demands.

The Rotator Cuff: To Strengthen or Not To Strengthen? I see many overhead athletes using preventative shoulder injury exercises emphasizing rotator cuff strengthening. Great. I like seeing more and more people utilizing these exercises in the gym setting as well. However, if you have a shoulder injury, strengthening the rotator cuff muscles may not be the best thing and, in fact, may worsen your shoulder pain. Conversely, incorporating rotator cuff strengthening exercises may be a great way to keep your muscles ready for the upcoming season.

If you have pain during overhead activities, you should first seek medical attention before attempting to do these types of exercises.

Dynamic Trunk Stabilization: What's that? In layman's terms, working "the core" muscles. However, physical therapists and other healthcare and wellness professionals try to refrain from using the term, "core strengthening", because it has been erroneously equated to exercises used to develop the six-pack (or, rectus abdominus), which is far from the truth.

We're talking about getting the deep transverse abdominus muscles (which aren't visible) to work synchronously with the hip/pelvis muscles to provide a dynamically stable base of support, hence, dynamic trunk stabilization.

A dynamically stabilized trunk provides better power and improved stamina to your shoulder muscles during repetitive, overhead activities; in essence, you're creating a powerful "slingshot" effect by having your shoulders launch an object from a stabilized platform (deep abdominal muscles, hips, and pelvis). If you compare the relative size of your shoulder muscles to that of your hips, abdominals, and pelvis, you can appreciate why dynamic trunk stabilization is important in protecting your shoulders for the long haul.

That all said, exercising the right muscles, the right way, will help you keep your shoulder well- prepared for the spring onslaught!!

If you want more specific advice about your shoulder and exercises to help prevent shoulder injury, please contact Dr. Yoo at mavenoffice@gmail.com.

Dr. Jerry Yoo
Clinical Director/Co-Owner of Maven Sports Medicine