Rotator Cuff Problems: Should I Have Surgery?
You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Rotator Cuff Problems: Should I Have Surgery?
Get the facts
- Have surgery, followed by physical therapy.
- Try other treatment, including physical therapy.
Key points to remember
- You may be able to stop or reverse early rotator cuff damage without surgery. Try using rest, ice and heat, anti-inflammatory medicines, and physical therapy. If you have symptoms that don't get better after 3 to 6 months, you may need surgery.
- You may want to think about surgery if you have torn your rotator cuff in a sudden injury and the tear is causing shoulder weakness. But surgery can't fully reverse problems that occur over time with wear and tear of the rotator cuff.
- Whether you choose surgery or other treatment, you will need rehabilitation and physical therapy.
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.
Many people with shoulder problems feel shoulder weakness and pain. You may be able to use your shoulder, but it hurts. When you have severe shoulder weakness, you can't raise your arm, no matter how hard you try. This kind of weakness may be caused by a tear in one of the shoulder tendons.
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:
- Subacromial smoothing. This removes scar tissue; irregularly shaped bone; and damaged tendon, bursa, and debris from the joint (debridement). It usually works well to relieve pain.
- 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. Rotator cuff repair improves strength and movement.
Surgery may be a good choice for you if both of the following are true:
- You have severe shoulder weakness.
- 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.
- 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 weakness.
- You have not gotten better after 3 to 6 months of other treatment and physical therapy.
Compare your options
What is usually involved?
What are the benefits?
What are the risks and side effects?
- You are asleep or numb during surgery.
- If you have subacromial smoothing or rotator cuff repair using arthroscopy, you may go home the same day as surgery.
- If you have rotator cuff repair using open surgery, you may stay in the hospital for several days. Your arm will be in a sling for several weeks.
- With either type of surgery, you will start with range-of-motion exercises to loosen up your shoulder. Then you'll continue physical therapy for up to 8 weeks.
- You get relief from your pain.
- You have improved shoulder strength and movement.
- Surgery may not restore full strength to your shoulder.
- You may need more physical therapy or another surgery.
- Other risks of rotator cuff surgery include:
- Pain or stiffness that won't go away.
- Nerve damage.
- All surgery has risks, including the risks of bleeding and infection and risks related to anesthesia. Your age and your health can also affect your risk.
- You rest your shoulder. Gentle movement is recommended so your shoulder doesn't get stiff.
- You try ice packs to reduce pain and swelling.
- You try using moist heat during gentle shoulder movement.
- You take anti-inflammatory medicines to relieve pain.
- You try physical therapy to help you learn how to lift and carry objects.
- You avoid the cost and risks of surgery.
- You avoid having surgery that you don't need if rest and physical therapy improve the use of your shoulder.
- You can have surgery later if other treatment doesn't work.
- If you have severe shoulder weakness, rest and physical therapy alone may not help.
- Without any treatment, rotator cuff disorders may get worse. Over time you may have more pain and may lose range of motion and strength in your shoulder.
Personal stories about having rotator cuff surgery
These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.
I recently started swimming, and I think the overhead movements have aggravated my shoulder and caused some tendinitis. I have a lot of pain at night, especially if I roll onto my side. I've talked to a couple of people who have had shoulder surgery, and I really hope that I don't need to. My doctor recommended that I try to rehabilitate the shoulder over the next few weeks. I'm resting it quite a bit, taking anti-inflammatory medicines, and using ice and heat to ease the pain. It seems to be working. Soon, I'll start some exercises my doctor showed me to strengthen my shoulders so that swimming doesn't hurt them.
Patty, age 27
My shoulder has been bothering me for over a year now. The pain sometimes wakes me up at night, especially if I roll onto that side. It's also hard for me to lift things with that arm, even dishes or groceries. I've had some tests that showed a tear in one of my rotator cuff tendons. My shoulder moves better after physical therapy, but it is still weak. My doctor is reasonably sure I will have more range of movement and less pain with arthroscopic surgery, as long as I am committed to doing all I can to prevent more problems and to following through with physical therapy. I think I can manage a long-term rehab program.
Jennifer, age 47
I've had shoulder pain for quite a while now, but it got worse a few weeks ago. After resting my shoulder for a few days, I saw my doctor. He said that I had a chronic tear of my rotator cuff, judging from the symptoms I had and the ultrasound exam. He suggested that the best first step would be a good, aggressive physical therapy program, which will also help us understand better just what the problem is. At my age, surgery takes a bit more out of me than when I was younger, so it seems worth a try to see if I can avoid it.
Dan, age 67
Every time I move my shoulder a certain way, it's really painful. My range of motion has gotten better with physical therapy, but it still hurts a lot when I move it overhead. My doctor believes that the tendons are getting pinched in one area and that surgery may help relieve the pinching and pain. I know I'm going to be doing physical therapy for a long time still. But we agree that the surgery is reasonable to help that specific problem.
Kwame, age 49
What matters most to you?
Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.
Reasons to have rotator cuff surgery
Reasons not to have rotator cuff surgery
I think surgery and physical therapy will help me regain the use of my shoulder faster.
I don't mind waiting longer while I try rest and physical therapy to heal my shoulder.
The cost of surgery doesn't bother me.
I'm worried about the costs of surgery.
I can't do my daily activities because of my rotator cuff problems.
I'm still able to do most of my daily activities even with my rotator cuff problems.
The benefits of surgery outweigh the risks for me.
I don't want to have surgery for any reason.
My other important reasons:
My other important reasons:
Where are you leaning now?
Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.
Leaning toward NOT having surgery
What else do you need to make your decision?
Check the facts
If you have torn your rotator cuff in a sudden injury that is causing weakness in your shoulder, should you think about surgery?
- YesYou're right. Surgery may be a good idea if you tore your rotator cuff in a sudden injury and the tear is making your shoulder weak. But surgery can't fully reverse problems that occur over time with wear and tear of the rotator cuff.
- NoSorry, that's wrong. Surgery may be a good idea if you tore your rotator cuff in a sudden injury and the tear is making your shoulder weak. But surgery can't fully reverse problems that occur over time from wear and tear.
- I'm not sureIt may help to go back and read "Why might your doctor recommend rotator cuff surgery?" Surgery may be a good idea if you tore your rotator cuff in a sudden injury. But it can't fully reverse shoulder problems that occur over time.
Can you limit rotator cuff damage by trying to treat it on your own?
- YesYou're right. You may be able to limit early rotator cuff damage with rest, ice and heat, medicines to relieve pain and swelling, and physical therapy.
- NoSorry, that's not right. You may be able to limit early rotator cuff damage with rest, ice and heat, medicines to relieve pain and swelling, and physical therapy.
- I'm not sureIt may help to go back and read "What are other treatments for rotator cuff disorders?" You may be able to limit early rotator cuff damage with rest, ice and heat, medicines to relieve pain and swelling, and physical therapy.
Is surgery a good choice if you still have symptoms after 6 months of rest and physical therapy?
- YesYou're right. If you have symptoms that don't get better after 6 months of rest and physical therapy, you may need surgery.
- NoSorry, that's not right. If you have symptoms that don't get better after 6 months of rest and physical therapy, you may need surgery.
- I'm not sureIt may help to go back and read "Why might your doctor recommend rotator cuff surgery?" If you have symptoms that don't get better after 6 months of rest and physical therapy, you may need surgery.
Decide what's next
Do you understand the options available to you?
Are you clear about which benefits and side effects matter most to you?
Do you have enough support and advice from others to make a choice?
How sure do you feel right now about your decision?
Use the following space to list questions, concerns, and next steps.
Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.
|Primary Medical Reviewer||William H. Blahd, Jr., MD, FACEP - Emergency Medicine|
|Specialist Medical Reviewer||Timothy Bhattacharyya, MD|
Last Updated:August 7, 2012