If you’ve been told you have a rotator cuff tear, one of the first questions you might ask is: “Do I need surgery?”
Not necessarily.
Many rotator cuff tears, particularly degenerative tears that develop gradually over time, can respond well to physiotherapy and a structured strengthening program without surgery. Surgery may be considered in some situations, such as after a significant traumatic tear, in younger or highly active people, or when a genuine trial of rehabilitation hasn’t improved symptoms.
The decision isn’t based on the scan alone. Your symptoms, strength, shoulder function, the type of tear and what you need your shoulder to do all matter.
What is the rotator cuff?
The rotator cuff is a group of four muscles and tendons that help control and stabilise your shoulder while you move your arm.
A tear can happen in different ways. Sometimes it follows an injury, such as a fall, heavy lift or sudden jolt. Other tears develop gradually as part of age-related or degenerative changes, sometimes without any obvious injury.
Rotator cuff tears are also found in people who have no shoulder pain. So, seeing a tear on an MRI or ultrasound doesn’t automatically mean that the tear is the source of your pain or that you need surgery.
Not all rotator cuff tears are the same
A small partial-thickness tear is quite different from a large full-thickness tear.
The location of the tear, which tendon is involved and how much it affects your shoulder strength and function all help guide the decision about treatment.
This is why we look beyond the scan. Two people can have similar-looking tears but very different symptoms and levels of shoulder function.
Does a bigger tear mean more pain?
Not necessarily.
A relatively small tear can be very painful, while someone with a larger tear may have surprisingly little discomfort. Pain isn’t determined by the size of the tear alone. Irritation of surrounding tissues and how sensitive the nervous system has become can also influence how much pain you experience.
So while your scan can provide useful information, we also want to know what your shoulder can actually do.
Can you lift your arm? How strong is it? Which movements are painful? Are you struggling with work, sport, lifting or sleeping?
Those findings are often just as important when deciding what to do next.
Can physiotherapy help a rotator cuff tear?
For many degenerative rotator cuff tears, physiotherapy is a reasonable first step.
A structured program can work on gradually improving shoulder strength and function, while managing activities that are currently aggravating your symptoms. This may involve progressively loading the rotator cuff and strengthening the other muscles around the shoulder so they can share the workload.
The program should be based on what your shoulder can currently tolerate rather than simply giving you a list of exercises.
For some people, we might start with relatively simple strengthening and gradually increase the resistance and demands as their symptoms and strength improve.
When is surgery considered?
Surgery may be considered in situations such as:
- A significant traumatic tear accompanied by sudden, marked weakness
- A large or worsening tear that is affecting daily function
- Symptoms that haven’t improved despite a genuine trial of physiotherapy over several months
- A younger, highly active person with high physical demands on the shoulder
That doesn’t mean everyone in these categories automatically needs an operation. The decision still depends on the individual presentation and their goals.
For example, the best option for a physically active tradesperson in their 30s may be very different from the best option for someone who mainly wants to garden and swim comfortably.
So, what should you do?
If you’ve been diagnosed with a rotator cuff tear, the first step is to have the shoulder properly assessed.
We’ll usually look at your:
- Shoulder range of motion
- Strength
- Pain with different movements
- Ability to perform your normal activities
- Specific tasks that are currently limited
From there, physiotherapy will often involve progressive strengthening, load management and a gradual return to the activities you want or need to do.
It’s also useful to track your progress rather than judging recovery purely by how the shoulder feels on a particular day. Changes in strength, range of motion and function can give you a clearer picture of whether rehabilitation is working.
When should you get your shoulder assessed?
It’s worth getting assessed if you have:
- Sudden, significant weakness or you’re unable to lift your arm after an injury
- A traumatic injury followed by immediate pain and loss of function
- Shoulder pain that isn’t settling after a few weeks
- Night pain that is regularly disrupting your sleep
- Ongoing weakness despite exercising
- A feeling that your shoulder is unstable or giving way
A particularly important finding is sudden loss of strength following an injury. That warrants assessment rather than simply waiting for it to settle.
What can you do in the meantime?
You generally don’t need to completely stop using your shoulder.
Instead, try to modify activities that clearly aggravate your symptoms rather than avoiding movement altogether. Heavy overhead lifting may need to be reduced until you’ve had the shoulder assessed.
Ice or pharmacist-advised pain relief may also help manage symptoms if appropriate.
If you’ve already had an MRI or ultrasound, bring the results with you. The scan can be useful, but we’ll interpret it alongside your symptoms, strength and shoulder function.
Get clarity on your shoulder
Finding out that you have a rotator cuff tear can sound concerning, but the scan doesn’t tell the whole story.
A proper assessment can help work out how much the tear is actually affecting your shoulder, what you can reasonably expect from rehabilitation, and whether a surgical opinion is worth considering.
At PhyxYou Physiotherapy in Port Macquarie, we’ll assess your shoulder, explain what the findings mean and help you work out the most appropriate next step, whether that’s physiotherapy or a surgical opinion.
Book a shoulder assessment with PhyxYou Physiotherapy today.
