Do I need surgery for my torn rotator cuff?
Surgery or physical therapy? If you have a rotator cuff tear, you have probably asked this question and may have had trouble finding an answer. The good news is you are not alone. Although both of these treatments have been around for decades, healthcare providers still debate about which one results in better outcomes. Much of this debate stems from the lack of high-quality long-term research available on this topic. However, you need not despair! Below, we will explore the available evidence related to this question to help guide you on your path to recovery.
Traumatic/non-traumatic rotator cuff tears and how to treat them
It turns out that not all rotator cuff tears are the same. They vary in size, what causes them and the symptoms they produce. All these factors make it helpful to divide rotator cuff tears into different categories so we may better understand which interventions are most appropriate for each situation. Specifically, we will compare treatment strategies between traumatic and non-traumatic tears. A traumatic tear typically occurs as a result of an injury (e.g., fall) and causes immediate shoulder pain and weakness. In this situation, prompt surgical repair is usually considered the best intervention. On the other hand, a non-traumatic tear results from gradual degeneration of the rotator cuff tendons over time4. In this situation, the most appropriate intervention is not as clear.
Regarding non-traumatic tears, the research shows that physical therapy can be an effective treatment strategy. In fact, one large-scale study showed ~75% of individuals with rotator cuff tears who underwent physical therapy chose not to receive rotator cuff surgery 2 years later. On average, the individuals in this study demonstrated significant improvements in their shoulder symptoms and function by the end of physical therapy. However, this study failed to directly compare surgery to physical therapy, so it did not really address which of these two treatments is better.
Rotator cuff physical therapy management vs. Surgery
Fortunately, some recent research does directly compare rotator cuff surgery to physical therapy management. One investigation showed that surgery typically results in greater improvements in shoulder pain and function compared to physical therapy 1 year after treatment. However, before you conclude surgery is the best way to go, this research also showed that both the surgery and physical therapy groups demonstrated equivalent improvements in shoulder outcomes 2 years later. Therefore, surgery may be better initially, but it is unclear if it is better in the medium-term. Regarding long-term research, one high-quality study revealed that individuals who received surgery or physical therapy both demonstrated significant improvements in pain and function during the first 1-2 years after treatment. However, the physical therapy group did see a decline in their improvements compared to the surgical group at the 10-year follow-up. Despite the decline, the physical therapy group still demonstrated improved pain and function compared to their baseline values and reported satisfactory outcomes.
To summarize, the lack of high-quality long-term research on this topic does not provide a definitive answer to whether surgery or physical therapy is more beneficial. However, it is safe and practical to engage in physical therapy before considering an invasive surgical procedure in most cases. The decision of whether or not to get surgery should be individualized and made in light of the understanding that physical therapy is effective at improving pain and function in those with rotator cuff tears.