When You Don’t Need Surgery for a Torn Rotator Cuff

A torn rotator cuff can be agonizing — and it can really get in the way of your everyday life. Suddenly, you can’t hit your golf swing or pick up your grandkids or even pull on a T-shirt without pain. And if you have a job that requires manual labor, you may find that you can’t do it at all.

“Your rotator cuff keeps the ball and socket in your shoulder aligned,” explains orthopaedic surgeon Kirk Haidet, MD. This is what allows your arm to rotate, like when you’re lifting, reaching or throwing. “If it tears, the ball hikes up and the muscles are out of balance. This can make it so that you can’t really move your shoulder at all.”

You might assume that an injury of this magnitude will require surgery, but Dr. Haidet says you likely have options. You might be able to regain movement and mobility — and reduce your pain — with nonsurgical treatments instead.

When not to have rotator cuff surgery

There are times when surgery is the main recommendation for treating a torn rotator cuff. But this isn’t always the case. “Partial rotator cuff tears — and even some complete tears — can often be managed without surgery,” Dr. Haidet says. “In many cases, nonoperative treatment will suffice.”

You may not need surgery if you:

• Have a partial tear. This is when your tendons are still partially attached to your bone. About 80% of people with partial rotator cuff tears respond well to nonsurgical treatments.
• Don’t have any pain. More than 40% of people ages 60+ have a rotator cuff tear, but many people don’t even know it. If you find out that you have this injury but it isn’t causing you pain, you likely won’t need surgery. But you’ll still want to address it so it doesn’t get worse.
• Still have a good range of motion. If your torn rotator cuff isn’t impacting your quality of life, your healthcare provider may recommend other types of treatments before suggesting surgery.

But there are times when your healthcare provider may skip right to recommending surgery for a torn rotator cuff. If you’re young, active and sustain an injury that leads to a full-thickness tear — meaning that your rotator cuff has completely separated from the bone — you’re likely to need surgery to repair it within three to four weeks.

Nonsurgical options

“The decision to have surgery for a rotator cuff injury is quite individual,” Dr. Haidet notes. “It’s always reasonable to try conservative or nonsurgical treatment before you jump into surgery.” He outlines treatments that may help instead.

Physical therapy

A physical therapist can teach you strengthening and stretching exercises that can help improve your functionality and lessen your pain. For a torn rotator cuff, you’ll typically need to see a physical therapist for three to six months.

“Physical therapy involves working on range-of-motion exercises and strengthening both the rotator cuff muscles and other shoulder stabilizing muscles,” Dr. Haidet explains.

Medication

Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Motrin® and Advil®) or naproxen (Aleve®) can help minimize pain and swelling. Or your healthcare provider may write you a prescription for pain medication.

Corticosteroid injections

Also known as cortisone shots or steroid injections, these shots deliver medication directly into the injured area of your shoulder. This helps reduce inflammation (swelling), which ultimately helps relieve some of your pain.

But you can’t get cortisone shots indefinitely. There’s usually a limit on how often you can receive them because if they’re given too frequently, they can actually have a negative effect on your healing.

Don’t forget about rest!

When you’re trying to heal a torn rotator cuff without surgery, it’s important to give your shoulder a break from regular activity.

“In particular, avoid overhead activities like lifting and reaching, which can exacerbate your pain,” Dr. Haidet advises.

Your healthcare provider may recommend icing your shoulder and wearing a sling to help give it the rest it needs.

Is it too late for rotator cuff surgery?

Rotator cuff injuries are common with age, and the older you get, the more likely you are to experience a tear. Your first instinct might be that surgery is more trouble than it’s worth and that you should just live with the pain.

“One question I get a lot is, ‘Am I too old to have this done?’ but I don’t put an age limit on it at all,” Dr. Haidet reassures. “Sometimes, people get to the point where nothing else has helped and they feel miserable day in and day out. If you find yourself saying that you’re not able to do things you love because of the pain, then it’s time to talk about surgery.”

When is rotator cuff surgery not an option?

Dr. Haidet warns that there are times when a rotator cuff tear can’t be repaired with arthroscopic (minimally invasive) surgery. Think about a tendon like a rubber band: It’s stretchy and elastic until it isn’t. Over time, if it stretches too much, it loses its elasticity and just can’t snap back into place the way it used to.

The same is true of your rotator cuff. If the tendons have lost elasticity, your surgeon can’t pull it back over the bone where it belongs. They might be able to use a muscle from your back instead, or they could use a balloon spacer to create a buffer between your damaged rotator cuff and bone.

But you might need shoulder replacement surgery, especially if you’re dealing with arthritis related to a torn rotator cuff. In these cases, the only reliable treatment is a reverse shoulder replacement.

“I’ve had patients who are barely able to raise their arm, almost as though it has become paralyzed,” Dr. Haidet recounts. “After a reverse shoulder replacement, though, they’re back to being able to raise their arm with full strength.

Will a torn rotator cuff heal on its own?

With rest, physical therapy and medication, many people are able to recover from the pain of a torn rotator cuff. But if you don’t give it the care and attention it needs, this injury can get worse with time — and you’ll almost surely eventually need surgery.

“There’s a lot to consider when you’re deciding what treatment is best for a rotator cuff injury,” Dr. Haidet acknowledges. “Have an open discussion with your doctor to decide about the optimal treatment for you.

And, he points out, shoulder pain doesn’t necessarily always mean a problem with the rotator cuff. Other injuries that cause shoulder pain include:

• Shoulder arthritis
• Frozen shoulder (adhesive capsulitis)
• Biceps tendonitis

Treatment for these also moves to surgery if conservative, nonsurgical options don’t work.

“Getting in to see your doctor and getting properly diagnosed is your springboard to figuring out what comes next,” Dr. Haidet urges. “As doctors, our job is to keep you doing what you want to do — and if you reach the point where you no longer can, then it may be time to talk about surgical options.”