So you have a chronic (long-standing) rotator cuff tear. Is physiotherapy or surgery the right solution?

The short answer is: physiotherapy is the correct initial treatment for chronic tears. The more detailed answer is as follows …..

What is the rotator cuff of the shoulder?

The rotator cuff is a group four muscles around the shoulder joint which are integral in controlling movement, generating strength and power for rotation and abduction, and providing stability to the shoulder throughout the range of motion. A tear in of these four muscles (supraspinatus, infraspinatus, subscapularis, teres minor) can be partial or complete and can be the result of either an injury or gradual wear and tear over time.

How do patients with rotator cuff tears present to a doctor?

The way a patient experiences a tear in the rotator cuff is through a combination of night pain, pain with activity, weakness, and/or limitations in functional activities.

What is the best treatment of rotator cuff tears?

Just like the way patients’ experience a rotator cuff tear, managing these tears needs to be individualized. Certainly, the treatment of rotator cuff tears has quite a bit of controversy associated with it. Recently the American Academy of Orthopaedic Surgeons has published clinical practice guidelines for rotator cuff tears and highlights many of the relevant issues.

According to the best evidence, all patients with chronic (long-standing) rotator cuff tears should be managed with an initial period of physiotherapy that consists of improving range of motion, strengthening, techniques to decrease inflammation and to teach activity modification tactics to prevent pain in the first place. There may also be a role for a single injection to help with symptom relief and improving inflammation. Data from the MOON study in the United States has demonstrated that after a formal physiotherapy/non-operative program, 75% of patients were able to avoid surgery at a follow-up period of two years. For those patients who are still suffering from pain or functional limitation, arthroscopic or open rotator cuff surgery is a great option to restore function. A visit with an orthopaedic surgeon can provide more insight into some of the surgical techniques and approaches that are available depending on the exact tear characteristics.