1) Is my rotator cuff tear old or new?
It is important to get some idea of how old your rotator cuff tear is. This can be
determined from an MRI. The orthopedic surgeon is not going to be able to
pinpoint an exact time the tear occurred but they can often make an assessment
as to the chronicity of the tear. Older tears may be retracted with muscle
atrophy. More acute or newer tears will not have those properties. The reason
this is important is this can give you an idea about the causation of pain. If the
tear appears to be very old but you have good function and your pain just
recently began then the cuff might not be the source of your pain. This can help
guide your decision to having a rotator cuff repair.
2) How much is my neck contributing to my shoulder pain?
A large portion of middle-aged patients with shoulder have involvement from
the neck . Unless you have been screened for neck referral patterns into the
shoulder you are potentially having a surgery that will do no good in decreasing
your shoulder pain. I can say that I have personally seen a handful of rotator cuff
repairs on patients with significant pain that was not resolved with shoulder
surgery because the pain was coming from the neck. This screening can be done
easily by a trained physical therapist, and you can find relief without surgery.
3) Have I tried conservative treatment?
To answer this you must first know what constitutes conservative treatment. It
includes, but is not limited to, physical therapy, chiropractic, massage,
acupuncture/dry needling, yoga, weight training, injections, and anti-
inflammatories. Many of these treatments are successful in decreasing pain
from a rotator cuff tear. The only caution I would give about some of these
treatments is that they are not looking at the patient as a whole. There are many
potential causes of pain in the shoulder including the rotator cuff tendon, rotator
cuff muscle, deltoid muscle, trapezius muscle, cervical discs, cervical facet joints,
and many more. Unless a medical professional such as an orthopedist or PT
screens for these potential pain causers you will not know if you are treating the
actual culprits of your pain or just treating the symptoms.
4) Do I have someone that can stay with me or at least help me
considerably for a couple weeks?
Rotator cuff tears are typically very painful. The surgeon will have you in a sling
and restricted shoulder motion for up to 6 weeks. This can make some daily
activities quite challenging. To have someone to help you around the house with
bathing, dressing, toileting and cooking may be necessary. If you are going to have
a rotator cuff repair you must be prepared to have help for a couple weeks
after the surgery.
5) If I don’t do the surgery will the tear get larger?
The short answer to this question is YES. But there are some qualifiers that
come along with that statement. Many rotator cuff tears are degenerative in
nature. Think of an old pair of blue jeans with a hole worn in them. The hole
continues to slowly get bigger with time. The rotator cuff is similar, only it can
take years. It is important to know that as the tear gets larger the prognosis after
surgery is worse, and it may be harder to repair. My advice is this: a small tear
typically responds well to therapy, but you will want to periodically check in
with your orthopedist to make sure the tear is not getting bigger and decreasing
your chances for a successful repair.