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.
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