Does My Rotator Cuff Injury Require Surgery?

You get out of bed each morning and take for granted that you’ve got the body parts necessary to help you get through the day — whether you’re making a cup of joe or shooting off an email to your colleague.

These seemingly simple tasks can become exponentially tougher when you have an injury like a rotator cuff tear. Rotator cuff injuries send about two million Americans to seek medical help each year (and, spoiler alert, not all of them require surgery).

If you have a rotator cuff tear and you’re wondering what is the best path forward to regaining use of your shoulder and arm, the team here at William Schell, MD wants to cover some important points. In the following, Dr. Schell discusses rotator cuff tears and when surgery might make good sense or whether time, patience, and a lot of physical therapy are enough.

Appreciating your rotator cuff

If you’re pondering your options after a rotator cuff tear, we want to first make sure that you fully understand the function of this important connective tissue.

Your rotator cuff is a tendon that’s formed by a group of four muscles that cover the head of your humerus (upper arm bone) and attaches it to your scapula, or shoulder blade. So, the fact that your rotator cuff connects your arm to your shoulder is its first important task.

Second, your rotator cuff helps keep your upper arm bone firmly in the socket in your shoulder blade.

Lastly, the rotator cuff helps you to lift and rotate your arm.

So, when you’re making decisions about how to deal with a rotator cuff tear, it’s good to bear in mind all the functions of this connective tissue and how long you can go without full use of your arm.

The extent of the rotator cuff tear

One of the biggest initial considerations when figuring out whether rotator cuff surgery is a good idea is to evaluate the extent of the tear. Using advanced imaging, we identify where the damage falls:

• A partial tear in which the tendon is still attached to your shoulder blade, but the tissue is weakened and damaged
• A full-thickness, incomplete tear in which a piece of the tendon is detached from the bone
• A full-thickness, complete tear in which the tendon is completely detached from your bone

Figuring out the extent of the tear will guide our recommendations moving forward — the more severe the tear, the more likely that surgery is a better option.

Guidelines for rotator cuff repair

It’s impossible for us to say here whether you would benefit from rotator cuff surgery because each person’s situation is unique.

That said, we often start with these guidelines for suggesting surgery:

• Your pain has persisted for 6-12 months
• You’re having difficulty using your arm
• You have a tear that’s larger than 3 centimeters
• The surrounding tendon is strong
• You tore your rotator cuff in an acute injury 

Now, let’s flesh these out a little. The reason why we cite an acute injury is that rotator cuff tears due to progressive wear and tear are harder to repair, as there’s more tissue damage in your shoulder joint.

When we refer to weakness in your arm and shoulder, is this something that’s interfering with your ability to work? In other words, can you live with the weakness or is it important for your circumstances that you regain full use of your arm? In this case, surgery is a better path.

We also take your general health into consideration. If you have a preexisting condition like heart disease or diabetes, we may not recommend surgical repair of your rotator cuff.

As we said earlier, everyone’s situation is unique, and we’re here to help you find the best option for your rotator cuff tear. If it’s surgery, be assured that you’re in good hands with Dr. Schell. If it’s not surgery, you’re still in great hands as we see you through your shoulder injury.

For a closer look at your rotator cuff tear and to explore your treatment options, please contact our New York City office, which is located on Columbus Circle on the Upper West Side.