Did a recent MRI confirm a Rotator Cuff Tear (RCT)? You are not alone! RCT is a common musculoskeletal injury that results from trauma or age related changes. The purpose of this blog post is to discuss non-surgical options for a rotator cuff injury and when surgery may be indicated. Petri et al. (2016) reviewed multiple clinical outcome studies and found conservative management for rotator cuff tears to have a 75% success rate1 That is a very promising statistic, as most rotator cuff injuries can be managed well with physical therapy. With this success rate, does that mean there will still be pain? Not likely! Here are a few imaging studies that confirm we can have rotator cuff pathology with no symptoms. Frost et al. (1999) showed rotator cuff pathology was related to age but did not correlate the MRI findings with symptoms.2 Girish et al. (2011) found abnormalities in 96% of asymptomatic (no symptoms) individuals.3 Do these tears get worse if I do not have surgery? In a study by Kong et al. (2017) found partial thickness tears to progress in 16% of their participants. BUT, the more important statistic from the study was, 25% of the tears decreased in size.4
Kuhn et al. (2013) analysis found most patients will elect to have surgery if conservative management fails at week 12.5 We would agree, three months is a good trial of physical therapy before deciding to go under the costly knife. An important aspect of this trial is patient optimism; Dunn et al. (2016) found, “A patient's decision to undergo surgery is influenced more by low expectations regarding the effectiveness of physical therapy than by patient symptoms or anatomic features of the rotator cuff tear.”6 A study reviewed by Edwards et al. (2016) found four factors to contribute to better non-operative outcomes; preserved range of motion in external rotation (>52 degrees), negative impingement signs, little or no atrophy of the supraspinatus muscle [1 of 4 rotator cuff muscles], and a preserved intramuscular tendon of the supraspinatus.7 If the patients presented with at least three of the above criteria, there was a 87% success rate in non-operative management.7
In the picture below, Edwards et al. (2016) presents an algorithm on nonoperative vs. operative management of a rotator cuff tear.7
Why does physical therapy help? Correctly dosed rehabilitation can help reduce pain, improve non-optimal movement strategies, and strengthen the intact rotator cuff tendon complex to improve your quality of life. Find out here what we think makes a good physical therapist. Diving into a little bit of the tendon science aspect, tendons respond positively to mechanical loading which is strength training. Tendons break down from cyclic loading which is repetitive motion activity. If you would like to learn more about tendons and how physical therapy can help reference here. Another aspect of physical therapy care is workload management, which is a key component to helping you return to the activities you love. Here, you will find our newsletter on workload management and how this can help reduce your risk of injury.
In conclusion, correctly dosed rehabilitation including but not limited to, building tendon strength, optimizing your shoulder movement and positional tolerance, as well as workload management is essential to help you return to your prior level of activity and function. If you would like to find out more how we can help you, we offer free phone consultations as well as in-person discovery visits where you can come in and see what we’re all about!
Written by: Dakota Ezell, PT, DPT
Nick was so attentive to my needs and he structured his schedule to fit mine. My therapy was focused on my strengths and weaknesses; therefore, my recovery time was much shorter than expected. I highly recommend Nevada Physical Therapy for any lingering pain you may be experiencing.Read More Reviews
I cannot say enough positive things about this place. Came in with an ACL injury. I spent a few weeks working with jonathan. His evidence-based approach and motivational ability was really really inspiring. He helped me get back to normal and then some!Read More Reviews
DAKOTA EZELL is at the top of MY list as a highly skilled, intuitive, present professional who values and treats me as a whole person, not just someone to fill a time slotRead More Reviews
The best Physical Therapy place I have ever visited. Rare to see an emphasis on finding the best method to improve injury instead of giving everyone the same plan. But the best part about this place is it's approach to well being during and after PT.Read More Reviews
I was referred to Brian Fearnley by someone with significant credibility. I consider working with Brian a huge stroke of luck. This specific 'PT' is increasing my recovery potential a hundred fold. Brian knows his stuff. He is well versed in PT. He has athletic history at UNR and is active in our local community. He is clearly in this profession to help people recover and get under their own power.Read More Reviews
After two plus years of hip pain, three other physical therapists, quarterly injections and no relief, Crista made the pain go away! If I could give her and this practice 10 stars I'd do it!Read More Reviews
As a professional athlete, injuries can make or break a career. Luckily, in my case, I had Nevada Physical Therapy on my side. Not only did they physically help me recover from a meniscus surgery, but they provided the best emotional support you could ask for in such a difficult time.Read More Reviews
Phenomenal. I had some brutal injuries that resulted in four surgeries and seriously disrupted my life. There can be no doubt that the quality of life I enjoy today was a direct result of working with Nevada Physical Therapy.Read More Reviews
I attended Nevada Physical Therapy for my post surgery physical therapy and have nothing but great things to say. For any of you reading this, this place is by far the best physical therapy place I have ever attended with exceptional staff. I had the pleasure to work with Dakota who is extremely knowledgeable, patient and would go above and beyond to make sure you're taken care of.Read More Reviews