My shoulder MRI report says that I have a rotator cuff tear – What are my options?

Shoulder Q&A with Dr. Brent J. Morris, MD a shoulder and elbow specialist in Lexington, Kentucky at Baptist Health Lexington Orthopedics and Sports Medicine.

Who is Dr. Brent J. Morris?

Dr. Brent J. Morris is an orthopedic shoulder and elbow surgeon in Lexington, Kentucky at Baptist Health Lexington Orthopedics and Sports Medicine. Dr. Morris is a fellowship-trained shoulder and elbow specialist with interest in rotator cuff tears.  Dr. Morris performs rotator cuff repairs with minimally invasive techniques using shoulder arthroscopy.  Dr. Morris is co-author of a textbook devoted to shoulder surgery, Shoulder Arthroplasty, 2^nd Edition.

Question:  My shoulder MRI report says that I have a rotator cuff tear.  What are my options?

Dr. Morris: First of all, I would always recommend discussing the findings with an orthopedic shoulder specialist.  Shoulder MRIs are very helpful but they must be interpreted in the context of the patient and their symptoms.  I always like to tell my patients that we “treat patients, not pictures.”  Although a shoulder MRI is a very helpful piece of the puzzle, especially when dealing with shoulder injuries, it is not the only piece. 

I would recommend getting a CD of the actual shoulder MRI images and an official shoulder MRI report to provide to the orthopedic shoulder specialist.  An orthopedic shoulder specialist will personally review the shoulder MRI images and the official shoulder MRI report to confirm the findings.  Not all rotator cuff tears require surgery.

The orthopedic shoulder surgeon will talk with you to gather a history of the findings related to your shoulder pain and perform a thorough physical examination.  The history and physical examination will help to determine if your ongoing shoulder pain and symptoms are related to the rotator cuff tear on the MRI and if surgical treatment is the best course of action.

Question: Do all rotator cuff tears require surgery?

Dr. Morris: No.  Fortunately, not all rotator cuff tears require surgery.  There are many important factors in the patient’s history, physical examination, and shoulder MRI that all contribute to the decision-making process to pursue surgical or non-surgical treatment.  Consultation with a shoulder specialist is important to help make this important decision. 

Question: What are my treatment options if I am fortunate to have a rotator cuff tear that can be treated without surgery?

Selective rest and activity modifications are recommended while the shoulder recovers.  These measures are a reminder that you still have shoulder pain and “no pain, no gain” doesn’t apply.  You need time to allow your shoulder to recover.

Counseling is an important piece of the recovery process.  You have to have a good understanding of your diagnosis and treatment plan.  You need to be sure to have all of your questions answered and have a way to seek follow-up care or a way to have your questions answered along the way.  You should have a good idea of the upsides and downsides of both surgical and non-surgical treatment of your rotator cuff tear.

NSAIDs like all medications do have risks and side effects, but they can provide some relief of pain caused due to inflammation in the shoulder.  NSAIDs should be discussed with you shoulder specialist prior to taking these medications.  NSAIDs do not heal the tear, but can help relieve some of the pain and inflammation in the shoulder.

A corticosteroid injection is an option to consider, but I emphasize that this is a short-term pain relief option and generally NOT recommended in the setting of a rotator cuff tear as it can potentially increase the risk of infection or non-healing if the patient does decide to proceed with surgical intervention.  If surgery is out the question then a single corticosteroid injection can be considered.

Physical therapy can be an option to help with pain from a rotator cuff tear and improve function.  The rotator cuff tear will persist without surgery, but the outcome of nonoperative treatment will physical therapy can be very helpful in properly selection patients and for properly selected rotator cuff tears.  We focus on scapular stabilization exercises and deltoid strengthening to recruit other muscles to assist in shoulder function.

Follow-up is generally recommended to closely monitor symptoms and progression of the rotator cuff tear and symptoms over time.  An increase in pain and/or weakness over time may indicate the rotator cuff tear has increased in size and surgery may still need to be considered.

Question: Are there some rotator cuff tears that surgery is more strongly recommended or is relatively more urgent to proceed with rotator cuff repair?

Dr. Morris: Yes.  Just like there are some rotator cuff tears that can be successfully treated without surgery, there are other rotator cuff tears that are best treated with surgery and there is a timing component as well.  An orthopedic shoulder specialist can help to distinguish rotator cuff tears that may benefit from surgery, and more specifically, those rotator cuff tears that may benefit from more urgent surgical timing.

Question: Surgery was recommended for my rotator cuff tear.  Should I consider a second opinion? 

Dr. Morris: A second opinion is not always necessary, but it can be very helpful to seek a second opinion from a shoulder specialist to gather more information to help you during this important decision.    

Question: What if rotator cuff repair surgery is recommended, but I am not ready for surgery yet?

Dr. Morris: There are some rotator cuff tears that are better served by proceeding with surgery more urgently and an orthopedic shoulder specialist can help you to determine which rotator cuff tears fit that category. Fortunately, there are some other rotator cuff tears that are more chronic and the timing does provide some flexibility. 

Close follow-ups and symptom monitoring are critical and a repeat shoulder MRI would likely be needed depending upon how much you postpone the surgery.  Healing of the repaired rotator cuff may be less predictable on a delay, but a shoulder specialist can help assist you when making these decisions.

Learn more about arthroscopic rotator cuff repairs.