Is surgery the answer for my rotator cuff-related shoulder pain?
If you’ve got shoulder pain, stiffness, or an ache – it’s very tempting to think that it’s nothing, that it will fade away soon. You may even pass it off as having slept awkwardly on it the night before or that it’s just a “spasm” or a slight stiffness that many people your age suffer from.
You may not even know why the pain began initially, but what you do know is that it is not getting better! Adding to the frustration is the fact that most bouts of shoulder pain typically last between at least 3-6 months.
So it’s no wonder why some people think that surgery may be their only option for shoulder pain relief. This blog will discuss the options for treating non traumatic rotator cuff-related shoulder pain and whether surgery is the best treatment option.
What’s likely causing my shoulder pain?
Shoulder pain can be caused by several issues, a few of which aren’t even involved with the shoulder (such as the cervical spine and gallbladder). The primary causes of non-traumatic shoulder pain, however, involve three likely sources:
- Rotator cuff tendon tear (usually due to over-use and age-related changes)
- Shoulder instability (history of a dislocated at least once)
- Arthritis (age-related changes)
One common thing we hear from people who are suffering from shoulder pain is how they first sought help from their doctor. Their doctor typically suggests rest, pain meds, or muscle relaxants and to come back in a few weeks if it’s not any better.
Fast forward 3-4 weeks later, they are back at the doctor’s office, usually with worsening shoulder pain. The doctor now suggests an MRI and maybe some more potent pain medications. A few weeks later, they return to the doctor for the MRI results and learn they have a torn “this” and a degenerative “that” and may need an injection or even a consult with a surgeon.
Yikes! Does this sound like you?
If yes, let’s dive a little deeper into answering the question, “Do I need surgery for my rotator cuff related shoulder pain?”
What are my options for treating my rotator cuff-related shoulder pain?
There are many options out there for shoulder pain. These include steroid injections, pain meds, physical therapy, and surgery. My bias, of course, is physical therapy–but not for the apparent reason of being a P.T.
Instead, I choose to favor physical therapy because research continues to tell us so. We will explore that a little later in the blog.
Will a Steroid injection help my shoulder?
Corticosteroid injections are a standard treatment offered by physicians for shoulder pain. The problem with steroid injections is more and more studies are showing that these injections may do more harm than good.
A 2018 study by Mohamadi et al. found that corticosteroid injections for shoulder pain may accelerate tendon degeneration, offer only short-term pain relief (4-8wks), and potentially increase the chance of older patients who end up having surgery, later on, have a poor outcome (sometimes even requiring a second surgery!)
What about pain medication/anti-inflammatories for shoulder pain?
Anti Inflammatories, such as Ibuprofen, are commonly prescribed for shoulder pain and can be helpful. The problem is the medication is not treating the actual cause of the shoulder pain — just the symptoms. This can lead people to rely on pills for relief over long periods, leading to deadly consequences.
According to a 2005 study, Each year, the side effects of long-term NSAID use cause nearly 103,000 hospitalizations and 16,500 deaths. As you can see, pills aren’t a good long-term solution either.
So that leaves us with Surgery vs. Physical Therapy…(drum roll, please)
Physical Therapy for Rotator cuff-related shoulder pain for the WIN!
Rotator cuff-related shoulder pain can be treated either conservatively with physical therapy or with surgery. Most folks suffering from a rotator cuff tendon tear believe surgery will get them better quicker. Unfortunately, this isn’t the case.
What makes physical therapy stand out as the better choice is the boatload of research showing that shoulder surgery for rotator cuff tear shows no better improvement in pain and function than just doing physical therapy at 1 and 2 years post-surgery. Powerful stuff, right?
Physical therapy is cheaper and doesn’t have the risks associated with surgery (i.e., infection, blood clots, nerve injury, death).
What is even more exciting from the research is that no matter the size of the tear in your rotator cuff, from small to large, you still have a 75-80% chance of a positive outcome with just performing physical therapy for your rotator cuff tear.
Another study to support this theory was a 2018 study by Paavola et al. that compared 212 people with shoulder pain related to subacromial impingement. In the study, a portion of the group had a decompression surgery (Blue Line), and the others had a conservative physical therapy program (Red Line) and were followed up for two years. At the two years mark, the surgical group pain relief at rest or during their daily activities.
So the take home message is: the key to a successful outcome from shoulder pain is to perform a shoulder specific exercise program for at least six months and up to 2 years consistently (3-4x/wk).
I don’t know about you, but I will take that any day to avoid surgery while gaining relief from my shoulder pain.
If you’re curious if the mobile physical therapy team at Move Empower Concierge Physical Therapy (located in Austin) can help you live with less Shoulder Pain, we invite you to take advantage of our FREE in-person (or virtual) Discovery Session.
The Discovery Session is perfect for folks who are unsure or skeptical if physical therapy will work for them. If this sounds like you, then please take advantage of the risk-free, no-obligation opportunity.
We offer only a few Discovery Sessions per month, so don’t delay. Click here to get your Discovery Session today!
Together, we can find a treatment plan for your rotator cuff related pain.