Rotator Cuff Tears: What You Need to Know (and What Your Doctor Won't Tell You)
If you've been told you have a rotator cuff tear, you are wondering about the best options to fix your shoulder pain. Doctors may have said that surgery is the only solution for your rotator cuff tear. Even physical therapists might have suggested that there is no way to fix shoulder pain from a rotator cuff tear besides surgery.
In this article, we will explore the science behind shoulder pain, rotator cuff tears, and shoulder surgery. We will also examine methods to relieve shoulder pain without surgery, even if you have a rotator cuff tear. Some of the information will surprise you.
How Common Are Rotator Cuff Tears?
Rotator cuff tears are very common, even in people without shoulder pain. In one study, rotator cuff tears were found in 10-60% of people depending on their age group.
A study by Dunn et al. (2014) examined the relationship between the severity of rotator cuff tears and symptoms. They studied 393 subjects with symptomatic, nontraumatic, full-thickness rotator cuff tears. Interestingly, they found that the severity of the tear did not correlate with the level of pain experienced.
Some patients have no symptoms despite having significant tears. According to Yamamoto et al. (2011), it is unclear why some rotator cuff tears cause symptoms while others do not. Their study examined 211 people with full-thickness tears identified by ultrasound, and found that 65.4% had no symptoms in shoulders with rotator cuff tears.
In other words, the presence of a rotator cuff tear doesn't mean it's causing your pain.
Some experts even speculate that rotator cuff tears might be a normal anatomical variant. Decades ago, doctors believed that signs of "damage" in the spine were the cause of back pain. Today, medical science generally accepts that spinal "damage" does not correlate with back pain. This "damage" is seen as part of the normal aging process and isn't necessarily the cause of any pain or discomfort.
Do Rotator Cuff Tears Cause Shoulder Pain?
It is unclear if rotator cuff tears actually cause shoulder pain. As mentioned, a high percentage of people have rotator cuff tears with no symptoms.
One study on rotator cuff tears found no correlation between the size of a rotator cuff tear and the level of pain.
Furthermore, people who have had surgery to repair rotator cuff tears can re-tear the rotator cuff muscles and still have good range of motion.
Another study found that retears after rotator cuff repair do not correlate with pain.
This raises serious questions about the assertion that rotator cuff tears cause shoulder pain.
You can have a rotator cuff tear and no pain. You can have shoulder pain and no rotator cuff tear. You can have shoulder pain and a rotator cuff tear, but that doesn't mean the pain is from the rotator cuff tear.
No matter what images and tests you use, it's currently impossible to determine if the rotator cuff tear in the image is actually responsible for your shoulder pain.
This begs the question: Does surgery fix shoulder pain from a rotator cuff tear? Let's delve a little deeper.
How Effective Is Surgery for Shoulder Pain from Rotator Cuff Tears?
Subacromial decompression used to be the go-to recommendation for people suffering with shoulder pain. Surgeons believed that rotator cuff tears and symptoms of shoulder impingement were the result of incorrectly formed bone shapes. Specifically, they believed that the shape of the acromion process could predispose you to shoulder impingement and rotator cuff tears.
After decades of using this procedure, science discovered two stunning facts.
First, there is no correlation between the bone shapes in your shoulder and shoulder pain / shoulder impingement. In other words, the theory that your shoulder bone shapes predispose you to rotator cuff tears and shoulder pain is NOT supported by evidence.
Second, subacromial decompression is no more effective than a FAKE shoulder surgery. In fact, the results of doing nothing versus surgery are about the same.
In other words, surgery to fix shoulder impingement doesn't get better results than if you trick a patient into believing they had a real shoulder surgery. Or if you just plain do nothing.
What About Rotator Cuff Repair?
As of writing, I have not been able to find any studies comparing rotator cuff repair surgeries with sham surgeries. There have been studies comparing different non-surgical treatments to surgery and different surgical techniques to others.
A recent paper summarizes the state of evidence on rotator cuff surgical interventions: "Regarding the treatment of reparable full-thickness rotator cuff tears, to date, clear evidence of superiority of surgical repair over conservative treatment is lacking."
And a 2021 meta-analysis further explains: "According to the American Academy Orthopaedic Surgeons guidelines, surgical RC repair is a valid option for patients with chronic, symptomatic full-thickness RC tears. However, the quality of evidence is unconvincing (emphasis added). On the other hand, there is also a lack of supporting evidence for conservative treatment and, thus, the AAOS recommendations remain inconclusive. Moreover, the superiority of surgical over the conservative treatment is challenging to demonstrate, due to heterogeneity of studies’ findings."
In other words, there really isn't a lot of good evidence that surgery is better than non-surgical interventions in the long-term. Existing studies are hard to compare because the setups have all been so different. So nobody can conclusively say that surgery for rotator cuff tears is actually better than exercise interventions.
Which Surgery Is Better for Rotator Cuff Tears?
Finally, when looking at different surgical techniques, the literature is ambiguous. One 2021 study looked at arthroscopic surgery versus open surgery and found the results were comparable. In other words, they all seem to end up about the same.
So what can we conclude about rotator cuff repair surgery? It might work. It might be better than conservative care. But it's really hard to know because nobody has done any high quality studies to compare the different surgery types to sham surgery and to a high quality exercise intervention.
While it is possible that rotator cuff repair can help you, it's not clear that surgery is always the best option. It's also not clear how medical professionals can differentiate between those who need surgery and those who would benefit from a non-surgical intervention.
Until someone can identify specific criteria that can predict long-term success with exercise or with surgery, we should be looking for the lowest-cost, lowest-risk, most practical method of testing available to us.
How Can You Fix Shoulder Pain Without Surgery?
The lowest-cost, lowest-risk intervention is to ATM - Always Think Muscles. Remember that muscles move bones. In the majority of cases, if a position is painful, it's because the muscles that control that position aren't healthy enough to do so properly. When the muscles can't get you into a position or keep you there, you get discomfort and pain.
To improve your movement capabilities, you need to retrain muscles. To retrain muscles, you need to exercise.
This includes self-massage, stretching, and strengthening work. A blend of these techniques improves your flexibility, strength, and overall range of pain-free motion. You want to train all the shoulder and torso muscles to have the necessary strength to move and stabilize your shoulder bones. You want to train all those muscles to be able to lengthen to achieve full ranges of motion in a pain-free way.
In other words, you want all the muscles that influence shoulder mechanics to have strength at every length.
Often the exercise interventions used in surgical studies are designed to fail. Because the researchers assume that the problem is with structures like tendons and bones, they design exercise programs that do not address the entire human movement system.
Almost without fail, they choose exercises that do not actually improve function. Ironically, they do this because they believe challenging exercises may make the pain and structural damage worse. This means the exercise programs block off any chance of movement improvement.
You can see a clear example of this in a hip impingement study that was designed to prove that surgery is better than exercise.
So to fix your shoulder pain, you must make an assumption with productive potential.
Believe you might be able to fix your shoulder pain without surgery. Believe that improving muscle function can improve shoulder function. Then you have a chance at beating shoulder pain, even if you have a rotator cuff tear. You just need to start exercising in a smart way.
How to Exercise Your Shoulders in a Smart, Safe Way
Focus effort on restoring range of motion and strength throughout the full available range of motion. Focus on your general posture. Focus on the muscles that influence your shoulder joint as well as the motion of your scapula. Stay within pain-free ranges of motion, AND don't be afraid to safely challenge your range of motion.
Key Points for Fixing Shoulder Pain with Exercise
1. Remember that the shoulder and scapula muscles are responsible for safe, strong, pain-free movement.
2. Find motions and positions that feel weak and stiff. Gradually make those positions feel strong and smooth.
3. Do not push through pain, pinching, or jamming sensations. Your goal is to coax more function. Impatience will lead to further injury.
See also: How to Fix Muscle Imbalances
Exercises to Fix Shoulder Pain
With those three key ideas firmly in mind, you can start with shoulder exercises to fix your shoulder.
I have a free video here to show you extremely helpful exercises for shoulder pain. Even if someone claims your shoulder pain is from a rotator cuff tear, labrum tear, tendonitis, or whatever, it is still a good idea to explore the power of smart, careful exercise.
Give the exercises a try and see how you feel after consistently doing them for a month or two. You might surprise yourself (and your doctor).
Even More Help for Shoulder Pain
I had a lot of issues with my shoulders for years. I've helped a lot of people with their shoulder problems since 2007. I've put everything I've learned into a straightforward shoulder program you can do at home.
If you find that the free exercises in that video aren't enough, check out my Shoulder Fix program. While I can't guarantee it'll work for you, I know that it has been helpful for thousands of people with shoulder pain. And I can guarantee that if you don't get the results you want, you'll get your money back. 💪
