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QI’m experiencing shoulder pain, and an MRI shows I have a rotator cuff tear. The orthopedic surgeon I saw recommends surgery, and I plan to get a second opinion. How is it usually treated and when is surgery needed?

AA torn rotator cuff is a common shoulder problem, and MRIs are very reliable in showing the extent of the injury. It’s usually a good idea to get a second opinion when surgery is recommended.

The rotator cuff is a group of muscles and tendons that stabilize the joint. A tear in one of these structures can result from a sudden injury, such as a bad fall or from lifting something very heavy overhead.

Many times, people can’t recall a specific incident in which they hurt their shoulder. The injury can occur slowly over time, resulting from normal wear and tear and repetitive activities. This type of degenerative tear is more common, especially in people over age 50.

A significant number of older adults likely have a small rotator cuff tear but don’t know it because they aren’t experiencing major symptoms. They may experience occasional pain and some minor weakness and are advised to avoid strenuous overhead activities, which could make it worse.

When symptoms become more pronounced, people can experience an aching shoulder, pain at night, or “referred” pain that travels down the outside of their arm, usually not below their elbow. They may find it difficult to lift their arm above shoulder level.

Most rotator cuff tears can be treated initially without surgery, especially when it’s a degenerative tear. At HSS, we generally prescribe physical therapy, ice and anti-inflammatory medication as the first line of treatment.

When the tear is the result of a sudden injury, early surgical intervention is more likely to be considered. The orthopedic surgeon should evaluate each case on an individual basis. Considerations include the nature of the injury and whether it is a partial or a complete tear; the age of the patient; and specific symptoms. If someone tries conservative treatments and continues to have pain and difficulty with activities after two or three months, surgery may be the best option.

There have been advances in the way the procedure is performed. At HSS, the rotator cuff is repaired arthroscopically using regional anesthesia. The success rate is high in terms of pain relief, restoring shoulder movement and improving quality of life. The recovery generally takes four to six months, and patients continue to gain strength and function for up to a year.

Physicians differ in their training and surgical techniques. Patients are advised to choose an orthopedic surgeon who performs a high number of rotator cuff procedures, can communicate effectively and with whom they feel comfortable.

Answer from Answorth Allen, MD, a sports medicine surgeon at Hospital for Special Surgery (HSS) in New York City and at HSS Long Island.

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