Rotator Cuff Tears: Physical Therapy vs. Surgery, Is There A Difference?

The Rotator Cuff and Shoulder Girdle

By Megan Morgan, DPT

A recent study that was conducted in Finland determined that Physical Therapy alone for non-traumatic rotator cuff tears (supraspinatus) results in equal functional outcomes at one year compared to surgically repaired tears. All of the groups in the study received the same Physical Therapy (PT) instruction and prescription of a home exercise program as well as 10 PT sessions. The study found that patient’s who did receive surgery did not report any superior results than those who only received PT.

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Role of the Rotator Cuff and Scapular Stabilizers

The rotator cuff is a group of four muscles that connect the humerus (upper arm) to the scapular (shoulder blade). These muscles not only create movement of the arm but they play an integral role in providing stability to the shoulder joint. The tendons of these muscles form together to create the cuff; which work together to create a force couple relationship that results in the humerus to remain centered on its base of the scapula (also known as glenoid). When a muscle of the rotator cuff is torn dysfunction of this force couple relationship results and the shoulder has difficulty maintaining its stability.

Another critical component of a healthy functioning shoulder is scapular strength and proper muscle activation. The scapula is the base that connects our humerus to our body via the placement of the humeral head on the glenoid of the scapula. There are multiple muscles that connect our scapula to our spine and these are referred to as our scapula stabilizers. A common analogy for the role of these stabilizers is a seal trying to balance a ball on its’ nose; they have the role of creating a stable base so the ball (humeral head) can stay balanced for the humerus to move on. These muscles are just as important to providing stability to the shoulder joint, as the rotator cuff. Therefore it is important to strengthen these stabilizers and create the proper awareness of one’s scapula position. Physical Therapists are here to help develop your awareness and the appropriate individualized strengthening program.

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The study was limited in that it only incorporated individuals whose tears were <75%. Therefore, we cannot apply these findings for all rotator cuff tears, as the severity of tears varies between individual cases. But an important take away message from this study is that for partial rotator cuff tears PT and a home exercise program can independently get you back to your prior activities of choice.

References:
https://www.apta.org/PTinMotion/NewsNow/2014/3/12/RotatorCuffTears/?blogid=10737418615