Should I get Surgery for my Sore Shoulder?

It is a reasonable question. Your shoulder has been sore for a while, you’ve had a scan (MRI or ultrasound, most likely) and you’ve been told the “dreaded” news…

You have a rotator cuff tear! 

Immediately, you start to feel your dreams of a huge bench press, playing sport or even lifting up your kids or grandkids slowly disappearing. 

Hopefully you’ve kept reading for the good part. A rotator cuff tear is not the end of the road, nor does it mean a swift trip to the orthopaedic surgeon. 

Many studies have shown that conservative treatment (AKA physiotherapy) is effective at improving shoulder pain and, more specifically, rotator cuff tears. 

Two such studies looked at the comparison between physiotherapy treatment and surgical intervention in people with full thickness rotator cuff tears. 

The first study looked at why people fail conservative rehabilitation. The definition of ‘failing’ physiotherapy treatment was electing to have surgery instead. Of the 433 participants, only 87 (roughly 20%) elected to have surgery. The kicker here is, why did they fail? The primary reason, identified by the researchers, was the patient’s expectations of physiotherapy. Those patients who went in with the expectation that physiotherapy would not work, didn’t get better. 

The second study looked specifically at the effectiveness of physiotherapy. Patients were provided an evidence based exercise plan and then asked if they were ‘cured’, ‘getting better’ or ‘no better’ at 6 and 12 weeks. 75% of the patients were ‘cured’ with physiotherapy.

Furthermore, it is cost-effective. A 2009 study looked at the cost of four different shoulder surgeries. The results showed an average surgery cost of $10 422, with one costing a whopping $16, 323! A Swedish study, conducted in 2012, looking at the cost of physiotherapy in people with shoulder pain, determined the average cost of physiotherapy was only $288. So not only is physiotherapy physically effective, but it is cost effective too!

The important thing to remember is that physiotherapy treatment can take time. The best results are seen between the 6 and 12 week mark. This is not the ‘quick fix’ we all want, however physiotherapy is proven to work and ultimately saves a significant hole in your back pocket!

The take home message - a ‘damaged’ structure does not always equal pain or dysfunction. Consider giving physiotherapy a try, persevere with your treatment plan for 6 to 12 weeks and reap the rewards of evidence-based, cost-effective treatment!

Dunn, W. R., Kuhn, J. E., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., ... & Jones, G. L. (2016). 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. Journal of Shoulder and Elbow Surgery, 25(8), 1303-1311.

Kuhn, J. E., Dunn, W. R., Sanders, R., An, Q., Baumgarten, K. M., Bishop, J. Y., ... & Ma, C. B. (2013). Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Journal of Shoulder and Elbow Surgery, 22(10), 1371-1379. Milne, J. C., & Gartsman, G. M. (1994). Cost of shoulder surgery. Journal of Shoulder and Elbow Surgery, 3(5), 295-298.

Virta, L., Joranger, P., Brox, J. I., & Eriksson, R. (2012). Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden. BMC musculoskeletal disorders, 13(1), 1.