Question:

I have had shoulder pain for 10 months now but improved somewhat. Recent MRI shows high grade, articular sided tear of the supraspinatus involving greater than 60% of cross sectional thickness. Small partial thickness tear of subscapularis. Bursitis, tendinosis, etc.

Question is: Is surgery worth it? Will therapy help me get my range of motion for posterior and side actions restored for the most part?

As things have evolved (I thought it was just arthritis at first, so just endured it) I’m having pain into the neck, spasms in the back. Pain is improved, I can sleep on the arm now, but unable to reach really high cupboards, fasten a bra strap, pull pants up or down or wave/gesture suddenly without some pain and what feels like a blockage of that movement. Lifting is a little weak but not impossible. and I find that it’s the smaller movements that cause discomfort. Will PT be helpful in this regard?


Answer:

We’re limited in our ability to give you specific information without doing an examination of your shoulder but can give you some general guidance on prognosis for partial subscapularis tears. The subscapularis is one of four rotator cuff muscles. These muscles support the head of your shoulder in the socket and provide stability with reaching, lifting, carrying, dressing, etc. The subscapularis is particularly helpful with helping reach behind your back for activities like fastening a bra. The muscles of the scapula (shoulder blade) also work with the rotator cuff and other shoulder muscles to provide full motion and strength.

Because of the overlap of the shoulder and shoulder blade muscles, there are ways that physical therapy can help make up for the partial loss of the subscapularis by strengthening the surrounding muscles and addressing any joint tightness in the neck, shoulder, shoulder blade, or upper back. The goal of this work is to improve the ability to reach, carry, and dress/undress with less pain and restriction. 

There are two types of rotator cuff tears, acute (sudden) or degenerative (slowly over time). Acute tears typically respond well to surgical correction. Degenerative tears may or may not respond as well as acute tears so it is important to follow up with an orthopedic surgeon on your options. Many people respond very well to physical therapy and other conservative management of degenerative and partial rotator cuff tears and do not go on to get surgery.  


**This reply is for informational purposes only. It’s not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, physical therapist, or other qualified health provider with a medical condition.