First, let me give you a brief explanation of the rotator cuff. It's a combination of muscles and tendons that control movement and maintain the shoulder's stability.
We have four tendons in the shoulder, which is the most complex joint in the human body because it's designed to rotate in all directions. A torn rotator cuff injury can cause pain and limited mobility.
We take this joint for granted, and I wish I had understood that previously as I could have avoided damage. The options for having a continued quality of life are either surgery or physical therapy.
By the time I was in my 60s, I had never thought twice about my age. I always did things as if I were still in my 30s, never considering that my body was older and that I should change the way I did things.
When I started having aches and pains in my shoulder, I ignored them because I thought it was just part of aging. I had pain in my right shoulder when I tried to reach to wash my back when showering. My mother had arthritis, so I thought that might be what was going on for me since I was getting older.
I could still lift things, but when I tried to lift heavy boxes over my head, I had to shift the weight to my left hand quickly or else drop the box.
My doctor recommended an orthopedist who sent me for an MRI. And that revealed I had torn three tendons in the rotator cuff of my right shoulder. Two were only partial tears, but I had a full-thickness tear of the Supraspinatus Tendon.
After my doctor explained my options for recovery, I researched everything I needed to know to make the right decision, and I discovered treatment does not always require surgery.
Since I let a year go by, my orthopedist said surgery might not be successful anymore. Besides, I was still able to function. I could lift things, do house chores, and just about anything. However, when I made the wrong move, I felt the pain.
My doctor explained that people who are immobilized by a rotator cuff tear are the ones that have no choice but to have surgery. However, in my case, having good mobility and little pain, surgery is the last option to consider.
I found out why waiting a year was not good. With a full-thickness tear, the muscle is no longer used and atrophies over time. That means it becomes more like fatty tissue. When a surgeon sutures1 a healthy tendon, it holds. When they try to suture through fatty tissue, it just tears right through.
An easy way to understand what I mean is to think about eating a steak. You can't run your fork through the meat, but if you try to pull your fork through the fatty part, it slides right through.
Due to the atrophied muscles, surgery was not a viable option anymore since it most likely would have failed. My orthopedist told me that surgery should be done soon after the injury to have any possibility of success.
Many rotator cuff tears can be repaired with minimal invasion by arthroscopic surgery if recommended by the doctor and done in time.
Ironically, I never needed surgery, even though I had a full tear of the Supraspinatus Tendon and a partial tear of two of the four tendons.
My doctor had sent me for physical therapy. They taught me various exercises to retrain the body to function with the torn tendons. This was accomplished by training the working muscles to keep the shoulder in the proper position.
My doctor said I'm one of the few who's at one end of the spectrum—having had a full tear and still able to function 90%. I hardly have any pain and almost full mobility. At this point, I wouldn't even know that I had torn three tendons of my rotator cuff if it weren't for the MRI that showed the damage.
Don't make any decisions based on what I'm explaining here. I'm just sharing what I have learned. Deciding whether to have surgery or not is a choice you need to make with your doctor.
I explained above the two reasons why my doctor was against surgery for me:
I'm pretty much okay, except that I need to avoid lifting things over my head. That will bring on the pain and can even cause more damage.
Many people have rotator cuff tears without even knowing it. Maybe they are like me, thinking they are just getting older and expecting discomfort. And therefore, they're not getting it checked out.
In a study of cadavers, physicians and scientists found that 32% had partial-thickness tears, and 19% had full-thickness tears.2 Nevertheless, they were functioning throughout their lives.
I was curious to know why some friends who had the same problem complained about excruciating pain or lost their ability to use their injured shoulders.
My doctor explained that my muscles were well-balanced and compensated for the torn tendons in my case. That came from a lifetime of proper exercise. You may laugh, but since high school, I kept doing those push-ups we had to do in gym class. That could have made the difference.
Nevertheless, I still hurt myself. How? I don't know for sure. I have always done extreme things that I should have stopped doing as I got older. For example, I like to do carpentry around the house, and I sometimes move heavy objects, even lifting them above my head to place them on racks high up.
That must be it!
Remember, the surgery might not work that well in my case since I waited so long. In addition, it's not recommended when one still has functionality in their shoulder, as I do.
I discussed this with my new orthopedist, to who I went for a second opinion. I asked her what I could do to get through the rest of my life if I didn't have surgery. Her answer was, "Avoid lifting things above your shoulders."
I asked her why. She explained that we use different muscles when we lift things only up to shoulder level, but when we lift things higher than our shoulders, we're putting stress on our rotator cuff.
Wow! That was an enlightening lesson. They should teach us those things in elementary school as common knowledge to take with us throughout life! (Just like the three R's and the multiplication table.)
Taking care of our shoulders as we age can have a great impact on our ability to continue living life to the fullest.
I learned that if I avoid lifting heavy objects above my head, I might be okay.
My doctor continued to explain that there are no guarantees. She said it might get worse. Two of my tendons only have partial tears and are still functional to some degree.
However, if I abuse my shoulder, it can get worse. The one with the full-thickness tear is already non-functional, but it's incredible how the remaining tendons compensate for that.
The first orthopedist I saw told me I needed surgery or else it would continue to get worse. I felt like she was focusing on doing as many surgeries as possible in her practice.
Another doctor was honest enough to say that surgery might not help any better than routine physical therapy. As it turned out, that was all I needed.
Over the last decade, I have continued doing the physical therapy (PT) they taught me. I do it on my own at home three times a week.
I am sure this keeps me going because a few times (when I stopped for a couple of weeks), the pain came back, and I started losing mobility. Each time I went back to doing the PT exercises, the pain once again would clear up.
I never had surgery, and I'm functioning very well with full mobility.
I had asked my doctor why I could do almost anything even though the major tendon was completely torn. He explained that I am continually training the other muscles to take over because I'm doing the PT exercises.
That is also confirmed in an article by the Mayo Clinic, which said exercises could be all that's needed to manage the symptoms.3
My doctor also said that as long as I continue the PT for the rest of my life, it might never get any worse.
It will be a lifetime of continuing the PT exercises every other day to keep the other muscles balanced. I can live with that. I'm avoiding the pain, and I'm maintaining full mobility.
Now, many years later, I'm pain-free with full mobility. The trick was that I needed to continue the PT exercises two or three times a week at home. Diligence with continued exercise is what's necessary.
That might not be the solution for everyone. It all depends on your physical makeup and health. You need to discuss the alternatives with your doctor and ensure they aren't just looking to do surgery for the money.
