Will a torn rotator cuff require surgery?

This answer to this question depends on the condition of the other shoulder muscles and the patient. In general, Dr. Tauro recommends repair of symptomatic small and medium size full thickness rotator cuff tears since these tears may progress to larger, unrepairable tears as time goes on. In older patients who have massive, multiple tendon tears, Dr. Tauro recommends a trial of a cortisone injection and physical therapy. This is because many of these tears cannot be fully repaired and so the results of surgery are not as good. However, even patients with these massive tears who have chronic severe pain that is not relieved by injections and therapy can expect significant improvement with an arthroscopic repair of as much of the cuff as possible. In the younger age groups with tears that are caused by a sudden injury, early surgery is the most important in order to insure a successful treatment outcome.

What is physical therapy likely to do to make mechanical impingement better?

Physical therapy is the mainstay of treatment for impingement. The vast majority of patients improve with therapy and oral anti-inflammatory medication. Strong rotator cuff muscles can relieve impingement symptoms by exerting a downward force on the humeral head, opening up the space available under the acromion. Spurs that develop beneath the acromion cannot be resolved with physical therapy, but the healthier the rotator cuff is, the less likely it is that surgery will be required.

Are there harmful effects of steroid injections for impingement?

Generally speaking, a limited number (3-5) of steroid injections into the bursa are a safe, and often effective way to locally reduce inflammation and alleviate pain. These locally applied steroids do not have the same risks associated with the chronic use of oral steroids since the body does not systemically absorb them. However, it has been shown that repeated steroid injections can damage the quality of the rotator cuff tendons if a repair is later required.

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