Will a torn rotator cuff require surgery?
This answer to this question depends on the condition of the other
shoulder muscles and the age of the patient. Many older patients
have no symptoms with a rotator cuff tear and continue to function
without pain or disability. In one study, up to 40% of patients
over the age of 70 had no symptoms with a tear of the rotator cuff
tendons. The goal of physical therapy is to maximize the function
of the remaining tendons, and hopefully avoid surgery. In the younger
age groups, particularly when tears are caused by a sudden injury,
early surgery is generally recommended to insure a successful treatment
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
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.