Rotator cuff tear: Torn tendon in the shoulder – Does it need to be operated on?

The rotator cuff tear

A fall on the arm, years of wear and tear, or constant overhead work: Suddenly the arm loses strength, lifting it to the side causes massive pain, and the MRI shows a Rotator cuff tear. Very often, the so-called Torn supraspinatus tendon or completely severed.

For many patients, this sounds like an immediate case for the operating room. But we want to encourage you: by no means does every tear have to be sewn up! The human body is a master of compensation.

Typical symptoms

• Loss of strength when raising the arm laterally
• Pain, especially when working on the upper back or lying on the affected shoulder at night
• A audible or palpable tearing in the moment of injury (in acute trauma)

How the shoulder can function without an intact tendon

The rotator cuff is a composite of four muscles that enclose the humeral head like a cuff and center it in the joint. If a tendon tears, a gap is created in the system. However, the brilliance of our body allows other muscles (such as the deltoid muscle or the remaining parts of the cuff) to take over the function of the torn structure.

The problem: After the injury, the brain often no longer knows how to properly control these „replacement muscles.“ This is where physical therapy comes in. With a Tear of the tendon in the shoulder without surgery is rehabilitation primarily about neuromuscular relearning. Through neuro-centric training, we show your nervous system how to stabilize the shoulder joint again and move it pain-free.

Looking beyond the shoulder

Rotator cuff therapy does not cure itself. When the shoulder weakens, the neck often cramps up, the shoulder blade is in the wrong position, and the thoracic spine becomes stiff. In therapy, we therefore always look at the entire biomechanics. Is the torso stable? Is the cervical spine free? The better the surrounding tissue functions, the easier it is for your injured shoulder. Persistent muscular overloads (trigger points) that arise from this compensation can, if necessary, also be gently and precisely treated with manual techniques or, if desired, punctually with Dry needling relax.

Rotator cuff rupture: surgery or physiotherapy?

The studies provide encouragement. A Cochrane review with nine studies and 1007 participants concluded that whether suturing the tendon in a rotator cuff rupture brings any noticeable benefit is uncertain. Compared with treatment without surgery, it may have little or no clinically significant benefit in pain and function (Karjalainen et al., 2019).

In small fractures without injury, a Finnish study involving over 55-year-olds also showed no difference between physiotherapy alone and surgery followed by physiotherapy (Kukkonen et al., 2021). Even in the case of a minor, fresh rotator cuff rupture after an accident, surgery and physiotherapy after a year were equally effective. However, the tear increased by more than 5 millimeters in about a third of the non-operated patients (Ranebo et al., 2020).

For you, this means that in the case of a minor rotator cuff tear, physiotherapy is often an equally effective first course of treatment. It is important to have medical supervision so that a deterioration can be detected early. The studies primarily examined minor tears. In the case of large tears or when the arm is barely able to be raised after an accident, the decision to undergo surgery lies in the hands of a shoulder specialist or a shoulder specialist.

Self-help: Everyday practical tips for more stability

• The shoulder blade focus: In everyday life (especially at your desk), make sure to lift your breastbone slightly and gently let your shoulder blades glide toward your back pockets. This centers the head of the humerus and takes the pressure off the irritated supraspinatus tendon.

• The Isometric Wall Exercise: Stand sideways against a wall. Gently press the back of the hand of the affected side against the wall (without moving the arm). Hold the tension for 5 seconds. This activates the remaining rotator cuff without irritating the joint.

Rotator cuff rupture: When to see a doctor or go to physical therapy?

Have your shoulder examined promptly if you have injured your arm after a fall or injury. can hardly lift anymore, If you experience severe pain at night, feel noticeably weak when lifting, or the symptoms do not improve despite adapted exercise and therapy over several weeks, this indicates that conservative therapy is not sufficient for your rotator cuff tear and that an operation may be necessary.

Sources on rotator cuff rupture

• Karjalainen T. V. et al. (2019): Surgery for rotator cuff tears. Cochrane Review. PubMed
• Kukkonen J. et al. (2021): Operative versus conservative treatment of small, nontraumatic supraspinatus tears in patients older than 55 years: over 5-year follow-up of a randomized controlled trial. Journal of Shoulder and Elbow Surgery. PubMed
• Ranebo M. C. et al. (2020): Surgery and physiotherapy were both successful in the treatment of small, acute, traumatic rotator cuff tears: a prospective randomized trial. Journal of Shoulder and Elbow Surgery. PubMed

Trust specialists near you Are you facing a difficult surgical decision or looking for a second opinion? The experienced team of Physiotherapy Waidfuss Based in the heart of Zurich (Wipkingen/Höngg), we advise you honestly and competently. Book your appointment online now and let's work together on your shoulder stability!

After an accident? Information on the cost coverage by the Accident Insurance (UVG) and on the course of therapy can be found on our page. Physiotherapy after an accident in Zurich.