Rotator Cuff Related Shoulder Pain (RCRSP) accounts for 70% of all shoulder problems and is characterised by pain and weakness with shoulder movement, particularly lifting the arm over head or behind the back. The underlying tissue changes may involve the tendons (e.g. tears) or the bursa (e.g. thickening or fluid).
Although there is no perfect treatment for this problem, current clinical guidelines recommend exercise and advice with a healthcare professional before invasive options such as surgery. If you have visited a health practitioner such a doctor or physiotherapist, it is likely that these options have been discussed. Before you make your decision, it is important that the risks and benefits of all of your options have been thoroughly explained so you can make the best and most informed choice for you. A recent study among people with rotator cuff related shoulder pain found that this does not always occur.
This study interviewed 15 people with rotator cuff related shoulder pain who had had surgery. Participants were asked about the reasons why they opted to have surgery. Unsurprisingly, shoulder pain and its impact on daily life and activities was a primary reason, with many patients experiencing pain for long durations and with innocuous activity such as getting dressed or writing or washing hair. These patients were likely keen for surgery and had often exhausted or “failed” with other treatment strategies such as exercise leaving them with no other options.
Patients surveyed in this study also reported their decision for surgery was driven by the perception that they had a mechanical defect which would not resolve with physiotherapy management and their pain would therefore remain if they did not choose a surgical approach. At a surface level, this can be difficult to argue as many patients will have sought medical imaging to confirm their diagnosis and it can seem reasonable to assume that any pathology evident on a scan is the reason for their pain. It is important to note however, that for people who have rotator cuff tears – even if you have a full thickness tear – exercise and education can lead to a positive outcome which enables you to avoid surgery.
A crucial part of the management strategy for people that have rotator cuff related shoulder pain is a shared decision-making process involving you sitting down with a health care professional that you trust to work through all the pros and cons of the treatment options available to you. This is a crucial part of your healthcare experience and may cause you to think different about your choice of treatment (as was reported by some people in the interview study)
Please get in touch one of the physiotherapists at our clinic if you would like to learn how this information may relate to your shoulder condition, or with any other queries you may have.
Malliaras, P., Rathi, S., Burstein, F., Watt, L., Ridgway, J., King, C., & Warren, N. (2021). ‘Physio’s not going to repair a torn tendon’: patient decision-making related to surgery for rotator cuff related shoulder pain. Disability and rehabilitation, 1–8. Advance online publication. https://doi.org/10.1080/09638288.2021.1879945