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Q: What rehabilitative techniques are necessary for torn rotator cuffs? When is surgery necessary and when is it avoidable?

Typically, in degenerative rotator cuff tears, shoulder range of motion is abnormal and muscles are weak. A muscle strength imbalance often exists. Additionally, there are postural concerns that need to be addressed. Therefore, normalization of range of motion and strength are necessary as well as improvement of posture. Above-the-head and heavy lifting activities are to be avoided.

Treating rotator cuff injuries is not simplistic. There are chapters in books and whole books themselves written on rotator cuff injuries for both post surgical and nonsurgical rehabilitation techniques. Based on my experience of 15 years and my supervision of probably 2000-3000 rotator cuff injuries, success in non-surgical rehabilitation is 60-80%. Of course, age, severity of rotator cuff tear, current physical status, etc. are all factors that affect overall outcomes. Typically, patients choose surgery based primarily on pain. Secondarily, surgery is chosen due to loss of function. Elderly patients more often choose not to pursue surgery as compared to younger, athletic populations. I certainly recommend conversing with your orthopedic doctor about surgical and nonsurgical alternatives.

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