Question 1

How do I know if I need to see a shoulder specialist?

Accepted Answer

If your shoulder pain isn't getting better after a few weeks, is getting worse, or is interfering with your daily activities, it's time to get evaluated. You should definitely see a specialist if you're having trouble sleeping because of shoulder pain, can't lift your arm overhead, feel weakness in your shoulder, or heard a pop followed by immediate pain and weakness.

You don't need a referral to schedule an appointment - you can contact me directly. I see patients at all stages, whether you've already tried physical therapy or you're just starting to figure out what's wrong.

Question 2

What's the difference between a rotator cuff tear and shoulder arthritis?

Accepted Answer

These are two completely different problems, though they can sometimes happen at the same time.

A rotator cuff tear is damage to the tendons that help lift and rotate your arm. You'll typically feel pain on the outside of your shoulder, have trouble reaching overhead or behind your back, and might have weakness. Night pain is really common with rotator cuff tears.

Shoulder arthritis is wear and tear of the cartilage in your shoulder joint. The pain is usually deeper in the joint, and you'll notice stiffness and grinding or catching when you move your arm. Arthritis pain often gets worse with activity and better with rest.

The good news is that both can be treated. Sometimes physical therapy and injections help. When they don't, there are excellent surgical options like rotator cuff repair for tears or shoulder replacement for arthritis.

Question 3

Can physical therapy help a rotator cuff tear?

Accepted Answer

Yes, absolutely. Physical therapy can't heal the tear, but it can strengthen the surrounding muscles to compensate for the damaged tendon. Many patients get significant relief from a good PT program.

I usually recommend trying conservative treatment first unless there are specific reasons to move straight to surgery (like a traumatic tear in a young, active person or rapidly progressing weakness).

Question 4

Will my rotator cuff tear heal on its own?

Accepted Answer

Unfortunately, no. Once a rotator cuff tendon is torn, it doesn't heal back to the bone on its own. The good news is that "not healing" doesn't mean you'll definitely need surgery. Many people live perfectly fine with rotator cuff tears that never heal.

The key is whether the tear is causing problems in your life. If it is, we can talk about surgical options. If it's not, we can monitor it and focus on keeping your shoulder as functional as possible.

Question 5

What size rotator cuff tear needs surgery?

Accepted Answer

The decision about surgery isn't really about the size of the tear - it's about how the tear affects your life.  I look at a few key things:

Are you having pain that keeps you up at night? 
Is your shoulder weak enough that it's hard to do everyday activities? 
Are you losing muscle (atrophy)?

Some people have large tears and manage fine without surgery. Others have smaller tears that cause significant problems. If you're near age 65 or older, I might recommend a reverse total shoulder replacement instead of repairing the tendon, especially if there's muscle loss.

The bottom line: surgery is about improving your quality of life, not just fixing what shows up on an MRI.

Question 6

What does "complete retracted tear of the supraspinatus" mean?

Accepted Answer

A complete tear means the tendon is torn all the way through. "Retracted" means the muscle has pulled back away from where it should attach to the bone - kind of like a rubber band that's been cut and snaps back.

Retraction is a sign of a more severe tear because that pulled-back muscle isn't working properly to move your shoulder. Retracted tears are also more likely to develop muscle atrophy (shrinking and weakening of the muscle).

If you have a retracted tear, it doesn't automatically mean you need surgery, but it does mean we need to have a conversation about your symptoms and goals. In some cases, especially if there's significant retraction and muscle loss, I might recommend a reverse total shoulder replacement or a lower trapezius tendon transfer instead of trying to repair the tendon.

Question 7

Do all rotator cuff tears need surgery?

Accepted Answer

No. This is one of the biggest misconceptions I see. Many people do well with physical therapy, activity modification, and sometimes anti-inflammatory medications or injections.

The tears that typically need surgery are the ones causing significant pain (especially at night), weakness that interferes with daily activities, or progressive muscle atrophy. If your symptoms are manageable and you can do the things you want to do, surgery might not be necessary.

Question 8

How do I know if my shoulder pain is from a rotator cuff tear?

Accepted Answer

Common signs include pain on the outside of your shoulder (not the joint itself), difficulty reaching overhead or behind your back, weakness when lifting or rotating your arm, and pain that wakes you up at night - especially when you roll onto that shoulder.

The only way to know for sure is to get evaluated. An MRI can show if there's a tear and how severe it is, but remember - the MRI doesn't tell the whole story. Your symptoms and how they affect your daily life matter just as much.

Question 9

What happens if I don't get my rotator cuff tear fixed?

Accepted Answer

It depends on the tear. Some tears stay stable for years and cause minimal problems. Others can get larger over time, and the muscle can atrophy (shrink and weaken).

If you're having significant symptoms that aren't improving with conservative treatment, waiting too long can sometimes make surgical repair more difficult or less successful. That said, even if a tear becomes irreparable, there are still surgical options like reverse total shoulder replacement or lower trapezius tendon transfer that can restore function.

The best approach is to get evaluated so we can figure out what's going on and make a plan that makes sense for your situation.

Question 10

When should I consider shoulder replacement surgery?

Accepted Answer

Shoulder replacement is typically for people with severe shoulder arthritis who have tried everything else - physical therapy, medications, injections - and are still having significant pain and loss of function.

If you can't sleep because of shoulder pain, can't do basic activities like getting dressed or washing your hair, or your quality of life has really declined because of your shoulder, it might be time to talk about replacement.

There are different types of shoulder replacement. A traditional (anatomic) shoulder replacement works well if your rotator cuff is intact. If you have a rotator cuff tear along with arthritis, or if you're older with a large rotator cuff tear, a reverse total shoulder replacement might be a better option. I perform over 100 reverse shoulder replacements each year and have an infection rate well below 1%.

Question 11

What is a reverse total shoulder replacement and how is it different from regular shoulder replacement?

Accepted Answer

In a normal shoulder replacement, we replace the worn-out ball and socket with artificial parts that look similar to your natural anatomy - a ball on the arm bone and a socket on the shoulder blade.

A reverse total shoulder replacement flips this around. We put a ball where the socket used to be and a socket where the ball used to be. This sounds weird, but it works really well for certain problems.

The reverse design lets you use your deltoid muscle (the big muscle on top of your shoulder) to lift your arm instead of relying on your rotator cuff. This makes it perfect for people who have rotator cuff tears that can't be repaired, arthritis combined with rotator cuff problems, or failed previous shoulder surgeries.

Most people get excellent pain relief and can return to their normal activities after a reverse shoulder replacement. Recovery takes a few months, but the results are usually worth it.

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