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 outcome.

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 required.

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.

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