Should My 72-Year-Old Mother Choose Rehab or Surgery for Rotator Cuff Tear?

Rotator cuff tear

Hello, Dr.
Yin.
My mother has a rotator cuff tear in her shoulder.
She has seen two doctors at two different hospitals, and both performed ultrasounds.
They mentioned that the tear is quite large and there is some fluid accumulation.
One doctor suggested starting with six months of rehabilitation before considering surgery, while the other doctor recommended proceeding directly with surgery.
I would like to ask Dr.
Yin whether my mother should first undergo rehabilitation for six months or opt for surgery right away, as she is 72 years old and I am unsure which option would be more suitable for her.
The doctor who suggested immediate surgery mentioned that my mother would need two metal screws, while the doctor who recommended rehabilitation attempted to drain the fluid but said it was difficult to extract.
Thank you for your advice.

Xiao Wu, 30~39 year old female. Ask Date: 2022/09/01

Dr. Yin Xinbei reply Rehabilitation

The shoulder rotator cuff is composed of four muscles, and the rupture of one of these muscles can affect the range of motion and strength of the shoulder, but it is not usually severe.
Unless the individual is an athlete with specific needs, surgical repair or fixation is generally not necessary.
This is especially true for elderly patients, where the focus should be on managing symptoms such as pain and joint stiffness.
Elderly individuals often avoid movement due to fear of pain, which can lead to secondary frozen shoulder (adhesive capsulitis), resulting in an inability to raise the arm completely.
This condition is not caused by the rupture of a specific rotator cuff muscle but rather by the tightening of the shoulder joint capsule.
With patience in rehabilitation, the contracted shoulder joint capsule can be stretched, and other shoulder muscles can be trained to compensate for the ruptured muscle, thereby restoring the shoulder function necessary for daily activities.

Reply Date: 2022/09/01

More Info

When considering whether your 72-year-old mother should undergo surgery or rehabilitation for a rotator cuff tear, several factors must be taken into account, including her overall health, the severity of the injury, and her personal preferences.
Rotator cuff tears are common, especially in older adults, and they can lead to significant pain and functional limitations. The rotator cuff is a group of muscles and tendons that stabilize the shoulder joint and allow for a wide range of motion. When a tear occurs, it can result in pain, weakness, and difficulty in performing daily activities.

Rehabilitation vs. Surgery
1. Rehabilitation:
- Pros: Non-invasive and generally safer for older adults. Physical therapy can help strengthen the shoulder muscles, improve flexibility, and reduce pain. Many patients experience significant improvement with conservative treatment, especially if the tear is partial or if there is no significant loss of function.

- Cons: It may take time to see improvement, and there is a possibility that the tear may not heal completely, leading to ongoing pain or functional limitations. If rehabilitation does not yield satisfactory results, surgery may still be necessary later.

2. Surgery:
- Pros: Surgical intervention can provide a more definitive solution, especially for complete tears or when conservative measures fail. Surgery can restore function and alleviate pain, allowing for a return to normal activities.

- Cons: Surgery carries inherent risks, particularly for older patients. These risks include complications from anesthesia, infection, and a longer recovery time. Additionally, post-surgery rehabilitation is often required, which can be intensive and may take several months.

Factors to Consider
- Overall Health: Your mother’s general health status is crucial. If she has other medical conditions that could complicate surgery or recovery, such as heart disease or diabetes, these should be carefully evaluated. A thorough assessment by her primary care physician or a geriatric specialist may be beneficial.

- Functional Status: Consider how the injury affects her daily life. If she is unable to perform essential activities or experiences significant pain, surgery might be more appropriate. If she can manage her symptoms and maintain her quality of life through rehabilitation, that may be the better option.

- Personal Preference: It’s essential to involve your mother in the decision-making process. Discuss her concerns, fears, and expectations regarding both options. Her willingness to engage in rehabilitation or her desire to avoid surgery can significantly influence the decision.

- Second Opinions: Since you have received differing opinions from two doctors, seeking a third opinion from an orthopedic specialist who focuses on shoulder injuries may provide additional insights.

Conclusion
Ultimately, the decision between rehabilitation and surgery for your mother’s rotator cuff tear should be made collaboratively, considering her health status, the severity of the tear, and her personal preferences. If she is generally healthy and active, and if the tear is not severely limiting her daily activities, starting with rehabilitation may be a wise choice. However, if her quality of life is significantly impacted, or if she has a complete tear, surgery might be the more appropriate option.

In any case, close monitoring of her progress during rehabilitation is essential, and if her condition does not improve, revisiting the surgical option should be considered. Always ensure that she has a supportive healthcare team to guide her through this process.

Similar Q&A

Understanding Degenerative Disc Disease: Surgery vs. Rehabilitation Options

Hello Dr. Chiu, My mother is 61 years old. About nine months ago, she sought treatment for hip pain, and the doctor diagnosed her with cartilage degeneration. Recently, she has started experiencing numbness in her legs for the past month, so surgery is being considered. When I ...

Dr. Qiu Yushu reply Neurosurgery
There are many causes of lower back pain. Please visit the outpatient clinic to determine the best treatment method. Thank you.

Should My Mom Choose Steroid Injections or Surgery for Shoulder Tendon Issues?

Hello Doctor: My mother has been experiencing shoulder pain for about three months. An MRI revealed that her tendon is nearly torn. She has taken pain medication, but her condition has not improved. The doctor suggested she could receive a steroid injection and undergo rehabilita...

Dr. Hong Ximing reply Orthopedics
Hello: You have been experiencing shoulder pain for three months, and the MRI has shown that the tendon is close to rupture. It is recommended that you undergo surgical repair first. After the wound has healed, you can then proceed with rehabilitation therapy to prevent further d...

Neck Disc Herniation: When to Consider Surgery After Rehab

My mother (48 years old) experienced neck and hand pain earlier this year and consulted a neurosurgeon. After an MRI, she was diagnosed with a herniated disc at the C3-C4 level. The doctor recommended surgery, but due to her allergy to anesthesia, she opted for rehabilitation. Al...

Dr. Ding Xianwei reply Neurosurgery
Due to the lack of imaging data and not having personally examined you, I can only provide suggestions based on your information. If rehabilitation does not show improvement, surgery may be a consideration. However, since I am not aware of the specifics of your allergy to anesthe...

Effective Rehabilitation Strategies for Shoulder and Arm Pain Relief

My mother often says that she is a useless woman. At 50 years old, she experiences aches and pains in various parts of her body. When she lifts something slightly heavy, her arms become sore; if she carries something with her shoulders, the pain becomes unbearable. Especially wit...

Dr. Chen Xianchang reply Rehabilitation
Hello, thank you for your inquiry. Here are my responses and recommendations: 1. Generally speaking, individuals over the age of fifty may experience muscle and joint degeneration and atrophy, making it difficult to handle heavy weights. 2. It is advisable to apply heat therap...