Hi! I’m 46 and have an 8 mm AP, near full-thickness bursal-sided supraspinatus tear, according to the MRI findings. I also had a pretty significant AC separation in the same shoulder about 24 years ago (I was told grade 4 at the time - no surgical repair).
This wasn’t from any specific injury. My shoulder has bothered me off and on for years, but it’s gradually gotten worse, especially over the last year. It’s gotten to where it wakes me up at night sometimes and has made some of the things I do pretty miserable.
I currently have rotator cuff surgery scheduled for 9/23, but I’m having a hard time deciding whether to go through with it or give PT a real chance first.
For some background, I’ve followed BBM for a long time. I did SSLP and was actually coached by Leah before she joined BBM. I haven’t lifted in over a year though, and honestly my consistency had gotten pretty bad for a couple years before that.
Getting back to lifting is one of my goals, but it’s not my only concern. I also blacksmith and regularly use a 3-lb hammer. I kiteboard, where most of the normal pull is through the waist harness, but there can obviously be sudden loads on the shoulder from gusts, steering, crashes, catching yourself, etc. I also have a 20-year-old disabled son who weighs about 115 lbs that I transfer between his wheelchair and bed a couple times a day.
So I need more out of the shoulder than just being pain-free doing normal day-to-day stuff, if possible.
I’ve been reading quite a bit about surgery vs nonoperative treatment, and I’m having trouble finding a clear answer. It seems like plenty of people can function really well with an unrepaired tear, but feeling better obviously doesn’t mean the tear healed. On the other hand, some high-grade tears progress over time. What I really can’t find is much evidence about what happens when someone rehabs one successfully and then goes back to putting significant demands on it for years.
I got a second opinion from a nonsurgical sports medicine doctor, and his answer was basically that the outcomes are too inconclusive to really know. I’ve also started seeing a performance-oriented PT, and I found that visit much more helpful.
He took some baseline rotational strength measurements, to find differences between left and right arms, and wants to see what happens over the next couple weeks. Right now he only has me doing two exercises, but every day:
- A 10-lb dumbbell side raise, but only maybe 1/3 of the way up. I raise it until I feel the muscle really kick in and/or start to feel some pain, and hold it there for 30 seconds. 3 reps.
- A light resistance band with my upper arm straight out to the side at 90 degrees, elbow bent and forearm vertical (like I’m waving at someone). I step back until there’s tension trying to rotate the shoulder forward and hold against it for 30 seconds. 3 reps.
His thought is that if we can measure an improvement in strength and I’m having less pain over the next couple weeks, it would be worth rescheduling the surgery and continuing to work on it, adding in more exercises as well. If we continue seeing improvement, then potentially cancel surgery altogether. If there’s no improvement, he recommends I go ahead with surgery.
What do you guys think of that approach? Is a couple weeks enough to tell us anything meaningful, or would you approach this differently? And would BBM’s self-guided shoulder rehab template make more sense, or would you stick with what the PT is doing and progressively build from there?
The bigger question I’m trying to answer is whether it’s actually realistic to manage a near full-thickness tear like this long term and get back to lifting, blacksmithing, kiteboarding, and transferring my son without eventually making the tear worse.
I’m not against surgery. Actually, if I’m probably going to need it eventually anyway, I’d rather just do it now and get the recovery over with. What I don’t know is whether PT gives me a legitimate chance of avoiding surgery long term, or if I’d mostly just be postponing it and potentially dealing with a bigger tear later.