[BoneDoc]

Hey JonPop,

A lot of people do recover just fine from a rotator cuff tear. When someone says they have a "rotator cuff" tear, they are usually referring to their supraspinatus tendon specifically (there are a total of four muscles that make up the rotator cuff). The supraspinatus muscle is attached to the top of your scapula (a bone people often call the shoulder blade) and its tendon passes laterally, under the acromion (a bone that is part of the scapula) and attaches to the top of your humerous (the bone in your upper arm). It helps you lift your arm up and out from your side (called abduction), along with your deltoid muscle. If you have a partial tear of your supraspinatus tendon, there is a good chance for recovery. If you have a full-thickness or near full-thickness tear, you will need surgery at some point if you plan on using your shoulder for anything semi-strenuous.

First, is this an old injury or a new one? Did you have an MRI done? Do you know if you have any acromion impingement on the tendon?

Ice and NSAIDs are the best initial therapy for a tear. I recommend ice three times a day, for 15-20 minutes, and ice anytime following heavy use of the shoulder. Ibuprofen is a great NSAID. I recommend two 200mg tabs three times per day for a couple of weeks. This will help knock down down any inflammation present. Of course, if you have any history of stomach sensitivity to NSAIDs or a history of gastric ulcers you will not want to do this. Alleve (aka naproxen) also works well and you can take fewer doses in a day compared to ibuprofen. I also recommend taking NSAIDs just prior to any strenuous activity as prophylaxis for inflammation.

After you have reduced the inflammation and pain from a recent injury (approx. two weeks), the right physical therapy program can help you strengthen other muscles in the shoulder to compensate for any supraspinatus weakness. The best way to do this is find a reputable physical therapist to get you started on the right routine. If you want, I can recommend a few exercises to get you started. The most important thing is to take it slow and not overdo it or you will be doing more damage than good, just like PE.

An MRI will tell you if you have a partial or full-thickness tear. This is an important thing to know. People can get by with a full-thickness tear without surgery, but they will certainly have shoulder weakness and have limited capabilities, even with physical therapy strengthening. Also, if you have any acromion impingement on the tendon, the tear is almost guaranteed to get worse with use. In this situation, the acromion bone is hooked and presses down on the tendon as it glides back and forth with use. The best thing to do for acromion impingement is to scope the shoulder and shave down the bone to give the tendon more space.

Hope this helps.