How JustAnswer Works:
  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.
Ask Delores Casso Your Own Question
Delores Casso
Delores Casso, Paramedic (EMT)
Category: Health
Satisfied Customers: 29
Experience:  Paramedic, Family Practice, OB, GYN, Internal Med. ER
Type Your Health Question Here...
Delores Casso is online now
A new question is answered every 9 seconds

rotator cuff injury

Customer Question

I have a partial tear of the bursal surface of the anterior distal fibers of the supraspinatus tendon. involving 70% of the tendon thickness. Will therapy and massage help or do I need surgery?
Submitted: 11 years ago.
Category: Health
Expert:  Kerry replied 11 years ago.


While prompt surgery is usually recommended for acute cuff tears in generally healthy shoulders, exercises may be helpful in maintaining the flexibility and strength of joints with long-standing cuff tears. In most cases, these exercises can be done in the patient's home with little equipment. Shoulder exercises are best performed gently several times a day on an ongoing basis. The exercises are not dangerous if they are performed gently so that they do not risk enlarging the cuff tear.

Sometimes physical therapists suggest other types of therapy. Patients should learn the possible risks of these approaches as well as their costs and anticipated effectiveness.

When combined with a good rehabilitation effort, rotator cuff surgery allows people to regain much of the lost comfort and function in shoulders with cuff disease. In experienced hands, this procedure can address the restricting scar tissue and roughness that frequently accompany cuff disease. If the quantity and quality of the tissue is good, surgery can help repair the tendon back to the bone from which it has been torn. This is most likely to succeed soon after a cuff tear in otherwise healthy shoulders of non-smokers who have not had multiple cortisone injections.

Rotator cuff surgery can improve the mechanics of the shoulder, but cannot make the joint as good as it was before the cuff tear. In many cases, the tendons and muscles around the shoulder have been weakened from prolonged disuse before the surgery. The tissue may be insufficient for a strong repair. In such cases the mechanics of the shoulder may be improved by carefully smoothing out the cuff area and moving the shoulder immediately after surgery so that new scars are not formed.

If the cuff is repaired, it takes months before the tendon is strongly healed to the bone. During this time, strengthening exercises must be avoided so that healing is not impaired. After the healing, it may take months of gentle exercises before the shoulder achieves maximal improvement.

The effectiveness of the procedure depends on the health and motivation of the patient, the condition of the shoulder, and the expertise of the surgeon. When performed by an experienced surgeon, rotator cuff surgery usually leads to improved shoulder comfort and function. The greatest improvements are in the ability of the patient to sleep, perform activities of daily living, and engage in non-contact recreational activities.


What will happen if a torn rotator cuff is not treated with surgery? Will I lose the use of my arm? Will the tear get larger over time? These are common concerns patients have, and the answers are not always clear. In one study, 40 percent of patients with a rotator cuff tear showed enlargement of the tear over a five-year period; however, 20 percent of those patients had no symptoms. Therefore, less than half of patients with a rotator cuff tear will have tear enlargement, but 80 percent of patients whose tear enlarges will develop symptoms. This data is based on a small group of patients; it is important to realize that once symptoms develop, progression may have already progressed and enlarged.

Non-surgical treatment typically involves:

  1. Strengthening Exercises
  2. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
  3. Injections
  4. Activity modification (avoidance of activities that cause symptoms)

Non-operative management of a rotator cuff tear can provide relief in approximately 50 percent of patients.

These studies show that about half (50 percent) of patients have decreased pain and improved motion, and are satisfied with the outcome of nonsurgical treatment. Surgeons may recommend nonsurgical treatment for patients who are most bothered by pain, rather than weakness, because strength did not tend to improve without surgery. There are a few predictors of poor outcome from nonsurgical treatment:

Long duration of symptoms (more than 6-12 months)
Large tears (more than 3 centimeters)

Nonsurgical treatment has both advantages and disadvantages.

Patient avoids surgery and its inherent risks:

    1. Infection
    2. Permanent stiffness
    3. Anesthesia complications
      Patient has no "down time"

Strength does not improve
Tears may increase in size over time
Patient may need to decrease activity level

Surgical management is indicated for a rotator cuff tear that does not respond to non-operative management and is associated with weakness, loss of function and limited motion. Because there is no evidence of better results in early versus delayed repairs, many surgeons consider a trial of non-operative management to be appropriate. Tears that are associated with profound weakness, are caused by acute trauma, and/or are very large (greater than 3cm) on initial evaluation may also be considered for early operative repair. Operative treatment of a torn rotator is designed to repair the tendon back to the humeral head (ball of joint) from where it is torn. This can be accomplished in a number of ways. Each of the methods available has its own pros and cons; all have the same goal--getting the tendon to heal to the bone. The choice of surgical technique depends upon several factors including the surgeon's experience and familiarity with a particular procedure, the size of the tear, patient anatomy, quality of the tendon tissue and bone, and the patient's needs. Regardless of the repair method used, studies show similar levels of pain relief, strength improvement, and patient satisfaction. eference-Library-Home/cat_id/6228

Hope that helps


Expert:  Delores Casso replied 11 years ago.
Kerry is right. Take it from someone who had shoulder surgery last Wed....I highly suggest you do it and get it over with. Shoulder are hard to mend. I know they want to try physical therapy first, but I know first hand how painful shoulder rehab is. I didn't have a cuff injury, I had frozen shoulder;however, these things rarely clear up on there own. I would say as a medical professional and as a patient to follow Kerry's advice :)

JustAnswer in the News:

Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.

What Customers are Saying:

  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
< Previous | Next >
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
  • I have been dealing with an extremely serious health crisis for over three years, and one your physicians asked me more questions, gave me more answers and encouragement than a dozen different doctors who have been treating me!! Janet V Phoenix, AZ

Meet The Experts:

  • Family Physician

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    Emergency Medicine and Family Practice for over 26 years
< Last | Next >
  • Family Physician's Avatar

    Family Physician

    Doctor (MD)

    Satisfied Customers:

    Emergency Medicine and Family Practice for over 26 years
  • Nurse Milli, RN's Avatar

    Nurse Milli, RN

    Nurse (RN)

    Satisfied Customers:

    20 years experience in many areas of Nursing. Both Hospital and Private Practice experience.
  • Dr. Ketch's Avatar

    Dr. Ketch


    Satisfied Customers:

    Medical Degree, Former Assistant Professor at School of Medicine at Yale University
  • Dr. Arun Phophalia's Avatar

    Dr. Arun Phophalia

    Doctor (MD)

    Satisfied Customers:

    MBBS, MS (General Surgery), Fellowship in Sports Medicine
  • A. Schuyler, NP's Avatar

    A. Schuyler, NP

    Nurse Practitioner

    Satisfied Customers:

    Board Certified NP, MS, RN. Private practice & hospitalist
  • Dr. Mark's Avatar

    Dr. Mark

    Doctor (MD)

    Satisfied Customers:

    U.S. Physician/Surgeon in Neurosurgery
  • Dr. Gupta's Avatar

    Dr. Gupta

    Doctor (MD)

    Satisfied Customers:

    Vastly experienced MD Physician with 19 years of experience.