I get this question all the time. While shoulder surgery is indicated and necessary in certain situations, it is not always required to return to full function. Fortunately I have been able to save multiple patients from unnecessary shoulder surgery.
Rotator cuff tear
Just because someone has a rotator cuff tear does not mean that they need to have surgery. Recent research has shown that non-operative care, such as physical therapy, may be successful in managing partial thickness and full thickness rotator cuff tears. Recent studies have suggested that individuals opting for physical therapy in place of surgery for rotator cuff tears have demonstrated high satisfaction, return to function and success in avoiding surgery (Edwards, Ebert, Joss, Bhabra, Ackland, Wang). Those who have trialed physical therapy with little success and still have reduced quality of life due to shoulder pain may require surgery (Itoi). Individuals looking to completely avoid rotator cuff repair surgery should ensure they have a comprehensive plan of care that includes a customized home exercise program with their physical therapist in order to get the best outcomes.
Shoulder surgery may be required if there was a traumatic incident involved, there is unidirectional instability, and a bankart lesion is present. However, if an individual has multidirectional instability, there is no presence of trauma, and pain/instability is present in both shoulders, then these people typically respond well to physical therapy treatment (Winge, Thomsen, Jensen, Klareskov). Just because there is clicking does not indicate a need for surgery but should be examined thoroughly by a physical therapist or physician.
Move Forward by the American Physical Therapy Association (APTA) does a good job in this article at discussing what a SLAP tear is and if you need physical therapy. Similar to the shoulder instability discussed above this may be managed conservatively with physical therapy. Often times this may be recommended first to avoid surgery. If physical therapy is unable to manage a person's symptoms or they are unable to return to full function then surgery is often recommended.
Watch the video below for more info!
Edwards, P., Ebert, J., Joss, B., Bhabra, G., Ackland, T., & Wang, A. (2016). EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE. International journal of sports physical therapy, 11(2), 279-301.
Itoi E. (2013). Rotator cuff tear: physical examination and conservative treatment. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 18(2), 197-204.
Winge S, Thomsen NO, Jensen CH, Klareskov B (1998). Shoulder instability. Ugeskr Laeger.160(25):3707-13.