There is an almost symbiotic relationship between physical therapists and orthopedic surgeons when it comes to rotator cuff tears. They stand shoulder to shoulder so patients once again can throw a football to their child or pick up their baby from a crib.
When surgery is needed, physical therapy is essential. Sometimes, physical therapy is even used before surgery to enable improved recovery. And sometimes, surgery might be unnecessary if physical therapy is really successful.
“They can message us immediately, if they see the patient struggling in therapy,” said Dr. Benjamin Assenmacher, an orthopedic surgeon at ProMedica. “Physical therapy is crucial for the appropriate return of full motion strength.”
Dr. Assenmacher went so far as to say physical therapy is more important to recovery after rotator cuff surgery than from any other surgical procedure.
Injuries to rotator cuffs, which are a group of four muscles and their tendons that surround the shoulder joint, are common with almost 2 million people in the United States seeking medical care each year, according to the American Academy of Orthopedic Surgeons. The rotator cuff attaches the humerus of the arm bone to the shoulder blade. A tear in any of the four muscles can be complete or partial.
“The rotator cuff is important in preserving the function of the shoulder,” Dr. Assenmacher said.
How many professional athletes return to play after arthroscopic surgery?
Of 208 athletes who had surgery between January of 1998 and December of 2016, 167 returned to play, which is about 80 percent.
Which athletes had the longest recovery times?
NBA players had significantly lower recovery times with an average of 201 days. MLB players had significantly longer recovery times with an average of 413 days.
What is the mean number of seasons played after shoulder arthroscopy?
MLB: 3.7
NFL: 4.7
NHL: 4.8
NBA: 5.8
Source: 2021 study, Professional Athlete Return to Play and Performance after Shoulder Arthroscopy varies by Sport at the National Library of Medicine
Tears can occur for many reasons. Some of the most common are age-related fraying, a sudden and serious injury, or ongoing repetitive movements. Often, it is an athletic injury. Those are the ones that garner the most attention, including the recent announcement by the New Orleans Pelicans that Trey Murphy III has been diagnosed with a torn labrum and partial tear of the rotator cuff in his right shoulder in a game against the Detroit Pistons. He will be out for the remainder of the NBA season. That post on X garnered nearly 116,000 views as of March 20. Most such diagnoses garner little fanfare.
“The biggest factor is age,” said Dr. Assenmacher, noting that after the age of 50 the blood flow begins to decrease and delivery of oxygen and nutrients needed for cellular repairs is slowed — making recovery more challenging.
Recovery can take from three to six months, depending on the size of the tear and what kind of operation is undertaken.
Shoulder arthroscopy is an outpatient procedure in which the surgeon makes tiny incisions. The surgery can take more than an hour for a large tear or less than a half hour for a small tear.
Traditional surgery may be required when there is a complete tear. Mike Coulter, a physical therapist with PT Link Physical Therapy, said he had to go the traditional route when he was diagnosed with a complete tear five years ago.
“Mine they had to open up because it was more detailed,” he said.
In most instances, surgeons want to try physical therapy before surgery with the aim of promoting a natural healing process. But once an operation is undertaken, there are procedures physical therapists generally follow in which the details are dictated by clients' doctors.
“Every doctor has their own protocol,” Mr. Coulter said.
Post surgery
The first step involves at least a couple of weeks of rest. Generally, patients will have a sling and may even sleep in a recliner to help keep that shoulder and arm from moving, according to Mr. Coulter.
Next is passive movement, in which a therapist will move the arm for the client. Next is actively moving the arm by themselves. And finally, weights or resistance will be added for additional strength.
“You are protecting that surgery while you are getting them back to full function,” said Mr. Coulter, who promotes a social-like atmosphere in each PT Link Therapy room. PT Link Therapy has locations in Ohio and Michigan.
Increasing blood flow is also an important part of that process. Heat, electric stimulation, lasers, dry needling, and cupping may come into play.
“The rehab location is just as important as a well-done surgery,” said Dr. Enesi Momoh, an orthopedic surgeon with Mercy Health Toledo. “If they are overly aggressive, it can have a negative impact on the patient's recovery.”
A painful process
Mr. Coulter knew he had problems with his rotator cuff because he was throwing the football to his son underhanded. Then, when it became painful to pull up the bedsheets at night, he knew action needed to be taken.
For some people, there may not be pain. There may be weakness. Movement may become limited at the shoulder making it difficult for the arm to reach above the head. Sometimes, there may be grating or cracking sounds when there is movement.
The injury may move beyond a physical ailment and into emotional distress.
“It is very depressing when you can't do what you want to do. It can be very emotional,” Mr. Coulter said.
Post-surgery also can be physically painful, according to Dr. Momoh.
“Your ability to regain motion depends upon the healing of the rotator cuff,” said Dr. Momoh, noting that blood flow is important to that process. “The issue with the rotator cuffs are there are portions of the tendon that have a decreased blood supply and that results in decreased healing.”
Other factors that come into play include smoking, obesity, diabetes, and poor bone density.
Nevertheless, Dr. Momoh said that about 90 percent of operations involving a small or medium tear are successful. That drops to about 60 percent to 70 percent when a large or massive tear is involved.
Dr. Momoh suggests seeing a neurosurgeon whenever a tear of any size is suspected. At the very least, ongoing monitoring — and maybe some physical therapy — might help prevent a small tear from becoming a massive tear.
First Published March 30, 2025, 4:00 a.m.
