Rotator Cuff tear - doc says I need surgery

[SomeGymGuy]

Hi Folks,

Long time follower of these forums. This is my first post.

Had an MRI with contrast done on my shoulder and the doc says I need surgery. There is a lot on here that has helped me with an injured back, and no surgery was required (given, I still battle it from time to time). Id like to get somebody smart to look at the below shoulder MRI report and tell me if I really need surgery or if this is manageable w/the right rehabilitation. Basically, where the rotator cuff attaches to the outside of the shoulder, it tore but is still hanging on by a few threads.

--FROM RADIOLOGY REPORT--
Findings:
Rotator cuff: Supraspinatus and infraspinatus: There is a large full-thickness tear of the supraspinatus demonstrating a .9cm retraction. The infraspinatus is intact.

SA-SD bursa: Contrast is present within the subacromial subdeltoid bursa consistent with full-thickness cuff tear.

Marrow: There is mild increased T2 signal laterally within the humeral head, possibly related to mild bone marrow contusion.

--END--

There is more analysis on the report but the rest seems normal.

Thanks to anybody that can give me a non-surgeon's opinion!!

[Nick D'Agostino]

How did the tear happen? Did you have the oh shit I fucked up moment with lots of force involved (fall skiing, car accident, threw a football 60 yards after not throwing for a decade)? Or are you not really sure how it happened, the pain seemed to just emerge one day (after you cleaned out the garage, painted the house, ect) and progressively got worse?

[SomeGymGuy]

I've had problems w it all my life. I remember it hurting all the way back to baseball in elementary school, and throughout football in HS. I remember it hurting in the military but I dealt with it.

Always managed it w rotator cuff exercises.

The recent catalyst that caused all these problems was me doing bicep curls. I was probably doing too much weight and it popped and I immediately was in pain. A few weeks later, I still couldn't sleep or function without Motrin (or alcohol and Benadryl for sleep), so I went to the doc...

[Nick D'Agostino]

How old are you? Do you have other important/meaningful overhead activities in your life besides press that you do regularly (throwing a ball, swing a racket or club, lift things constantly over your head for work, ect)?

[Suwannee Dave]

I am fairly certain I tore a rotator cuff tendon a few months ago while bench pressing. My left elbow got out a little too far and I felt a pop and immediate pain and dropped the bar to the safeties. I did not go to the doctor because at my age (71) I am not interested in surgery that has uncertain outcome. I took a month off from pressing movements, then started back with very light weights and reduced range of motion. Have gradually increased both but now only use a narrow grip bench and do not bring the bar all the way to my chest. Also I mostly do sets of 3 reps. I still get a little pain but take naproxen sodium for it. I believe that the base of strength in the major shoulder muscles developed over the last few years of training helped mitigate the injury.

[SomeGymGuy]

I'm 36 and I don't really perform any overhead lifting activities besides in the gym, and since this injury not even in the gym.

Thanks!

[Nick D'Agostino]

I would try conservative management first before surgery for 3-4 months and see if you gradually get better. If you are not progressing then I would reconsider the surgical route. I would use the same strategies found on this board and Rip has talked about in the past. Start with very light weights in a manageable ROM, gradually increase ROM and weight, use press or bench (start with whichever is the least irritating) as the primary exercises and do it every 48-72 hours making a small progression if you can. Do not push through the pain or completely seek to completely avoid it. Instead give yourself permission to nudge the pain as you rehab. Set the expectation that rehab is going to look like the stock market, with both good and bad days (sometimes very bad as we are seeing right now). Do not push it on a bad day, instead focus on getting quality work in. The important thing is that the trend over the course of each week/month is positive. Your goal is not to build strength right now but to increase your shoulders load tolerance. This is the force output that is associated with pain. You are trying to nudge this up over time. If you are still feeling the same amount of pain in your shoulder but are pressing/benching 50 more pounds than what you started with you are improving. Keep us updated on your decisions and progress.

[SomeGymGuy]

Lots of good advice. I very very much appreciate it.

I'll keep you updated.

[Nick D'Agostino]

You're welcome and sounds good man!

[SomeGymGuy]

So it's been a while since my original post. I appreciate the help previously.

Shoulder is feeling much better. Still limited in what I can do, and I do wake up in pain multiple times a night. Still, it's better.

I'm leaning towards surgery. The doc is being a bit of a turd when it comes to scheduling it, but it's probably more the nurse than him. In theory they've resumed surgeries because COVID19 is becoming more manageable.

Every day I'm torn on whether to have surgery or not. I'm probably still going to opt for it because I've struggled with this thing, one way or another, for decades now.