Illustration of a rotator cuff tear in the shoulder highlighting the supraspinatus tendon between clavicle and humerus.

Physical Therapy vs. Surgery for Rotator Cuff Tears – What Works Best?

June 06, 2025

Most people do not expect a shoulder injury to slow them down. Then the pain, weakness, and frustration of a rotator cuff tear arrive. Lifting even a cup of coffee or reaching for a seatbelt suddenly feels impossible. When you are in this position, one big question often comes up. Should you start physical therapy, or will you need surgery to get back to normal?

This article explores the pros and cons of each rotator cuff tear treatment and how your doctor can support your choice.

Understanding the Two Paths for Rotator Cuff Tears

A torn rotator cuff can limit your independence and lower your quality of life. When it happens, your doctor will likely talk to you about two main paths to recovery. You can start with physical therapy or consider surgical repair. Each treatment has unique advantages and challenges.

What Is a Rotator Cuff Tear?

Your rotator cuff is a group of four muscles and tendons that hold your shoulder joint in place. These muscles help lift and rotate your arm. Rotator cuff tears usually happen after an injury, overuse, or aging. Common symptoms include pain, weakness, and limited range of motion.

Physical Therapy for Rotator Cuff Tears

Therapy uses targeted exercises, stretches, and manual therapy to restore function and ease pain. Many people with small or partial rotator cuff tears recover well with therapy. Physical therapists design programs tailored to your specific injury and lifestyle. Here are the benefits of physical therapy as a rotator cuff tear treatment:

1. Non-Invasive

Physical therapy does not involve incisions or anesthesia. There are no risks linked to surgery or anesthesia reactions.

2. Shorter Recovery Time

Most people start daily activities soon after beginning treatment. You may see improvement in strength, motion, and pain within two to three months.

3. Lower Cost

Physical therapy often costs less than surgery, especially if you need only a few months of care.

4. Strengthens the Shoulder

Exercises target the muscles that support your shoulder. Over time, stronger muscles may help protect against future injuries.

5. Reduces Fear of Movement

Therapists guide you through each step, helping you build confidence to use your shoulder safely and correctly.

Limitations to Consider

However, here are some limitations of physical therapy as a rotator cuff tear treatment:

Not for Every Tear: People with large or complete rotator cuff tears may not respond well to therapy alone.

Time Commitment: You must attend several sessions per week and complete exercises at home.

Some Tears Do Not Heal Without Surgery: Massive tears or those causing loss of function often require surgery for a full recovery.

Surgery for Rotator Cuff Tears

Surgery aims to repair the torn tendon directly. Most procedures are minimally invasive, where the surgeon uses tiny instruments and a camera. Open surgery is rare but may be needed for severe injuries. Here are some benefits of surgery as a rotator cuff tear treatment:

1. Directly Repairs the Tear

Surgery can reconnect the torn tendon to bone, which is crucial for large or complete tears.

2. Addresses Severe Symptoms

People who have tried therapy without improvement often regain strength, motion, and pain relief after surgery.

3. Prevents Further Damage

Unrepaired large tears can worsen, causing arthritis or further tissue breakdown. Early surgery may protect long-term shoulder health.

4. Can Return You to Sports or Heavy Work

Athletes or manual laborers may need surgery for full strength and stability.

Limitations to Consider

However, there are several limitations that are important to consider:

Longer Recovery Time: Full recovery can take six months or longer.

Risks: Any surgery involves risks like infection, stiffness, nerve damage, or reactions to anesthesia.

Cost: Surgery, especially with hospital stays or advanced imaging, is more expensive than physical therapy.

Rehab Still Needed: Even after surgery, you need physical therapy to rebuild mobility and strength.

How Your Orthopedic Doctor Can Help You Choose

Facing a choice between therapy and surgery can feel overwhelming. Fortunately, your trusted orthopedist can be your guide.

Here is how our team at Orthopaedic Associates of Maine can help:

Comprehensive Assessment

We start with a detailed evaluation of your shoulder. This often includes a physical exam and imaging, such as an MRI or ultrasound. We check the tear size, location, and the degree of muscle weakness. Your age, activity level, and goals are important, too.

Personalized Recommendations

Some rotator cuff tears respond very well to physical therapy. We might recommend therapy first for partial tears, mild pain, or if you do not play high-impact sports.

However, suppose the tear is large, full-thickness, or causes loss of function. In this case, surgery may be necessary for the best long-term results.

Coordinated Care

From your first visit to your last follow-up, our orthopedic team works closely with a team of providers. This includes physical therapists, surgeons, and your primary care doctor. This helps ensure you receive the help and information you need at each stage of recovery.

Rotator Cuff Tear Treatment in Portland, Windham, & Brunswick, ME

Injuries can change daily life, but you are not alone in finding the right rotator cuff tear treatment. Physical therapy is often best for small, partial tears and for those looking to avoid surgery. Surgery works well for larger or more severe tears or when therapy does not deliver results.

Trust Orthopaedic Associates of Maine to guide you toward the right decision for your unique situation. For your convenience, we have several orthopedic offices near you across Portland, Windham, and Brunswick. Contact us at (207) 828-2100 or submit an appointment request form to take the next step in your recovery.

We look forward to serving you!






Sources:

https://my.clevelandclinic.org/health/diseases/8291-rotator-cuff-tear

https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/symptoms-causes/syc-20350225

https://www.mayoclinic.org/diseases-conditions/rotator-cuff-injury/diagnosis-treatment/drc-20350231

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