Alternativesto rotator cuff surgery

There may be non-surgical ways to relieve your shoulder pain and things you can do to delay surgery.

Not all rotator cuff tears need to be repaired surgically. By the time you’re in your 70s, most people have a tear in one or both rotator cuffs, generally without knowing it.

You should only consider surgical repair to your rotator cuff if the pain is limiting your quality of life and you’ve already tried non-surgical options first. Three out of 4 people with full thickness tears (that are not due to trauma) get good symptom relief from a program of physiotherapy. If your rotator cuff tear is due to trauma, you may need to think about having surgery sooner rather than later.

Alternatives to surgery include:

Changing the way you do things

Check your posture. Stand in a straight and relaxed posture, without slumping. Don't lift things that are too heavy for you, especially not over your head.

Avoiding certain activities

Rest your shoulder as repeated activity that involves your shoulder can put more strain on your rotator cuff tendons. Avoid sports and other activities where forceful contact or falls are likely. Avoid activities that require you to raise your arms for long periods, such as painting a ceiling. If you have to do this, take frequent breaks.

Careful lifting

Lifting heavy objects can injure your shoulder. Ask for help or use devices to help you. Avoid catching heavy things that are falling.

Keep your muscles strong and flexible

Doing daily exercises that improve the strength and flexibility of your shoulder can help protect your shoulder from further damage. Many shoulder problems begin with a muscle imbalance. This leads to abnormal shoulder function, making the shoulder more susceptible to injury.

Supporting your shoulder

If shoulder pain bothers you at night, sleeping with your shoulder supported can take the strain off it. Experiment using pillows for support and try to find sleeping positions that keep your shoulder in a comfortable position. When you’re travelling, put a pillow under your arm to support it.

Hot and cold packs

After you’ve injured or aggravated your painful shoulder, putting a cold pack on it can help reduce the initial pain and stiffness. Apply the cold pack to your shoulder for 15–20 minutes every 3–4 hours. After a few days, or when things have improved, hot packs or a heating pad may also help.

Oral medications

There are several oral medications that can help reduce shoulder pain and improve function. Chances are you’ve already tried paracetamol.

Your doctor may also have recommended or prescribed a non-steroidal anti-inflammatory agent (NSAID). Common NSAIDs have the generic names aspirin, meloxicam, celecoxib, ibuprofen, mefenamic acid, diclofenac, naproxen, piroxicam and ketoprofen. They can cause gastric side effects and you should consult your doctor before trying them if you have any other health conditions. You may need to try more than one NSAID before finding one that works for you.

More powerful analgesics containing opioids such as codeine, oxycodone, morphine or tramadol can be prescribed but they’re not recommended for long-term use due to their side effects, toxicity and potential for addiction.

Topical medications

Ointments containing methyl salicylate, capsaicin, camphor, menthol or eucalyptus oil can help relieve pain by stimulating the nerves near the painful area and interrupting pain signals. Herbal ointments often contain these same ingredients, plus herbs as well.

Note: If you’re using painkillers, gels or ointments every day, it’s time to see your doctor. Chronic use of painkillers can have adverse effects.

Steroid injection

Your doctor may recommend a corticosteroid injection into your shoulder. It’s possible this will give you relief that lasts for weeks or even months.

Your GP may refer you to a rheumatologist for the steroid injection or to a radiologist where you can have an ultrasound-guided steroid injection. The injection sometimes causes side effects and can take a while to relieve your pain, so you may need to schedule some time off work or have the injection before a weekend break.

Physiotherapy

A physiotherapist can assess and treat your shoulder pain, giving you a program that includes stretching and strengthening exercises as well as practical advice about how to look after your shoulder. More intensive exercise programs are often more successful.

Massage

A program of massage may ease your shoulder pain, increase its range of motion and help you relax. Many physiotherapy practices offer massage therapy.

Acupuncture

An acupuncturist works to relieve pain by inserting fine needles into your skin. The needles are thought to stimulate your body’s production of natural painkilling chemicals. Because the needles are so thin, it’s not usually painful. The use of acupuncture isn’t part of traditional western medicine and its effects are unproven, but some Eastern medicine practitioners, as well as some doctors, chiropractors and osteopaths believe it’s an effective way to treat pain. However, clinical evidence of its effectiveness is limited.

Make sure your acupuncture practitioner is qualified and registered with the Australian Acupuncture and Chinese Medicine Association.

Note: HCF pays rebates to members with suitable cover who consult qualified physiotherapists, chiropractors, osteopaths, acupuncturists and massage therapists.