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Nine months ago, I fell on my outstretched hand and tore the rotator cuff. After surgery and rehab, I fell and tore it again. Despite all that, I seem to have good shoulder function. Was that first surgery even really needed?

Massive rotator cuff tears from injury or trauma usually require reconstructive surgery. Without it, the shoulder can become painful and very unstable. But there are some patients who seem to be able to rehab and strengthen their shoulder without surgery.

Good-to-excellent shoulder function is possible when other muscles within the shoulder complex are trained to maintain proper balance. For example, the deltoid muscle (along the outside of the arm) lifts the arm away from the body. Without the rotator cuff, contraction of the unopposed deltoid muscle causes the humerus (upper arm bone) to glide up into the shoulder socket.

This type of upward glide called superior translation can cause pinching of the soft tissue structures in the shoulder. The result can be an impingement syndrome. But the remaining muscles and tendons of the rotator cuff that weren't damaged can be strengthened and trained to overcome this problem.

Studies show that large and massive tears that are repaired often tear again. The recurrent tear may not be a complete rupture, so there is some stability remaining from the first repair. In such cases, patients can maintain excellent shoulder function. And if you don't stress the soft tissues with repetitive overloading, surgical repair may not be necessary the second time.

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