Q: I have a chronic shoulder problem from a degenerating rotator cuff and now bursitis on top of it. The surgeon has given me two treatment choices to consider: physiotherapy and rehab or surgery. I really don't know which way to go. What do you suggest?

A: Your decision may depend on a number of factors. First, what type of surgery is recommended? This question actually has two parts. Will the surgeon be doing the procedure using an open incision or using an arthroscope (requires only tiny holes to insert the scope).

Second, what type of surgery is proposed? With rotator cuff problems, the surgeon may just go in and debride (shave) the torn edges. Or it may be necessary to repair or reconstruct the torn tendon. Reconstruction with a tendon graft is much more complex surgery than debridement or even an acromioplasty.

Acromioplasty is a relatively simple procedure that involves shaving the underside of the acromion (or possibly removing the end of the bone). The acromion is a piece of bone that comes from the scapula (shoulder blade) behind the shoulder. It curves over the top of the shoulder and connects with the clavicle (collar bone) in the front of the shoulder.

If the acromion is pinching the rotator cuff tendons that pass underneath it, then it may be necessary to cut the end of the acromion off completely to remove the source of the problem.

Another consideration is your age along with your activity level and personal goals. If pain relief and improved function for daily activities is what you are after, then physiotherapy and rehab might be the better choice for you. The program works but it can take six weeks or more to get things turned around for you.

If you are an athlete involved in competitive sports, then surgery may be a faster approach. You'll still have to go through some rehab afterwards but you'll be able to return to sports participation sooner than if you try a course of conservative care and then end up in surgery if it doesn't help.

Your surgeon is really the best one to go over the various options and considerations in making this decision. Take this information with you to your next appointment and don't be shy about asking your surgeon to go over each point with you.

Reference: Mark A. Vitale, MD, MPH, et al. The Rising Incidence of Acromioplasty. In The Journal of Bone and Joint Surgery. August 2010. Vol. 92-A. No. 9. Pp. 1842-1850.