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shoulder torn muscles, should I get surgery /just physical therapy?

my father has severely torn muscles on both shoulders, and it's quite painful, we are considering whether we should get him a surgery to tack the muscles back, but on second thoughts we feel surgeries might be too invasive, we have all heard about stories of how doctors cut off too much muscles or ligaments or other important organs during surgery which result in permanent loss of certain functionings/inability to return to baseline. my father has talked to 4 different doctors, 1 recommended surgery while the other 3 doctors says he will recover with just physical therapy.

one thing I want to note is the 3 doctors who claimed my father's muscle injuries would recover with just physical therapy, when they checked out my father's injuries they all asked my father to perform the same test, which is to do a full 360 degree rotation of my father's upper arms around his shoulders. and my father, as of recently, is able to perform this task. that's why the 3 doctors recommended physical therapy.

my father first got his should muscles severely torn back in March 2018, at that time he did a MRI, below are the findings of his MRI:(please note these findings are dated back in March, when he first got his muscles torn. but since then it's been 5 months and many parts of his torn muscles have grown back and healed. I asked my father to get a new MRI again but he says it's too expensive. but I just want to note that it's best not to base the recommendation solely based on these outdated MRI finding. as I mentioned before, my father as of recently is able to perform the task of 360 degree rotation of his upper arms around his shoulders, something he couldn't do when he first got his muscles torn back in March. )

FINDINGS: There is enlargement of the AC joint. there is irregularity of the inferior aspect of the acromion. there are high-grade partial tears with severe tendinosis of the tendons of supraspinatus and infraspinatus.leakage of fluid into the subacromial and subdeltoid space is clearly demonstrated without retraction of the partially torn tendons of supraspinatus and infraspinatus. the subscapularis and teres minor are intact.the glenoid is intact. the labrum of the glenoid is well preserved. significant irregularity with subchondral cystic formation of the greater tuberosity of the humeral head is identified. the coracoacromial ligament is mildly thickened.

Impression: High-grade partial tears of the tendons of the supraspinatus and supraspinatus with leakage of fluid in the subacromial and subdeltoid space of the left shoulder. excessive osteophyte formation of the greater tuberosity of the humeral head and irregularity of the inferior aspect of the acromion are most likely the causes of rotator injury. chronic recurrent injuries by chronic impingement should be considered. no retraction of the injured tendons of supraspinatus and infraspinatus demonstrated, however.

should we get surgery or only physical therapy. I hear even with surgery the muscle can't regrow back to more than 60%-70% its baseline functioning. thank you for your recommendation, we really appreciate it!
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Avatar universal
So sorry your father is going through this :(    I had a shoulder issue a few years back. No injury, just degeneration/over-use . Had severe impingement, a torn rotator cuff, bursitis, synovitis, bone spurs, severe swelling almost to the point of a frozen shoulder.  I had multiple cortisone injections and did physical therapy for over six  months  and home exercise program. I ultimately had surgery: rotator cuff repair, synovectomy, bursectomy, shaving of bone spurs.  The shoulder was great immediately after surgery.  I did not have a lot of post-op shoulder pain at all, which I thought was unusual, as I had expected a lot worse pain-wise.  Recovery is a long one for this type of surgery:  I had to wear the "wedge" shoulder brace for about 4-5 months. Physical therapy for passive range of motion and then gradually up to strength and range of motion on my own...therapy lasted about 6-7 months, then onto a home exercise program.     Over time, the bone spurs formed again and three years after the first surgery,  I required a second shoulder surgery, this time for a distal clavical resection. That surgery/recovery wasn't too bad either.   .....I do now again have another large bony overgrown/osteophyte this time of the Acromion  and some "fraying' of one of the rotator cuff areas, but nothing that will need surgery any time soon, I will put it off  as long as possible.   In reading your Dad's MRI results, it does sound like he  has extensive damage within the shoulder joint..the  " excessive osteophyte formation" (bone spurs) could definitely be what is causing the tears, pain,swelling as there's no room int he shoulder joint for them,  it's a very tight capsule and anything that doesn't belong, such as swelling/inflammation/bone spurs cause issues.  Even if the muscle/tendons somewhat heal themselves, Bone spurs will not go away and will continue to cause further damage within the shoulder joint. ...Definitely do physical therapy  as it should help to improve his range of motion, strength the shoulder/arm  and some modalities (TENS unit, Heat/Ice) will  help get the swelling down...BUT  the findings seen on MRI will still remain within the shoulder joint/capsule and   will likely need to be surgically cleaned out  :(  
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None of us are medical experts, but my own experience with bone spurs no matter where they are is whether or not they are impinging on nerves.  If they aren't, it's not a problem.  Impingement is something entirely different, as that means a bone is where it shouldn't be and impeding a joint from functioning but if the docs he's seen are divided about surgery they have not seen the bone spurs pressing on a nerve.  That doesn't mean it isn't happening.  Only time will tell that.  Only surgery will actually tell that, because you can only see how far they're extending onto a nerve by getting in there and looking -- the MRI picture of bone spurs isn't conclusive, as it's really best at looking at soft tissue, not hard tissue.  No idea really what will happen, but the above person's experience is the reason to try to fix things without surgery if you can -- how many of the above person's issues with his long recovery and need for further surgery were inevitable and how many were caused by the initial surgery?  Nobody will ever know.  Peace, all.
Avatar universal
Mom asks what might be the most important question, which is the age of your father.  I'm 65, and I've got injuries all over my body.  I hurt everywhere, I've had a lot of MRIs and a lot of physical therapy and so just because of this quirk of my life I actually kind of understand the MRI your Dad got.  And here's what I know:  everyone over the age of 40 will show some wear in the rotator cuff area.  Whether surgery is required depends on whether it's severely torn or it's just wear and tear.  The same will happen with the spine -- everyone over the age of 40 will show disc deterioration.  Whether someone feels pain or impairment from it is individual -- some will, some won't.  Nobody knows exactly why.  Some people are more sensitive to pain than others, and sometimes there is impingement on nerves, which unless you can get rid of the inflammation associated with these problems can only be solved by some sort of invasive surgery.  It might be a nerve block, or something else, or it might be fixing the rotator.  But if your Dad goes back and does things that caused the injury, they will probably come back whether or not surgery is performed -- some are lucky with surgery and some are not.  Recovery time can be long.  Physical therapy, and this is after long experience, probably works better after surgery than without it -- it was really invented to help people get back to their activities after surgery.  The main benefit of it seems to be that the physical therapist stops you from doing the things you were doing that injured it in the first place and then gives you some preliminary stretching and then moves on to strengthening the muscles above and blow the injured area so they take on more of the load and the injured area less of the load.  But if you return to doing what you were doing, it will very often just come back again eventually because all of the problems are still there -- nothing was fixed.  On the other hand, surgery tries to improve the body from what nature made, and you're questioning whether docs really know what they're doing in this area is valid -- often they don't.  Often they differ on diagnosis.  Often they really don't care and just want to do surgery because it makes them the most money.  So, see the very best orthopedist in your area, the one everyone recommends.  Get second opinions from both other orthopedists and also physiatrists, who are pain docs -- but don't necessarily listen to them either because they're cortisone crazy.  The good news is, the important things don't seem to be broken from the radiologist report on the MRI, but surgery gets a better look and therefore will see things you can't see on diagnostic imaging.  And then consider that orthopedic surgery is about 50% of the reason for the opioid epidemic -- either because when it doesn't work it hurts worse or because they so often mess up on the surgery, doing it when it wasn't necessary and causing pain rather than reducing it.  Normally I'd say you have to listen to the experts because we're not experts on here, just folks, and we can't diagnose you but in this case I've had these kinds of pictures taken and had the same problem, one doc saying surgery and others saying there's no significant injury requiring it, got to PT.  So, bottom line, and note this will agree completely with Mom, get the PT.  See if it works.  Your Dad will need patience.  He'll have to realize his whole routine in life will now be different, forever.  He may get better and get back to doing what he wants, or he may have to give all that up and do things that don't stress the shoulders, such as no more weight lifting or heavy swimming, which is very shoulder intensive.  His workout will be a lot of PT, in part.  But if it works, it is much less time for recovery than surgery, and really, the main thing of PT is the rest and rest may be all he needs.  Now, again, I'm assuming your Dad isn't 30 years old.  I'm assuming he's in his 50's, when this stuff usually gets bad.  I'm assuming he doesn't make his money on doing things that require heavy use of his shoulders.  I'm assuming he has time to recover.  And again, after PT worked for me, when I hurt my foot and that forced me to go back to doing the things I had stopped doing, it all came back again.  Nobody knows what's going to happen.  But that's more true with surgery.  The final decision, though, is with your Dad, as he might be very anxious to just get it fixed so he can get back to what he wants to do.  I'm pretty chicken when it comes to this stuff.  The brave do what they have to do to get back the quickest to doing what they like to do.    
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Oh, and as for massage, it doesn't actually help healing at all.  It feels good, but scientific consensus is that it doesn't actually heal anything.  On the other hand, it can keep the pain mitigated so you can go on with your life without the risk of surgery.  I'm just not sure the shoulder area is one that massage can do much with unless the problem is actually muscular, not matter what the pictures show.  That's very often the case -- regardless of any damage showing up, that isn't causing the pain, stress on the muscles is.  I'm very partial to a part of the doctor's oath they don't take very seriously -- first, do no harm.  
Physical therapists provide massage during their treatments for the sake of aiding in healing the injury.  It can release muscles, help with pinched nerves, etc.  It can be very effective and has helped me beyond measure. For a tear of this sort, not sure it would be helpful though until down the road.  

Anyway, hope that this gets better and there is agreement that PT is a good route to take first.  

I agree that invasive surgery scare me.  I'd go the less invasive route first to see if I could avoid that.  
thank you for your advice, Paxiled, the reason I post on here is because I've heard some stories about doctors recommend surgeries to patients who don't need them just to monetize on it and make more money. this is the very thing  I am worried about, as our capitalist society trains doctors not to genuinely care for their patients but to monetize on their patients' illnesses.  I've talked with my father and now we are inclined to pursue the course of recuperation with PT rather than surgery. I have 3 questions right now:
1) your reply mentions seeing physiatrist, which is a rehabilitator like PT, but actual M.D.s who have been through formal medical school trainings. would you recommend me to see a physiatrist instead of a PT? but you also mentioned in your reply that psychiatrist don't help with the actually physical therapy regimen as much as PT, they are more like pain doctors who ove-rexcessively put pain-alleviating medications or injections into your body like cortisone crazy. since I've never never seen a physiatrist before, how different it is seeing a physiatrist in comparison to a PT? how different would physiatrist's treatment plan/regimen be from that of a PT? would you recommend me seeing a physiatrist instead?
2)my father has High Grade muscle tears on his two major shoulder muscles on both shoulders, supraspinatus + infraspinatus muscles on his upper back. it means both of his muscles are partially ripped across the muscle parts(not completely else there wouldn't be any muscles to hold his upper arms onto the shoulders) , imagine like a partially torn fabric ripped in the middle.  but his muscles are not displaced/fallen off of his shoulders, since the tendons/ligaments are still firmly attached to the rotator cuff shoulder areas and the tendons/ligaments are not ripped. in this case, without any surgery just by physical therapy alone, would the ripped muscle flesh regenerate/regrow back together into one single piece of muscle again?
3) I've heard surgery can cause muscle atrophy, because often it is the case that during surgery the surgeon cut off too much of muscle tissues/scar tissues that after the surgeries the muscle tissues majorly lose their ability to regenerate. is it true?

thank you for your reply, your reply is really helpful and contains a lot of good suggestions that open the horizon for us. the appreciation we feel for your help is really ineffable, thank you very much!
I wish I could answer you, but I'm not an expert, just a much too frequent patient.  I think your swipe at doctors is partially accurate but goes too far -- there are really good docs out there who care about money and patients -- they can care about both.  A lot of these folks donate a lot of time to helping people for free -- consider Doctors Without Borders.  My point is that we have a tendency to think of doctors, and for docs to think of themselves, in almost religious terms rather than human terms -- they take what they're taught as a matter of faith rather than science.  The science is seldom certain when it comes to medicine, and because people differ so much in their pain thresholds, how quickly they heal, etc. it's impossible to practice good medicine if you're treating everyone the same and spending very small amounts of time with patients.  That's where the insurance system and desire for money comes into it.  But a lot of docs are also just not very good at it and it's hard for patients to know who is really good and who is not.  Referrals can be helpful, but these days most group practices of general docs, who do the referring, are owned by the same corporations that own most of the hospitals, and they require all referrals to be made to their own docs, who might not be the best ones.  So getting second opinions is good, and you did that and the majority opinion was to try rehab.  I have no idea how well or how long it takes if it's possible for your Dad's muscle tears to repair themselves.  Didn't study medicine.  The key to tissue regeneration is bloodflow, and as long as bloodflow is not being constricted by inflammation, most tissue can eventually heal itself.  But that doesn't mean it will.  No certainty.  You just have to try and see.  Surgery fixes things quicker when it works and gets you back more quickly to doing what you want, but it also increases the chances of causing more harm rather than fixing the problem -- it's not because docs are bad people but because we don't really know how to do this stuff as well as has been advertised.  A physiatrist isn't related to a physical therapist.  It's an MD who specializes in pain control -- they are most like rheumatologists, meaning they mostly do pain killers and injections and some of those odd techniques you read about professional athletes getting, such as platelet replacement therapy, prolotherapy, glucosamine injections, all kinds of alternative things that insurance doesn't often cover because the evidence for success isn't convincing.  But before they do the cortisone and the Lyrica prescriptions, they also do the same diagnostic things orthopedists do and usually go further, testing for causes that might not be due to, say, a disc problem but might be caused by RA or something like that.  That wouldn't apply to a muscle tear.  I asked about your Dad's age because the older we get, the harder it is to fix us because often several things are going on and we heal more slowly with age.  We have an expiration date on the things in our bodies that is unknown until they permanently break or we die.  It's just life.  Do the best you can, and always start with the least invasive approach if the docs think it might work just because it might work and save the permanent changes in tissue surgery does.  As for muscle deterioration, you always get muscle deterioration when you're hurt because you stop using the muscles -- I think that's more of a factor than surgery, depending on whether the surgery can be done well or just can't be.  Obviously, if they have to cut off some stuff to repair the damage, you have less stuff.  If they don't, you don't.  But the rest you you go through when you're hurt starts the muscle deterioration anyway -- it takes working muscles to keep them strong.  Don't use them and they go away.  Best of luck.
Mom, I recently have researched ways of recovering from injury without surgery because I probably need about four of them and at my age and with my anxiety problem I'm not sure it's worth it.  Maybe better to just be dead at this point.  What I found was there is no scientific evidence whatsoever that massage, icing, heat, baths, or stretching has any effect whatsoever on healing.  Now, ice can reduce inflammation at the very onset of an injury, so at that point it does something, but if you've had a problem for awhile it stops doing anything at all except it might make you feel better for a brief period of time.  I was pretty shocked that this turns out to be a pretty universal opinion by medical professionals who also do research.  When the PT gives you that tiny little massage, what they're really doing is warming you up for the PT exercises that follow, not doing any healing.  If you're not warm, stretching and strengthening can make things worse.  So they use that tiny little massage -- it's not the more complete massage you would get if you went to a deep tissue therapist -- to get blood flowing and to also start improving range of motion, which is a measurement they must use to get reimbursed by insurance companies -- they have to have a measure of improvement or the insurance company stops paying for the therapy.  But the main purpose is to get you ready for the exercises.  Blew my mind to learn this.  There's a great article if you can find it by a former massage therapist who became a medical journalist, and he investigated a lot of things like the ones I mentioned to see if there was any evidence to back it up.  He didn't find any.  It's on the web somewhere if you can find it.  
But an interesting side not, he still stretches a lot and uses all these things anyway because they make us feel better, and who doesn't like feeling better?  Just because you can't heal something doesn't mean you can't live with it in a much more comfortable fashion.  Still, I thought that was pretty amusing, and he did too.
The thing is, evidence is from myself.  And no matter how hard you try, you can't dispute that.  :>))  I had a neck injury from an auto accident that created chronic migraines that were debilitating.  The medical massage I got that worked on my neck, shoulder and head, really ONLY on the injured side was by far the most valuable treatment I had.  Doctors wanted to put me on narcotics which I refused.  It was a difficult time for me and my situation improved tremendously from massage.  Stretching has released sciatica for me and my husband did PT instead of shoulder surgery recommended by a neurologist for a pinched nerve. He never had the surgery.  It's been four years since and he does not have a problem now at all.  He had the full PT with massage, icing and stretching.  The neurologist was insistent he should have surgery---  very pleased he did not. So, I'm sharing my personal stories and if you ever read about a 'scientific study' being conducted on this subject, let me know.  I'm happy to participate.  :))
Kind of late for you to do a study, Mom -- you're already better.
I will crash my car again to get another injury JUST to participate so I can prove it to you.  (not really)
Ooh, car crash.  That's how my great deterioration apparently began, but in my case I didn't know it.  I was a passenger in a car that got creamed while stopped by a drunk driver who didn't stop.  Flash forward 15 years, I have a minor back problem and on a whim go see a chiropractor, who takes X-rays and asks me if I was in a car crash 15 years before because, while my back looks fine, the cervical spine is in bad shape.  Flash forward to pain all over the place, causing me to do things that injured what was left intact.  So folks, if you get in a bad car crash and the docs tell you you're fine, nothing's broken, don't believe them -- the inflammation has started the deterioration and if you don't stop it you will pay down the road.  Something else I learned too late to do me any good.
I'm with specialmom on the massage... In July 2017, I developed a frozen shoulder and could barely move my right arm.  Combing my hair was nearly impossible and getting a shirt off was really a chore.  Not knowing what was causing my pain, I put up with it until about October of last year, then when I had an appointment with my primary doctor I talked to him about it.  He gave me a cortisone shot to ease the pain since I could barely move my arm away from my side and prescribed PT for 6 weeks.  

The best thing about the PT was the massage.  It wasn't just a tiny massage for warm up prior to doing the exercises; it was a deep massage done after I'd finished my exercises for the day.  The massages were actually horribly painful when I first started PT, but as time went on, they became less painful as the muscles in my neck and back slowly began to relax.  Of course, we had to get more than the initial 6 weeks authorized for PT... I think I went twice/week for about 4 months altogether.  

I still have the frozen shoulder...if you know anything about that, it can take up to 3 yrs for the "thawing" phase to complete if it ever does.  I still do as many of the exercises they taught me in PT as I can since I don't have all the equipment at home.  My range of motion still isn't good, but I keep going.  The problem is that I'm now getting it in my other shoulder...I was given similar massages when I went to PT for my peripheral neuropathy during which they discovered that I have plantar fasciitis.   I'd love to have those deep massages again on both, my shoulders and my feet.

Likewise, stretching exercises recommended by doctor did away with a pinched nerve in my back I'd dealt with for quite some time.  

I'll particpate in a study, as well.
Just to say, both of you -- and myself, as I've had more PT than almost anyone alive today I think, so much of it I think it ended up wrecking me because it just took too long and I got old -- you did a variety of things.  I realize the massage felt good, so did mine, but you also did exercises to stretch and strengthen.  Barb, you had a cortisone shot.  To do a scientific study, you'd only get massage and nothing else.  Another group would get only stretching.  Another group would only get strengthening exercises.  Etc.  Science doesn't work by you or me thinking the massage worked for healing because it felt good.  It would have to objectively improve our conditions.  In those studies, it doesn't show that it works.  Now, if you combine a bunch of stuff, who knows which part of it did what?  So remember, science when done properly must be objective and use controlled groups that are double blinded.  So sorry, folks, we're all way past being eligible for studies for past injuries.  I can only quote you what the studies done have all shown, and that is, almost all of the things we think work don't do what we think they do, but thinking something works might be better for us than something that has shown to work in studies because the mind is the best healer.  I again say I was really shocked to discover this.  And the former massage therapist turned journalist was also shocked, and again, still did all the things he had discovered doing his meta-studies of all of the available research and looking into all the medical textbooks didn't work because they felt good and feeling good is still something to like.  For me, the big discovery was when I ended up in PT -- again -- because, and I'm not a lucky guy obviously, I hurt three parts of my body withing a couple weeks.  I couldn't lift at the gym anymore because of arm and neck pain, couldn't run anymore because of a knee, and could barely stand because of a lower back problem.  It took a ton of PT, which became my whole workout.  The only thing I talked them into letting me do was an elliptical machine.  At that time, a few years back, I had a very high fitness level after years of basketball, running, kung fu, and gym workouts.  I grew up in So. Cal., and we were outside playing sports all the time.  So I was always active and had very few injuries until I got into my late forties.  So I did all this PT and I did stop hurting.  Unfortunately, I developed plantar fasciitis doing the elliptical -- I mean, who does that?  I wasn't running anymore, had long stopped playing basketball, and had stopped doing martial arts.  Because of that I had to go back to doing the things I had been doing that got me injured in the first place, and they all came back, only worse than before.  So the PT didn't actually fix anything, it just stopped me from doing things.  Life is complicated, and no matter how much we think this or that worked, objective information will very often come up and change the whole way the medicine we had was done.  It is what it is, folks.  But I'm really glad you all got relief from your pains at least temporarily.  By the way, when you get an injury and it doesn't really get fixed but you think it did, you very often will get the same injury on the other side of the body -- the other frozen shoulder, for example.  This can be because the stronger side compensates for the weaker side and works harder.  Pro athletes suffer this all the time -- they get cortisone or some treatment and get back to it and then the other side goes out.  If you're a sports fan you'll see this all the time.  Peace, all.
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Gosh, what an ordeal for your dad!  This is my thought . . . I would try physical therapy. That would be preferable to surgery and giving it a full chance to work would make sense.  Now, there are good physical therapists and bad, like anything else.  But I had a fantastic one for a neck injury I sustained in a car accident.  I had chronic headaches.  They did a combination of things from massage, icing, stretching and strengthening. I did recover.  I also am a big fan of medical massage ---  which is someone that you don't get the whole body worked on but just a specific area.  If you have a doctor's prescription you don't pay sales tax on it as it is like a medical service.  Anyway, I found that to be a life saver.

This is different than my injury but other than a bit of time, what do you have to lose by having him try to recover without surgery.  I was once recommended for surgery. Two doctors said yes, one said no.  I went with no.  I'm fine without the surgery.  And years later, I'm thankful I never had it.  

However, if you find your dad is not recovering ---  surgery can be a last resort.  

How old is your dad by the way?  What was the initial injury?
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thank you for your recommendation,  we really appreciate it! I think that physical therapy is way less invasive and more wholesome that surgery, that's why I post on here for advices from people who are like my dad, who were once recommended surgery but sought physical therapy and successfully recovered. the main question I have now is I don't know where to find a reputable and good physical therapist. I live in the Los Angeles area, do you know any good physical therapist in this area, or is there a medical forum that is like Yelp in nature, where there are patient reviews for each and every physical therapist on the forum so I can easily find a good physical therapist by my father?

my father is currently 64 and turning 65 this year. the initial injury was caused because he lifted something too heavy, both of his shoulder muscles are severely torn.
You can try 'vitals' for ratings of PT's in your city.  Also, I have found that my doctor is a great source of this information.  They don't recommend schleps usually--  and give you recommendations based on what their patients tell them or what they know personally.

I think this is a good route to go and hope your dad heals quickly.  Let us know!
Actually, Yelp also does doc reviews.  There are also local magazines that rate docs.  With general docs, it's patient ratings, but with specialists, it's usually ratings by other docs.  In my area one is named after the nearest city and the other is a local newspaper.  There are also subscription services, one is called Checkbook, that rates docs.  How reliable this is I don't know, I've used docs rated "best docs" and had awful care, so you never really know.  What I do know is that PTs are really different -- for my plantar fasciitis I was referred to three different ones for various reasons, and each had a completely regimen for dealing with the same problem.  Made my head spin.  But be wary of general docs and recommendations -- if you see an independent doc, it's probably fine, but some of this is done by kickbacks.  But a current trend is troublesome and has happened to both my wife's and my general practitioners.  They're having a very hard time surviving these days so group practices once owned by docs are largely now being sold to large corporations that also own hospitals.  Hospitals have practitioners associated with them, and these practices are required to refer to someone employed by the corporation that owns them.  If you don't want to see that person, however, they will give you a handout that will have a selection of practitioners in your area and if you Google any individual practitioner ratings will come up.  But again, ratings are of dubious value, because they are often old, the docs rated no longer work at the practice, awards might be years old and the docs no longer live up to those standards.  But it's the same with those ratings of furniture stores or restaurants -- they might not be that good anymore.  One other thing -- for anything really complicated, there might not be anyone in your local area who is actually the best to see -- that's why so many people travel to university hospitals for certain things, and why so many go a long distance to go to Johns Hopkins or the Mayo Clinic -- they're just often better.  As with everything, you do the best you can.  Some people love an IPhone, some love Samsung.  Docs are no different.  Personally, I do what Mom recommends, and usually start with a referral from my doc.  Then I Google the specialty in my area and start Googling the individual docs and see what pops up.  The only thing I will tell you for sure from recent experience -- don't get PT from a chiropractor!
Sorry, meant completely different regimen.

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