Impingement Syndrom(syndrome) and Small Rotator Cuff Tear

I had a car accident in Oct 2009...had MRI showing small tear, inflammation and impingement syndrom (syndrome) in right shoulder.  I have tried physical therapy (7 months x 3 times a week) and have had cortisone shot (made worse, not better)...it is now a year and 2 months later and still treating with the Orthopedic surgeon.  Shoulder pain is waking me up several times a night.

Is surgery a possibility at this point...my next appt. is December 14th...any pointers on questions for the doc.  I am frustrated and tired of not having any improvement .