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?
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.
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 :(