Rotator Cuff Tears: Should You Operate?The rotator cuff is a group of four tendons that support the shoulder joint. Researchers suspect that five to 40 percent of people may have tears in the rotator cuff without even knowing it. Most of the time, rotator cuff tears cause pain and other symptoms. Often these symptoms are treated with rest, physical therapy, and medications. But how successful is nonoperative treatment?
Research suggests that about half of patients are satisfied with the results of nonoperative treatment. Pain decreases, and range of movement improves. Shoulder strength usually stays about the same, however.
When is surgery necessary? In general, patients who have had shoulder pain for more than six to 12 months will do better with surgery, as will those with larger tears (more than three centimeters).
The rate of pain relief is better with surgery (85 percent) than with nonoperative treatment (50 percent). Surgery improves shoulder strength whereas nonoperative treatment does not.
Some doctors have suggested that the longer patients wait to have surgery, the worse their results will be. This is based on the unproven idea that rotator cuff tears tend to increase in size over time. In general, smaller tears have better results from surgery than large or massive tears. Although some tears may get bigger over time, this is a slow process. No study has shown that delaying surgery leads to poor results. However, early repair is still preferable for new tears.
Compared to nonoperative treatment, surgical treatment of rotator cuff tears gives more pain relief and shoulder strength. Nonoperative treatment may be a good alternative for older, less active patients.
Charles Ruotolo, MD, and Wesley M. Nottage, MD. Surgical and Nonsurgical Management of Rotator Cuff Tears. In Arthroscopy. May/June 2002. Vol. 18. No. 5. Pp. 527-531.
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