Why Surgery Isn't Always Needed for Rotator Cuff Tears

Rotator Cuff Exercises

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Surgery is a common treatment for a rotator cuff tear, but it is the rare exception that a rotator cuff tear requires surgery. The truth is that the vast majority of rotator cuff tears are never treated with surgery. In fact, most people who have a rotator cuff tear never have a problem with their shoulder. Those people who do have shoulder pain resulting from a torn rotator cuff can often find relief without surgical treatment.

Rotator Cuff Tears

The rotator cuff is the group of muscles and tendons that surround the ball-and-socket shoulder joint. Four muscles make up the rotator cuff. Rotator cuff problems range from inflammation and tendonitis to partial tears to full tears of the tendon.

Most people who have symptoms from a rotator cuff problem develop pain around the shoulder. Other common symptoms include weakness of the muscles and limited mobility of the joint. Rotator cuff problems can be diagnosed by examining a patient. Sometimes tests including x-rays, MRIs, and ultrasound, may be used to determine the extent of damage to the rotator cuff.

Tears Are So Common That They're Normal

The truth is that most people will eventually tear their rotator cuff. As people age, rotator cuff tears become increasingly common, even in people who never have symptoms of shoulder pain. Just as hairs turn grey and skin wrinkles, as people get older, the rotator cuffs tear. While not all tears of the rotator cuff can be considered normal, most are a normal part of the aging process.​

Researchers have tried to identify how many people have rotator cuff tears. The results vary, but one study of 600 people of all ages, published in 2013, found that 22% had a tear. Of these, 65% had no symptoms, so they did not realize they had a rotator cuff tear. And partial rotator cuff tears are undoubtedly much more common. The most commonly cited number is 20% of the population has evidence of a full-thickness rotator cuff tear.

We know that rotator cuff tears tend to be more common as people age (about 10% of people under 21, but more than 60% of people over 80 years old). Rotator cuff tears are also more common in the dominant arm and in people who have sustained some type of trauma to the shoulder.

A rotator cuff tear that is the result of aging, called a degenerative tear of the rotator cuff, must be distinguished from a tear that is the result of a traumatic injury to the shoulder. There is some crossover, where the chronic weakening of the rotator cuff from aging degenerating leads to susceptibility to tearing from relatively minor trauma. Therefore, each individual likely has components of both degenerating and trauma that contribute to their shoulder problem, and your orthopedic surgeon can help determine why your tear occurred.

Treatment

Treatment of a torn rotator cuff varies depending on the type of injury and the type of patient. Since a rotator cuff tear often exists in people with no symptoms of a tear, treatment does not necessarily need to include repairing the torn tendon. Most often, simple treatments are tried first, and consideration of a surgical repair is only made if these simple treatments fail to provide relief.

One study published in 2013 reported that conservative treatment (such as physical therapy) is effective in 73% to 80% of patients with a full-thickness rotator cuff tear. Without surgery, only about half of partial or full tears will progress (get larger), and not all of these will include new or increased pain.

When Surgery Is Necessary

There are some exceptions, and some people with rotator cuff tears may be better off with immediate surgery. These tend to include younger patients who have had a recent acute injury to their shoulder. In these people, a rotator cuff tear is not normal and not primarily the result of the aging process.

Rotator cuff surgery may be an appropriate option for shoulder pain resulting from a rotator cuff tear. However, simply having a rotator cuff tear is not a reason in and of itself to have surgery. The decision about when surgery is appropriate is complicated and depends on a number of factors that you need to discuss with your doctor.

A Word From Verywell

The vast majority of rotator cuff tears will never require surgery, and many people can find relief with nonsurgical treatments. Patients who are told they need rotator cuff surgery should understand the reason for surgery. In most cases, non-surgical treatments should be attempted first, the exception being in younger patients who have rotator cuff tears resulting from traumatic injuries. If you are unsure of the necessity of a rotator cuff surgery, a second opinion can be helpful.

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Article Sources

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