When Does a Rotator Cuff Tear Really Require Surgery?

A rotator cuff tear is a common injury to the shoulder joint. In fact, there comes a time in most people's life (if they live long enough) when a rotator cuff tear becomes an expected finding. That doesn't mean that everyone who lives a long life needs shoulder surgery. It really means that not every rotator cuff tear causes problems that require surgery to address. 

There is no question that some rotator cuff tears require invasive treatments. For some people, relief of pain and restoration of function will require something to be done about the damage to the rotator cuff tear. However, not all rotator cuff tears will need surgical treatment.

Determining when a rotator cuff tear will require surgery takes multiple factors into account, including:

• Response to Other Treatments: Most rotator cuff tears can be initially treated with non-surgical treatments including anti-inflammatory medications, physical therapy, and possibly a cortisone injection. If these options fail to provide relief after several months of treatment, then surgery may be considered.
• Degree of Symptoms: Patients with minimal symptoms may have surgical treatment delayed in an effort to achieve success with non-surgical treatment options. On the other hand, patients who have more constant pain, difficulty with simple activities (getting dressed, lifting household objects), or pain at night interfering with sleep may be more likely to undergo surgical treatment.
• Patient Requirement & Expectations: Some patients may not need rotator cuff surgery if their symptoms do not interfere with their usual activities. For example, a patient who has a rotator cuff tear of his non-dominant shoulder and lives a more sedentary lifestyle, may not need surgery. On the other hand, athletic patients who injure their shoulder may need surgery to return to their sport of choice.
• Type of Tear: Smaller tears can be monitored to see if non-surgical treatments may help alleviate symptoms. Larger tears may benefit from earlier intervention. Large tears can retract (leading to a permanently shortened tendon), and the muscle may irreversibly weaken, making it more difficult to delay repair. In patients with these tears, earlier surgery may help increase the likelihood of successful recovery.

So what should you do if you are diagnosed with a rotator cuff tear? First off, don't panic. While some rotator cuff tears need to be managed in a timely manner, there is essentially no rotator cuff emergency, so learn about your treatment options and what the pros and cons of different treatments might be. Understand that many (in fact, most) rotator cuff tears never need a surgical treatment. While surgery can lead to pain relief and improved function, many people can find these same effects with nonsurgical treatment.