When Does a Rotator Cuff Tear Really Require Surgery?

A rotator cuff tear is a common injury at the shoulder joint. However, not every rotator cuff tear causes problems that require surgery to address. 

Senior man suffering from shoulder pain at rehabilitation center
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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. However, there are a variety of ways to treat rotator cuff tears.

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, 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 requirements and 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: these tears can retract, leading to a permanently shortened tendon. As a result, 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.

Discuss with your doctor the potential risks and benefits of performing surgery. Each patient must be treated individually, since not all rotator cuff tears are the same, and different factors must be considered in each case.

A Word From Verywell

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 such thing as a rotator cuff emergency, so learn about your treatment options and what the pros and cons of different treatments might be. Understand that some rotator cuff tears never even cause symptoms, and many (in fact, most) rotator cuff tears never need surgical treatment. While surgery can lead to pain relief and improved function, many people can find these same effects with nonsurgical treatment. 

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  1. Dunn WR, Kuhn JE, Sanders R, et al. 2013 Neer Award: predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2016;25(8):1303-11. doi:10.1016/j.jse.2016.04.030

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