Rotator Cuff Tears: Is surgery better than non operative treatment?

Rotator cuff tears are one of the most common orthopaedic injuries. In fact, it has been shown that roughly 20% of sixty year olds have a rotator cuff tear and nearly 50% of eighty year olds. Fortunately, many of these patients can be successfully managed with non operative treatment. This typically involves physical therapy and possibly a cortisone injection. Research studies report that upwards of 75% of patients with rotator cuff tears respond well to physical therapy, are satisfied with non operative management and do not pursue surgery.

Surgical repair of rotator cuff tears also gives very good results but can be associated with a lenghty recovery. This operation is done arthroscopically with small incisions using a camera, but even though it is a minimally invasive procedure, the recovery is about six months. 

If non operative treatment gives a good result, why would you choose to have rotator cuff surgery? There are two main reasons

1. If not repaired, tears can increase in size. Approximately 50% of tears will increase in size over a five year period. 

2. Surgical treatment appears to give a better result than non operative management. A recent study in JBJS demonstrated that patients who had a rotator cuff repair had better outcomes than those who chose non operative treatment (see the attached commentary)

If you have a rotator cuff tear, there are different treatment options. Choosing the best treatment depends on the patient, their activity level and the type of tear. These research studies give us some more information to discuss when making these choices.