Is Surgery Needed to Treat a Rotator Cuff Tear?

Is rotator cuff surgery always necessary to treat a tear? The quick answer is no. One must distinguish a full-thickness tear from a partial-thickness tear before arriving at a more accurate decision. Full-thickness tears typically result in a patient unable to lift his/her arm and is associated with significant weakness during muscle testing; partial-thickness tears, on the other hand, vary in their presentation and may require an MRI study (see below).

Clinical evaluation is necessary in ruling in or ruling out a tear and more importantly, as to whether or not surgery is absolutely indicated. A thorough review of the patient's history is necessary to begin shedding some light on the prognosis. The examination performed by a physician (usually, orthopedist or sports medicine) or physical therapist provides valuable information about the patient's movement restrictions and limitations via range of motion testing, special clinical tests, and muscle/joint testing.

Is an MRI necessary? In some cases, yes. Partial-thickness tears, determined by clinical examination, may warrant the need for an MRI study, especially if the patient's signs and symptoms do not improve after a few weeks of physical therapy. Again, a good clinical examination will usually reveal the severity of a tear based on the functional limitations and impairments noted. If I see a patient for a diagnosis of "rotator cuff tear", and the patient is able to perform movements and tests without restriction, I usually tell the patient to rehab (or "prehab") the shoulder, and if the symptoms don't dramatically improve in 2-3 weeks, then I'll go ahead and refer the patient to the appropriate physician for further testing.

Can a rotator cuff tear "heal" on its own? Again, it depends on the size the tear. Full-thickness tears will not heal on their own. Partial thickness tears may scar down with time.
Gender, age, activity level, lifestyle, occupation, and diet are all factors that can influence general tissue healing and post-surgery recovery.