By Moby Parsons, MD

Rotator cuff tears an be either traumatic (i.e. they occur from an acute injury) or attritional (they let go over time due to the effects of age and wear and tear).  When acute tears lead to loss of strength and function in younger patients, particularly those involved in physical labor or those engaged in recreational or work activities that require substantial use of the arms, operative repair of the torn tendon is generally the treatment of choice. Connecting the completely torn tendon back to the bone restores power to the arm and reduces pain caused by the muscle pulling against a torn tendon.

Attritional tears may develop slowly over time allowing the body to adapt to the loss of muscle function through the recruitment of other neighboring muscles that perform the same type of work on the shoulder. In some cases, patients are not even aware that they have a rotator cuff tear as their strength is near normal and they have no pain. When patients have a non-traumatic painful but well functioning rotator cuff tear, conservative treatment is often effective in managing this problem without surgical repair. Conservative treatment focuses on diminishing the acute pain and teaching the shoulder to compensate for the torn tendon by strengthening and using other muscles about the shoulder.

Most rotator cuff tears involve only 1or 2 or the 4 tendons. Exercise programs that focus on strengthening the remaining intact tendons along with the anterior deltoid muscle and serratus anterior muscle may be successful in improving shoulder comfort and function to a level that is satisfactory to the patient without the need for surgery. A skilled physical therapist knowledgeable about such exercise programs can guide patients on the proper techniques to avoid aggravation of the tear. The success of a conservative program may be augmented by a cortisone injection which can help quiet down the acute pain, making it easier for patients to perform the necessary exercises to improve their shoulder function.

Surgery should be considered a last resort for attritional, non-traumatic rotator cuff tears, particularly for patients over age 65 for whom the success of surgery may be limited by the poor healing potential of the torn tendon. Make sure to discuss with your surgeon all treatment alternatives and be sure to maximize conservative options before considering surgery to repair the tendon.