Should Rotator Cuff Tears Be Treated Immediately?

In a recent study by The American Journal of Sports Medicine, research has shown delayed repair in rotator cuff tears yielded superior functional outcomes compared to immediate repair. The rotator cuff is a series of 4 muscles and tendons that help power and stabilize the shoulder. Rotator cuff tendons have a thickness to them and tears of the rotator cuff can either go all the way through the tendon (full thickness tear) or only partially through, so as to thin the tendon (partial thickness tear). In most cases, full thickness rotator cuff tears that are causing pain do best with a surgical repair. However, partial thickness tears can be treated successfully with or without surgery.

This study compared the outcomes of patients with partial thickness rotator cuff tears (but more than 50% of the tendon thickness was torn) treated either with immediate surgery or surgery after 6 months of non-operative treatment. Of the 34 patients, who were initially treated non-operatively, 10 decided not to have surgery because they were doing well with the non-operative treatment. When the remaining 24 patients (who ultimately had surgery) were compared to the patients who had immediate surgery, those who first had 6 months of non-operative treatment had better results when measured at the 6-month mark. However, both groups had similar results when measured at the 3-month, 12-month and 24-month

marks.

This shows that non-operative treatment can be effective for partial thickness rotator cuff tears, even though the tendon will not heal without surgery. Additionally, in cases where non-operative treatment fails to provide adequate relief, waiting 6 months to do the surgery does not have any negative effect on the outcomes for these patients.

SimpleTakeaway™

If you are being seen for shoulder pain and your orthopaedic surgeon diagnoses you with a partial thickness rotator cuff tear, in many cases, it may be reasonable to try non-operative treatment prior to deciding to undergo rotator cuff repair.

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Commentary by Dr. Russell Nord, M.D.

Dr. Russell Nord, M.D., is on the SimpleTherapy Clinical Advisory Board, the Orthopaedic Surgeon and Medical Director of Washington Hospital's Sports Medicine Program and Orthopaedic Surgery Section Chair at Washington Hospital.

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