Conservative Treatment vs. Surgery for Rotator Cuff Tears: What Do the Latest Studies Say?

Written By Courtney L’Hussier

Rotator cuff tears are a common cause of shoulder pain and dysfunction, particularly in older adults and athletes. Treatment options include conservative (physical therapy/non-surgical) management and surgical repair.

Conservative Treatment for Rotator Cuff Tears

For many patients, physical therapy (PT) and pain management can significantly improve symptoms, even for some full-thickness tears.

Physical Therapy (PT)

  • Range-of-motion exercises to prevent stiffness.

  • Strengthening exercises for the rotator cuff and scapular stabilizers to improve joint stability.

  • Postural training to improve shoulder mechanics.

  • Manual therapy to improve tissue mobility and reduce pain.

  • Dry Needling to reduce pain and improve tissue healing

  • Gradual resistance training to rebuild endurance.

  • Activity Modification

    • Avoiding overhead reaching, lifting, or repetitive movements that worsen symptoms.

    • Gradually reintroducing daily activities as strength improves.

Who are the best candidates for conservative treatment?
✔ Partial-thickness tears (<50% tendon thickness)
✔ Chronic full-thickness tears in older adults
✔ Irreparable tears where surgery is not an option

*For large, symptomatic full-thickness tears, conservative treatment is often not enough.

When is Conservative Treatment Not Working?

Research suggests patients should consider surgery if they experience:

✔ Severe pain persists beyond 3-6 months despite physical therapy.
✔ Significant loss of strength or function—difficulty lifting the arm, getting dressed, or sleeping.
✔ Tear size progression—MRI or ultrasound shows the tear is getting larger.
✔ Failed physical therapy—no improvement after 12-16 weeks of structured rehab.
✔ Pseudoparalysis—inability to lift the arm due to a massive rotator cuff tear.

Surgical Treatment: When is it Necessary?

Surgery is often recommended for:
✔ Acute full-thickness tears—especially in younger, active individuals.
✔ Patients with persistent pain or weakness after exhausting conservative options.
✔ Athletes and workers who need full shoulder function for overhead activities.

Conclusion: How to Decide Between Conservative Treatment and Surgery

Choosing between conservative care and surgery depends on several factors:
✔ Tear type – Small or partial tears often respond well to PT, while large, symptomatic full-thickness tears may require surgery.
✔ Patient age & activity level – Older, less active individuals may do well without surgery, whereas younger, active patients may benefit more from repair.
✔ Response to PT – If symptoms improve within 3-6 months, surgery may not be needed. If not, surgical repair should be considered.

Questions? Contact Plus Forte!

Website: www.plusforte.co

Email: admin@plusforte.co

Phone: 978-590-6951

Courtney L’Hussier
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