Do all rotator cuff tears need surgery?
No. Degenerative Rotator cuff tears, which develop gradually, are part of aging process. Many tears remain asymptomatic. Rehabilitation will result in good range of movement and pain improvement. But the strength will not improve. On the other hand, large cuff tears, profound weakness and an acute traumatic event causing the tear will give bad results if treated non-operatively. The surgeon will consider all these factors and will suggest the appropriate treatment for each patient.
Usually not. Many tears in people over 50 are simply the result of aging. We call these attritional tears, where the tissue simply wears out from use. Just like the front of your knee on your favorite pair of jeans — sometimes the rotator cuff tendon simply wears out. An acute, traumatic tear in a young patient is a very different situation; these tears will usually require surgery to repair the tear and restore function. This is a topic that needs to be discussed in person with an appropriately trained surgeon to determine whether your tear should be treated operatively or non-operatively. Large acute tears should not be watched too long without surgery. They can retract and result in significant atrophy, which can make a repair very difficult, if not impossible.
