Do I Have a Rotator Cuff Tear? Do I Need Surgery?

The shoulder can move in all sorts of ways. Unfortunately, this sets the shoulder up for tears and injuries. Did you know, roughly one in four people age 60+ have tears in their rotator cuffs?1 People of all ages can tear the rotator cuff, but most tears are non-painful. However, some tears can be debilitating.

What is the Rotator Cuff?

The rotator cuff is a collection of tendons and muscles fused to a capsule. As a group, this structure provides stability to the shoulder throughout its range of motion.

Do I Have a Rotator Cuff Tear?

A tear can be diagnosed with diagnostic ultrasound imaging.2 A tell-tale sign is shoulder pain that’s worse at night. The pain during the day is often more tolerable, but it can be aggravated by specific activities.

Do I Need Surgery?

Research suggests that some people can recover with physical therapy alone, but not all. Tears that develop without a sudden, major trauma do well in physical therapy. These are likely degenerative tears. In one study, 84% of patients who received physical therapy alone did not need surgery for more than four years.3 Most tears of less than 50% thickness also were treatable with rehab alone. In that same study, only 16% of people with traumatic tears were able to avoid surgery, and a minority of patients with greater than 50% thickness tears succeeded with rehab alone.  

Some patients need surgery followed by physical therapy and may benefit from pre-surgical physical therapy as well. A study recently published in the American Journal of Sports Medicine finds that delaying surgery for a course of conservative treatment in partial thickness tears improves functional results of surgery.4 


  1. Fehringer E, Sun J, VanOveren L, et al. Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in patients sixty-five years and older. J Shoulder Elbow Surg. 2008; 17: 881-885.
  2. Saraya S, El Bakry R. Ultrasound: can it replace MRI in the evaluation of the rotator cuff tears?. The Egyptian Journal of Radiology and Nuclear Medicine. 2016 Mar 1;47(1):193-201.
  3. Lo IK, Denkers MR, More KD, Nelson AA, Thornton GM, Boorman RS. Partial-thickness rotator cuff tears: clinical and imaging outcomes and prognostic factors of successful nonoperative treatment. Open Access Journal of Sports Medicine. 2018;9:191.
  4. Kim YS, Lee HJ, Kim JH, Noh DY. When should we repair partial-thickness rotator cuff tears? Outcome comparison between immediate surgical repair versus delayed repair after 6-month period of nonsurgical treatment. The American Journal of Sports Medicine. 2018 Apr;46(5):1091-6.
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