What is the treatment for a full rotator cuff tear?

Treatment for Full Rotator Cuff Tear

For symptomatic full-thickness rotator cuff tears, initial conservative management with physical therapy, pain control, and possibly corticosteroid injections should be attempted first, with surgical repair reserved for cases that fail conservative treatment. 1

Initial Assessment and Diagnosis

• Imaging options:

  • MRI, MR arthrography, or ultrasonography are strongly recommended to identify and characterize rotator cuff tears 1
  • Plain radiographs should include anteroposterior views in internal and external rotation 2

• Important prognostic factors to assess:

  • Patient age (older age associated with higher failure rates) 1
  • Presence of comorbidities, especially diabetes (associated with poorer outcomes) 1
  • Tear size, muscle atrophy, and fatty infiltration 2

Conservative Management (First-Line Treatment)

1. Pain Management:

   • Acetaminophen and NSAIDs at lowest effective dose 2
   • Single corticosteroid injection with local anesthetic for short-term improvement in pain and function 1
   • Avoid multiple corticosteroid injections as they may impair tendon healing 2

2. Physical Therapy:

   • Eccentric strengthening exercises focusing on rotator cuff muscles
   • Scapular stabilization exercises
   • Continue for at least 8-12 weeks for optimal results 2
   • Activity modification to avoid overhead activities that exacerbate symptoms 2

3. Duration of Conservative Treatment:

   • Continue until patient demonstrates increased weakness and loss of function not recoverable by physiotherapy 3
   • Conservative treatment has shown effectiveness in the short and intermediate terms 3

Surgical Management

Surgical repair should be considered when:

• Conservative treatment fails to provide adequate pain relief or functional improvement
• Patient has significant pain affecting quality of life 1

Surgical options:

• Arthroscopic repair is the preferred approach 2
• For high-grade partial-thickness tears, conversion to full-thickness repair is supported by strong evidence 1
• Single-row versus double-row repair: Strong evidence does not support double-row constructs for improving patient-reported outcomes 1

Post-surgical rehabilitation:

• Strong evidence suggests similar outcomes between early mobilization and delayed mobilization (up to 8 weeks) for small to medium-sized tears 1

Evidence for Treatment Effectiveness

• One level III study showed that surgical patients reported significantly less pain and better outcomes (81% excellent results) compared to non-surgical treatment (37% excellent results) 1
• However, a 2017 meta-analysis found limited evidence that surgery is not more effective than conservative treatment alone, with no clinically significant difference between surgery and active physiotherapy in 1-year follow-up 4
• A recent 2025 prospective longitudinal study demonstrated that surgical intervention resulted in significantly lower pain scores, higher functional scores, greater strength, and better range of motion compared to conservative management 5
• Surgical intervention was also protective against progressive muscle degeneration compared to nonoperative treatment 5

Special Considerations

• Asymptomatic tears: Surgery is not recommended for asymptomatic full-thickness rotator cuff tears 1
• Older patients: Higher failure rates and poorer outcomes after repair 1
• Diabetic patients: Higher retear rates and poorer quality of life after repair 1
• Biological augmentation: Strong evidence does not support routine use of platelet-rich plasma (PRP) for partial tears 1

The treatment approach should be guided by symptom severity, patient factors, and response to initial conservative management, with surgical intervention reserved for those who fail to improve with non-operative measures.