- Response to Other Treatments
Most rotator cuff tears can be initially treated with non-surgical treatments including anti-inflammatory medications, physical therapy, and possibly a cortisone injection. If these options fail to provide relief after several months of treatment, then surgery may be considered.
- Degree of Symptoms
Patients with minimal symptoms may have surgical treatment delayed in an effort to achieve success with non-surgical treatment options. On the other hand, patients who have more constant pain, difficulty with simple activities (getting dressed, lifting household objects), or pain at night interfering with sleep may be more likely to undergo surgical treatment.
- Patient Requirement & Expectations
Some patients may not need rotator cuff surgery if their symptoms do not interfere with their usual activities. For example, a patient who has a rotator cuff tear of his non-dominant shoulder and lives a more sedentary lifestyle, may not need surgery. On the other hand, athletic patients who injure their shoulder may need surgery to return to their sport of choice.
- Type of Tear
Smaller tears can be monitored to see if non-surgical treatments may help alleviate symptoms. Larger tears may benefit from earlier intervention. Large tears can retract (leading to a permanently shortened tendon), and the muscle may irreversibly weaken, making it more difficult to delay repair. In patients with these tears, earlier surgery may help increase the likelihood of successful recovery.
Dunn WR, et al. "Variation in orthopaedic surgeons' perceptions about the indications for rotator cuff surgery" Journal of Bone Joint Surg Am. 2005 Sep;87(9):1978-84.