Rotator cuff tears: is non-surgical management effective?

Background: Rotator cuff-related shoulder pain is a common musculoskeletal complaint with an increasing number of people with shoulder pain undergoing surgical repair each year. The relationship between rotator cuff tendon tears and shoulder pain remains equivocal due to the high prevalence of tears in people without symptoms, which suggests that a proportion of people will undergo surgery on tissues not related to their symptoms. As a result there have been suggestions to initially manage atraumatic tears non-surgically. Objectives: The objective of this narrative review was to present current evidence regarding the assessment and management of full-thickness rotator cuff tears. Major findings: To date, three randomised controlled trials have compared surgical with non-surgical management of rotator cuff tears. Outcomes show a small but non-significant effect in favour of surgery. Only one study has looked at long-term outcomes of greater than one year. Overall 129 subjects have completed a course of nonsurgical management and therefore low participant numbers may not be sufficient to draw firm conclusions. Conclusions: Current evidence currently supports the consideration of a non-surgical approach in the management of people with shoulder symptoms and identified rotator cuff tears, for a period of time.