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Rotator Cuff Tear: Surgery vs Physical Therapy

Not all rotator cuff tears need surgery. Learn when PT is enough, when surgery is necessary, and how to decide.

Types of Tears

Partial tears are damaged but not severed. Full-thickness tears go completely through. Acute tears are from sudden injury. Degenerative tears develop gradually over time — most common in patients over 50.

When PT Is Enough

About 70-80% of partial tears and 40-50% of small full-thickness tears can be managed without surgery. PT works best for partial tears, degenerative tears in older patients, and low-demand lifestyles.

When Surgery Is Needed

Recommended for acute tears in active patients, large tears that are retracting, significant weakness, and failed conservative treatment after 3-6 months.

Decision Framework

Lean toward PT: Over 65, partial tear, low demands, tolerable pain. Lean toward surgery: Under 60, acute injury, full-thickness tear, significant weakness, tear enlarging.

Frequently Asked Questions

Can a rotator cuff tear heal on its own?
Tears rarely heal spontaneously, but many become asymptomatic with strengthening exercises.
What happens if I don't fix it?
Small tears may stay stable. Some progressively enlarge, potentially leading to arthritis that may require shoulder replacement.

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