Operative vs. Non-Operative Treatment of Rotator Cuff Tears

The rotator cuff is a group of four muscles—supraspinatus, infraspinatus, teres minor, and subscapularis. These muscles originate at the shoulder blade and attach to the head of the humerus. Together, they help maintain proper alignment of the humeral head on the glenoid (the socket of the shoulder blade).

When the rotator cuff isn’t functioning properly, even simple movements—like raising your arm overhead—can place excessive stress on the surrounding structures. Over time, rotator cuff tears can lead to degenerative changes in the bone, tendons, and cartilage, contributing to pain and loss of function.

Patients with a rotator cuff tear are often faced with a key decision:
Should I treat this surgically or non-operatively?

While surgery may seem like the obvious solution, non-operative treatment has also shown strong outcomes, especially when underlying movement dysfunction is addressed.

Understanding the Root Cause

Most rotator cuff tears don’t occur spontaneously. They are often the end result of an underlying mechanical dysfunction—such as poor shoulder blade control, limited thoracic mobility, or muscular imbalances—that increases stress on the tendon.

Repairing the tear itself does not fix the root cause.
To restore long-term shoulder health, deficits in strength, range of motion, and neuromuscular control must be addressed—not just in the shoulder, but throughout the entire kinetic chain.

What the Research Shows

A 5-year follow-up study comparing operative vs. non-operative treatment for rotator cuff tears evaluated:

• Strength

• Range of motion

• Functional performance

• Need for future surgery

• Tear progression

• Tear size

Key Findings

1. No difference in strength or range of motion between groups

2. No difference in functional performance

3. Surgery did not reduce the risk of recurrent tears

4. Non-operative treatment showed larger tear sizes (expected without surgical repair)

5. Operative treatment reduced the risk of future surgery (also expected, as some cases require repair)

The main takeaway:
Patients had similar strength, mobility, and functional outcomes regardless of whether they underwent surgery.

Tear size differences were expected, and surgical groups naturally showed lower rates of future surgery due to initial repair.

So… When Is Surgery Necessary?

While many rotator cuff tears can be successfully managed conservatively, surgery is appropriate in certain situations, including:

• Acute full-thickness tears in younger individuals

• Tears caused by significant trauma

• Persistent loss of function despite rehab

• High-demand athletes or professions requiring overhead strength

• Progressive weakness or structural instability

The best decision is made collaboratively between the patient, physician, and physical therapist, based on goals, activity level, and examination findings.

The Kauno Perspective

Whether surgical or non-operative treatment is chosen, the most important part of recovery is addressing the body as a whole. At Kauno, we focus on:

• Restoring strength

• Improving range of motion

• Rebuilding movement control

• Correcting biomechanical dysfunctions

• Enhancing long-term joint health

Because meaningful recovery relies on more than repairing a tendon—it depends on rebuilding a capable and resilient system.

Reference

Chalmers, P. N., Ross, H., Granger, E., Presson, A. P., Zhang, C., & Tashjian, R. Z. (2018). The Effect of Rotator Cuff Repair on Natural History. JBJS Open Access, 1.
https://doi.org/10.2106/jbjs.oa.17.00043