12/22/2025
https://www.facebook.com/share/p/17Jeo63jXx/?mibextid=wwXIfr
💡“Is a rotator cuff tear NECESSARILY the cause of shoulder pain?
Let’s examine the clinical evidence:
âś… Rotator cuff tendon degeneration and tearing are highly prevalent, especially with advancing age, and are often considered part of the normal aging process. The majority of these cases do not require surgical repair.
✅ Rotator cuff tears are not always symptomatic — the presence of a tear does not guarantee that it is the source of the patient’s pain.
✅ Structured physiotherapy programs of at least 12 weeks duration can yield outcomes comparable to surgical intervention. Importantly, post-operative protocols still involve a period of immobilization (typically 4–6 weeks) followed by a rehabilitation program that closely mirrors non-operative care.
âś… Re-tear rates are higher following arthroscopic repair compared to open repair (46% vs. 39%).
âś… Post-operative re-tears do not necessarily correlate with poorer clinical outcomes, suggesting that anatomical healing is not the sole determinant of functional recovery.
✅ Surgery may be indicated in specific cases—such as acute, traumatic tears in younger or high-demand individuals—but most degenerative, non-traumatic tears with minimal functional impact do not require surgical intervention.
And importantly…
âś… Elite overhead athletes, such as baseball pitchers, are capable of performing at high levels (in terms of velocity, accuracy, and power) despite having full-thickness rotator cuff tears, often without any pain or functional limitation. Long-term follow-up (up to 5 years) shows sustained pain-free function in many of these cases.
✅ This raises an important clinical question: If high-performance athletes can function without pain despite full-thickness tears, why shouldn’t our patients be able to return to meaningful activities without surgery?
References: Lewis (2016), Lewis (2018), Carr et al. (2017), Brindisino F et al (2025)
