Rotator cuff tear: When should you consider surgery?

Shoulder pain is a common complaint that can affect your sleep, limit your ability to lift objects, and interfere with everyday activities. One frequent cause of persistent shoulder pain is a rotator cuff tear.

 

In this article, consultant orthopaedic and trauma surgeon Mr Amit Kapoor explains what a rotator cuff tear is, how it can be treated, and when surgery should be considered.

 

 

What is a rotator cuff tear?

 

The rotator cuff is a group of four muscles and their tendons that surround the shoulder joint, helping to keep it stable and allowing a wide range of motion. A tear occurs when one or more of these tendons become damaged, either through injury or age-related degeneration.

There are two main types of rotator cuff tear:

• Acute tears, usually caused by trauma such as a fall or lifting something heavy.
• Degenerative tears, which develop slowly with age or repetitive shoulder movements.

 

 

Symptoms of a torn rotator cuff

 

Spotting the signs of a rotator cuff tear early can help you get the right treatment sooner. Common signs include:

• Ongoing shoulder pain, especially at night or when lying on the affected side
• Weakness or difficulty lifting and rotating the arm
• Reduced range of motion
• A clicking or crackling sensation (crepitus) when moving the shoulder

If symptoms persist for more than a few weeks, it’s important to seek medical advice, as early diagnosis can prevent further damage.

 

 

When is surgery not needed?

 

Not all rotator cuff tears require surgery. In fact, many partial-thickness or small degenerative tears can be successfully managed with conservative treatments, like:

• Physiotherapy to strengthen surrounding muscles and improve shoulder function
• Anti-inflammatory medications to relieve pain and swelling
• Steroid injections to reduce inflammation and offer temporary relief

Surgery may not be necessary if shoulder function is preserved and symptoms improve with time and rehabilitation.

 

 

When should you consider surgery for a rotator cuff tear?

 

There are several situations where surgery may be the right choice:

 

1. Symptoms persist despite conservative treatment

If pain and weakness continue after 3 to 6 months of physiotherapy and medical management, surgery may be advised to restore function.

 

2. Full-thickness tear confirmed on imaging

Larger or complete tears that significantly affect arm strength and function are less likely to heal on their own and may require surgical repair.

 

3. The tear is due to a recent injury

Young or middle-aged patients who suffer an acute tear due to an injury are more likely to benefit from early surgical intervention, ideally within a few weeks, to prevent muscle atrophy and tendon retraction.

 

4. High functional demands

Individuals with physically demanding jobs or athletes may choose surgery earlier to regain optimal shoulder performance.

 

 

What does rotator cuff surgery involve?

 

Rotator cuff repair is commonly performed using arthroscopic (keyhole) surgery, allowing precise repair without damaging much of the surrounding tissue. The torn tendon is reattached to the bone using suture anchors.

 

After surgery:

• The arm is usually supported in a sling for several weeks
• A structured physiotherapy programme begins soon after
• Most patients return to full activity within 4 to 6 months (depending on the size of the tear and individual factors)

Early treatment usually leads to better outcomes, particularly when the tendon quality remains good and muscle wasting is minimal.

 

 

A rotator cuff tear can significantly affect quality of life, but not every tear requires surgery. For many people, conservative treatments are effective. However, if symptoms persist or the tear is severe, surgery may offer the best chance for a full recovery.

 

If you are experiencing persistent shoulder pain, consult with Mr Kapoor via his Top Doctors profile to explore your treatment options.