As mentioned above degenerate rotator cuff tears are most common, and half of people over 60 years old would have a tear and not know it. This is because most degenerate rotator cuff tears occur slowly over time and as they occur, the other muscles of the rotator cuff and the deltoid muscle can compensate for the weakened tendon. As a result, most degenerate rotator cuff tears do not cause any symptoms (asymptomatic). Degenerate tears can become painful if the rest of the rotator cuff and the deltoid lose their ability to compensate. This can be triggered by overuse or some minor injuries.
The first principle in symptomatic rotator cuff tears is to get the rest of the rotator cuff compensating again and so the first line of treatment in these patients is physiotherapy for 3 months. Only if non-operative management fails do we recommend a rotator cuff repair.
Traumatic rotator cuff tears are often acute and cause a sudden loss of function. The rest of the rotator cuff and the deltoid don’t have the time it takes to learn to compensate for the sudden tear. Traumatic rotator cuff tears have the best potential for healing and so to get patients the best result and recovery we recommend surgery within 6 months to repair their traumatic rotator cuff tears.
Most partial thickness tears can be managed without an operation but those partial thickness tears that are so thinned that they are almost full thickness, and don’t respond to physiotherapy, may require a rotator cuff repair.
Finally, chronic tears with large retraction of the tendon away from the attachment on the ball of the shoulder may not be repairable as the muscle may be contracted. If there is fatty change in the muscle, then we do not recommend a repair as the muscle will not be strong enough to work effectively anyway.