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Ask the Expert: Do I have to have surgery for my torn rotator cuff?
Michel Arcand, MD

The simple answer is no. To explain the answer you need to understand the rotator cuff and its function. The rotator cuff is a flat tendon that wraps around the humeral head, the ball in the shoulder joint. This tendon and its muscles make the humeral head rotate in its socket. Weakness in this tendon and its muscles can cause pain and inability to use the arm.

Rotator cuff tears are areas where the integrity of the cuff has been compromised. This can be a tear that goes through a part of the tendon or completely traverses the entire thickness of one or more of the tendons. Tears interrupt the cuff's ability to rotate the ball of the humerus.

Tears in the rotator cuff tendons seem to be a function of age. People under forty rarely get cuff tendon tears. In the general population, people in their 60s have 25-30% chance of having a tear. This can reach 50% in your 80s. Not all patients with a tear have pain.
There are two types of tears. Acute tears which usually happen from significant trauma and are seen soon after the injury. Patients often have pain and are unable to use the arm. Chronic tears often do not have a traumatic cause or the trauma is minor. Most people get a progressive pain and loss of use of their arm.
Non operative treatment is usually tried before operative treatment. It is the treatment choice for the vast majority of patients. It consists of rest, ice, anti-inflammatory medication, activity modification and physical therapy. If this fails, a cortisone injection may help relieve the pain and aid in rehabilitating the shoulder.

Operative treatment is reserved for patients who have failed nonoperative treatment, continued pain and loss of function. Large acute tears in young active patients might also be candidates for operative intervention.
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