We have evidence that rotator cuff tears appear in asymptomatic populations and increase in prevalence throughout life.
Most symptomatic rotator cuff tears tend to follow a natural history of improvement over time (i.e., regression to the mean).
Many clinicians operate from a false premise by dichotomizing traumatic versus non-traumatic rotator cuff tears to determine an appropriate course of action and choosing surgical repair for those deemed traumatic. Although the necessity of surgical repair is discussed with confidence by many clinicians, there is substantial evidence questioning the validity of surgical intervention and much more uncertainty exists.
We have evidence of similar outcomes between surgical intervention and conservative (i.e., nonsurgical) management.
Corticosteroid injection therapy appears to provide a small benefit in the short term (less than 8 weeks), but no clear benefit at any time point beyond that. We also have emerging evidence regarding risks of such injections.
Exercise therapy appears to be the best course of action based on the totality of evidence. However, given the variability among exercise interventions studied, more well-conducted studies are required to determine the appropriate type and dose of exercise.
We should also address psychosocial factors such as self-efficacy and patient expectations to increase the odds of positive long-term outcomes.
Overall, the evidence is supportive of conservative management for rotator cuff tears, but whether a particular subset of cases necessitate surgical intervention remains unknown.