Long Term Benefits to Rotator Cuff Surgery
Are There Long-Term Benefits to Rotator Cuff Repair Surgery? Insights from a Norwegian Study with 15 Year Follow-Up
Rotator cuff tears are a common source of shoulder pain and disability. If you have been diagnosed with a painful rotator cuff tear, do you opt for surgery? There are few long-term high quality randomized studies comparing surgical treatment to physical therapy for the treatment of rotator cuff tears. Many studies are biased by surgeon preference, retrospective review design, inadequate control groups, industry (implant manufacturer) influence, and other factors. Norway has an ideal healthcare system to investigate common yet controversial treatments due to the public nature of their healthcare system offering equal access to all, no financial incentives for treaters, and the stable population offering long-term checkups into older age.
A recent Norwegian study published in The Journal of Bone and Joint Surgery(1) provides compelling evidence on the superiority of surgical intervention over conservative treatments for small-to-medium-sized tears. This 15-year follow-up of a randomized controlled trial compared primary tendon repair—performed arthroscopically—with physiotherapy, revealing significant long-term advantages for surgery. For a brief dive into the key findings and recommendations, see below.
Understanding Rotator Cuff Tear Symptoms
Rotator cuff tear symptoms typically include persistent shoulder pain from rotator cuff injury, especially during overhead activities or at night. Some will cause weakness in the shoulder, and difficulty reaching, but some tears may not cause a functional loss, as least initially. Other common signs are a clicking or popping sensation, stiffness, and pain that radiates in the upper arm. These rotator cuff tear symptoms can worsen over time if untreated, impacting daily life and work. Early recognition is crucial, as delays can lead to larger tears and more complex treatment decisions.
The Norwegian study involved 103 patients with full-thickness tears up to 3 cm, randomly assigned to surgery or physical therapy. While short-term results were similar, differences emerged by year 5 and grew over time.
Treatment Recommendations for Rotator Cuff Tears
Historical treatment algorithms often start with non-surgical options like rest, anti-inflammatory medications, and physical therapy to strengthen surrounding muscles and improve mobility. However, this study strongly supports arthroscopic shoulder surgery for rotator cuff repair as the primary treatment, especially for active individuals. This minimally invasive procedure uses small incisions to reattach the torn tendon to the bone, promoting healing limited downtime compared to open surgery.
Post-surgery, a structured rehabilitation program is essential. This includes a sling for 4-6 weeks, followed by gradual physical therapy to restore strength and flexibility. Recovery timelines vary, but most patients regain full function within 3-4 months. Pain management with ice, medications, and gentle exercises helps during this period.
Risks of Not Opting for Surgery
Choosing physical therapy alone carries notable risks, as highlighted in the study. Over 15 years, unrepaired tears nearly doubled in size—from an average of 16.2 mm to 31.6 mm—leading to progressive deterioration. This enlargement exacerbates rotator cuff tear symptoms, resulting in increased pain (1.8 cm higher on a 10-cm scale), reduced pain-free abduction (16.2° less), and flexion (22.4° less). Functional scores were inferior, with Constant scores 11.8 points lower and ASES scores 13.9 points lower compared to surgical patients.
Without surgery, patients face higher chances of chronic weakness, irreversible muscle atrophy, and arthritis development. In the trial, 15 of 51 physiotherapy patients eventually required secondary surgery, often with poorer outcomes due to delayed intervention. These risks underscore why ignoring severe shoulder pain from rotator cuff tears can lead to long-term disability and reduced quality of life.
Conclusion
This landmark 15-year study affirms that arthroscopic rotator cuff surgery offers superior long-term results for small-to-medium tears, with better pain relief, function, and tear stability. If you’re dealing with rotator cuff tear symptoms, seek prompt evaluation from the best orthopedic shoulder surgeon in the Northwest Suburbs, Dr. Thomas Obermeyer, who services the Schaumburg, Elk Grove, Arlington Heights, Hoffman Estates, and surrounding areas. Early surgical consideration can prevent complications and restore your active lifestyle. Remember, individualized care is key—discuss options to make an informed decision.
References
- Moosmayer S, Lund G, Seljom U, Svege I, Hennig T, Tariq R, Smith HJ. Comparison between surgery and physiotherapy in the treatment of small and medium-sized tears of the rotator cuff: A randomised controlled study of 103 patients with one-year follow-up. J Bone Joint Surg Br. 2010 Jan;92(1):83-91.
