Rotator Cuff Tear · Conservative vs Repair

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Type/age/demand + reparability
   Tear type (acute traumatic full-thickness?) + age/demand + reparability?
   • Acute traumatic full-thickness tear, young/active → Acute traumatic full-thickness → arthroscopic repair
   • Partial tear/degenerative/elderly/low-demand → Degenerative/elderly → conservative
   • Massive irreparable + arthropathy (pseudoparalysis/humeral head migration) → Massive irreparable + arthropathy → reverse arthroplasty
2. [End] Degenerative/elderly → conservative
   Partial/degenerative/elderly/low-demand → conservative: active physiotherapy as the core, NSAIDs ± subacromial corticosteroid injection (~74–80% relief); re-evaluate for surgery if it fails/progresses.
3. [End] Acute traumatic full-thickness → arthroscopic repair
   Acute traumatic full-thickness, young/active → early arthroscopic repair (ideally <4 months from injury for better healing); massive/complex may need mini-open/open ± acromioplasty.
4. [End] Massive irreparable + arthropathy → reverse arthroplasty
   Massive irreparable (supraspinatus atrophy/fatty infiltration/humeral head migration) + arthropathy/pseudoparalysis → reverse total shoulder arthroplasty; without arthropathy, consider superior capsular reconstruction/tendon transfer.

Source guidelines & references

• Rotator cuff management (AAOS 2025 rotator cuff clinical guideline)

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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