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Rotator cuff tears can be symptomatic or asymptomatic (symptoms or no symptoms). According to this study, the rate of symptomatic tears was 34.7% and the asymptomatic tear rate was 65.3%.

There is not a percentage of people that will require rotator cuff surgery. Up to this date, there has not been a study to determine a percentage range. 

Instead, I searched for the “inclusion criteria for rotator cuff repair.” I’ll share the findings with you, below. 

Additionally, here are a few pieces of equipment that you will find useful as you are recovering whether you decide to have surgery or not:

• Adjustable dumbbell (amazon link)
• Long loop band with handle (amazon link)

What are the inclusion criteria for rotator cuff surgery?

This is the question of the hour! An inclusion criteria means, what signs and symptoms you need to present with in order to be a good candidate for rotator cuff surgery. 

The truth is, we don’t know for sure. 

The guidelines that we have are the best guess as to what makes sense based on the anatomy of the shoulder joint. 

But, as we’ve learned from meniscus tears of the knee and bulging discs of the back, our MRI, CT scans, and x-rays are not good enough tools to inform us of whether or not to get surgery. 

The stats I shared in the intro were about the people who were asymptomatic and symptomatic. That was from a study done in 2007. They took 664 people and did a diagnostic ultrasound on each person’s shoulders.

They asked in their questionnaires if the subjects had any shoulder pain currently or in the past. 

Then, based on their answers they put them into two groups. 

Reported shoulder pain equals symptomatic rotator cuff tear.

Non-reported shoulder pain equals asymptomatic rotator cuff tear. 

Based on this reporting method it’s my opinion that there are likely many more subjects in the symptomatic group that didn’t have symptomatic rotator cuffs. There are many structures in the shoulder that cause pain so this is likely an overcategorization. 

Another important point is that <5.4% of people who were 40 or younger had any sign of a RTC tear while approximately 54% had rotator cuff tears after the age of 40. 

A better inclusion criteria for a rotator cuff tear, as described in this study, done in 2007, would be as follows:

• (1) patients physiologically younger than 60 years; 
• (2) patients with clinically or arthrographically demonstrable full-thickness cuff tear; 
• (3) patients who failed to improve with nonoperative treatment; 
• (4) patients who need to use the involved shoulder in overhead elevation in their vocation or avocation; 
• (5) patients with full passive shoulder range of motion (ROM); 
• (6) patients willing to exchange decreased pain and increased external rotator strength for some loss of active abduction; and 
• (7) patients able and willing to cooperate with the postoperative care

If I were to add my own criteria it would be:

• Significant loss of strength as compared to the unaffected side
• Significantly decreased overhead range of motion
• No improvement from therapy and exercise treatment program for > 3 months (ideally > 6 months if the patient can tolerate)

There is a caveat to this. 

If you can barely raise your arm, it hurts like hell, it’s not making any forward progress after 4-6 weeks of therapy; you might need the surgery sooner rather than later. I have seen this happen but it’s important to also measure your passive range of motion lying on your back as the criteria suggested above. This would make sure you don’t have a frozen shoulder.

Key Takeaways

• According to the study shared above, 65.3% of individuals had full-thickness rotator cuff tears and no pain.
• 34.7% of those subjects were classified as having a symptomatic rotator cuff tear
• It’s likely that of the 34.7% many of those experiencing shoulder pain were experiencing pain that was of a different origin that the rotator cuff. I suspect this 34.7% is an overcategorization. 
• Likely the best indications for surgery is that you have a severe weakness where you can’t lift your arm, a lot of pain, and you’ve tried non-operative management for 4-6 weeks without any improvement. This is very uncommon but I do still see it. 
• Inform your family and friends about this so they don’t get unnecessary surgery!