Systematic review of 50 studies examining which patient factors — demographics, symptom duration, surgical timing, physical exam findings, and tear size — should guide the decision to surgically repair symptomatic full-thickness rotator cuff tears. All available evidence is Level III–IV; no RCTs exist on this question.
When evaluating a patient with a full-thickness rotator cuff tear, let weakness and functional disability — not age — drive your urgency: severe preoperative weakness and symptom duration beyond one year are the clearest indicators to move toward surgery rather than prolonging nonoperative management.
Counsel workers' compensation patients that their outcomes are likely inferior regardless of treatment choice, and document this expectation preoperatively.
Systematic review of 50 studies examining which patient factors — demographics, symptom duration, surgical timing, physical exam findings, and tear size — should guide the decision to surgically repair symptomatic full-thickness rotator cuff tears. All available evidence is Level III–IV; no RCTs exist on this question.
When evaluating a patient with a full-thickness rotator cuff tear, let weakness and functional disability — not age — drive your urgency: severe preoperative weakness and symptom duration beyond one year are the clearest indicators to move toward surgery rather than prolonging nonoperative management.
Counsel workers' compensation patients that their outcomes are likely inferior regardless of treatment choice, and document this expectation preoperatively.