In the absence of reliable evidence, it is the opinion of the work group that surgery not be performed for asymptomatic, full thickness rotator cuff tears.

Rationale
Although there is a growing awareness that a large proportion of our population can have full thickness rotator cuff tears that are asymptomatic, we were unable to find quality literature that addressed the issue of operative vs. non-operative treatment for such patients. The issue of appropriate treatment of asymptomatic full thickness tears is potentially important given the high prevalence rate, concerns regarding prrogression in the form of an enlarging tear, or deterioration into a symptomatic process. Given the potential importance of this patient population, the work group felt that a consensus opinion would be appropriate in light of a paucity of published evidence. The opinion that surgery not be performed for asymptomatic, full thickness rotator cuff tears was based on the following considerations:
  • Asymptomatic rotator cuff disease is highly prevalent in the older population. A large percentage of our population will have full thickness rotator cuff tears without any apparent difficulties. Thus, the presence of a tear in and of itself is not clinically significant for many people as they have no pain or apparent lack of function.
  • For patients with bilateral asymptomatic shoulders, there is no reliable evidence that surgery prevents long-term clinical deterioration of a rotator cuff tear.
  • Post-surgical healing rates are inconsistent in elderly patients - the patients most likely to have asymptomatic rotator cuff tear.
  • Surgical repair of the rotator cuff has peri-operative morbidity and risks, including pain and loss of use of the arm for a significant time period, infection, deltoid injury, implant failure, and arthrofibrosis. The morbidity and risk are probably not warranted in absence of symptoms.
  • Currently, the primary indication for rotator cuff repair is significant pain or dysfunction affecting quality of life; neither indication is present in patients with asymptomatic rotator cuff tears.
Given the above considerations, it is the opinion of this work group that patients with asymptomatic full thickness tears not be treated with operative repair.