Exercise rehabilitation in the non-operative management of rotator cuff tears: a review of the literature

The incidence of rotator cuff tears increases with age, with full-thickness rotator cuff tears present in approximately
25% of individuals in their sixties, and more than 50% of those in their eighties. While surgery is
considered an effective treatment, recurrent tears at the insertion site are common, especially with degenerative
tears, which are frequent in the older population. More recently, there has been increasing interest
in exercise rehabilitation and physical therapy as a means to manage partial and full thickness tears of the
rotator cuff by addressing weakness and functional deficits. Recent studies have suggested that patients opting
for physical therapy have demonstrated high satisfaction, an improvement in function, and success in
avoiding surgery. When considering the increasing rate of shoulder surgery and the associated economic
and social burden rotator cuff surgery places on both the patient and the health care system, non-surgical
management such as physical therapy and exercise may, in selected cases, be a treatment alternative to
surgical repair. The purpose of this clinical commentary is to provide an overview of rotator cuff pathology
and pathogenesis, and to present an evidence-based case for the role of conservative rehabilitation in the
management of rotator cuff injuries.