title: Non-Operative Management of Rotator Cuff Tears.
abstract: BACKGROUND
  The role of nonoperative management for rotator cuff tears remains a matter of debate. Clinical results reported in the literature mainly consist of level IV studies, oftentimes combining a mixed bag of tear sizes and configurations, and are contradictory to some extent.
  
  
  METHODS
  A selective literature search was performed and personal surgical experiences are reported.
  
  
  RESULTS
  Most studies show an overall success rate of around 75% for nonoperative treatment. However, the majority of studies also present a progression of tear size and fatty muscle infiltration over time, with however debatable clinical relevance for the patient. Suggested factors associated with progression of a rotator cuff tear are an age of 60 years or older, full-thickness tears, and fatty infiltration of the rotator cuff muscles at the time of initial diagnosis.
  
  
  CONCLUSIONS
  Non-operative management is indicated for patients with lower functional demands and moderate symptoms, and/or of course for those refusing to have surgery. Close routinely monitoring regarding development of tear size should be performed, especially in patients that remain symptomatic during nonoperative treatment. To ensure judicious patient counseling, it has to be taken into account that 1) tears that are initially graded as reparable may become irreparable over time, and 2) results after secondary surgical therapy after failed nonoperative treatment are usually reported to be inferior to those who underwent primary tendon repair.
authors.affiliation: Trauma Department Hannover Medical School (MHH) Carl-Neuberg-Straße 1 D-30625 Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Petri
authors.affiliation: Orthopaedic Surgery Department Hannover Medical School (MHH) Anna-von-Borries-Str. 1-7 D-30625 Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Ettinger
authors.affiliation: Trauma Department Hannover Medical School (MHH) Carl-Neuberg-Straße 1 D-30625 Hannover, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Brand
authors.affiliation: Trauma Department Hannover Medical School (MHH) Carl-Neuberg-Straße 1 D-30625 Hannover, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Stuebig
authors.affiliation: Trauma Department Hannover Medical School (MHH) Carl-Neuberg-Straße 1 D-30625 Hannover, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Krettek
authors.affiliation: Trauma Department Hannover Medical School (MHH) Carl-Neuberg-Straße 1 D-30625 Hannover, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Omar
keywords: Conservative treatment; clinical outcomes; injections; non-operative treatment; physical therapy; rotator cuff; rotator cuff tear