Exercise as effective as surgery in improving quality of life, disability, and pain for large to massive rotator cuff tears: a systematic review and meta-analysis

Review written by Jared Powell info

Key Points

  1. Exercise-led rehabilitation for large to massive rotator cuff tears is as effective as surgical repair.
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Rotator cuff tendon tears (RCTTs) are common and become more so with advancing age (1). This is pretty much fact and uncontroversial. What is less clear is the relationship between RCTTs and the experience of pain. The current consensus is small to medium RCTTs are frequently asymptomatic but large to massive RCTTs are more commonly associated with shoulder pain.

A large RCTT is a tear that measures between 3-5cm. A massive RCTT is a bit harder to define. Some say it’s a tear measuring >5cm, others suggest it’s a full thickness tear affecting 2 or more tendons, whilst a recent Delphi consensus study suggested it is a tear that exposes more than 2/3 of the greater tuberosity or has retracted medially of the glenoid rim (2). No matter how its defined, we need effective treatments for these larger tears, because they can be disabling.

This systematic review aimed to compare the effectiveness of surgery vs exercise on quality of life, disability and pain for individuals with large to massive RCTTs.

Rotator cuff tendon tears are common and become more so with advancing age.
The sensible conclusion from this study should be try exercise-led rehab first and if the patient fails to sufficiently improve, surgery is a viable secondary option.


The design of this study was a systematic review and meta-analysis of randomized controlled trials (RCT) following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The review was pre-registered on PROSPERO.

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