Surgery and science of the rotator cuff: editorial comment.

During the past few decades, both the diagnosis and the treatment of rotator cuff injuries have improved. Despite this, uncertainties remain. For example, when a patient first presents to the clinician’s office, we do not have good criteria for deciding whether he or she should be treated nonoperatively. This is the case partly because rotator cuff injuries are common and often minimally symptomatic, especially in the elderly, sometimes making it difficult to determine whether the symptoms in those patients who do come in with shoulder complaints are concordant with (or caused by) findings on imaging tests. And, among those patients who have symptoms, some are able to cope with them. Therefore, most clinicians recommend that treatment begin with nonoperative measures and surgeons see those whose symptoms fail to resolve. However, other clinicians recommend surgery in many of their patients with a cuff tear for fear of the tear getting more severe over time (ie, tear progression). While most surgeons have experience with an individual returning to their office several years after diagnosis of a small tear that has now become massive, our knowledge of tear progression is limited to a small number of shoulders over short time periods of a few years [3, 9] (Fig. 1). Fig. 1 Patrick J. McMahon MD. When rotator cuffs are repaired, many of them (about 25% in some reports) fail to heal [1, 2, 4–8]; thus, we need better repair techniques. These retears occur more often in severe rotator cuff tears, but other factors including the use of NSAIDs may also impair healing. In this symposium, the authors shed light on the answers for some of these problems. My hope for the future is that we can better select those patients needing treatment for their rotator cuff injuries and develop better surgeries that allow more of our patients to heal.