Surgery and Rotator Cuff Disease: A Review of the Natural History, Indications, and Outcomes of Nonoperative and Operative Treatment of Rotator Cuff Tears.

Rotator cuff tears are common and multifactorial in etiology. Natural history studies suggest that following initiation of a tear, rotator cuff disease may advance along a continuum of tear enlargement and symptom progression, muscular degeneration and fatty infiltration, and glenohumeral arthritis. Patient- and tear-specific features influence both the risk of clinical progression and the potential for tendon healing following a repair. General guidelines regarding management of rotator cuff tears are influenced by a patient's symptoms, risk of clinical progression, and potential for biologic healing.