Rotator cuff tears in older adults are most likely managed initially with which approach?

• A. Immediate surgery
• B. Corticosteroid injections only
• C. Physical therapy and NSAIDs
• D. Nonoperative management (physical therapy, NSAIDs) unless severe or persistent

Answer: (D)

Initial management of rotator cuff tears in older adults is nonoperative, emphasizing a structured physical therapy program to strengthen the shoulder muscles and restore range of motion, along with NSAIDs to control pain and inflammation. Many degenerative tears respond well to rehab, improving function without surgery. Surgery is typically reserved for cases with severe weakness or functional limitation, large tears unlikely to heal with rehab, or symptoms that persist despite an adequate trial of conservative treatment.

Corticosteroid injections can help with pain, but they’re usually not used as the sole treatment since they don’t fix the underlying tear or weakness. Immediate surgery is not the default choice because nonoperative care often yields good outcomes and avoids surgical risks.