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It is suggested that tears of the rotator cuff (RC) are a significant cause of shoulder pain. Given that the rates of surgical repair have risen approximately 200% across Europe and the USA over recent years,1 it seems that many clinicians and patients accept this suggestion, yet there is a strong case to question it.
The prevalence of RC tears increases with age and asymptomatic RC tears are common in those >50 years in the general population, with twice as many people showing evidence of RC tear without shoulder pain compared with those who show evidence of an RC tear with shoulder pain.2 It therefore seems timely to recognise the enigma of the RC tear and make the case for uncertainty with regard to clinical decision-making. The legitimacy of this proposal becomes more apparent when it is recognised that approximately 40% of RC’s retear or fail to heal following surgery but these patients report similar levels of pain and function as those patients whose RC is judged to be healed.3 Considering that surgical intervention is largely …
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