Being considered a Physical Therapy shoulder specialist I get asked this question a lot. While this is ultimately a personal decision between you and your surgeon, I as a PT can help you make this decision as well.
First let’s go through a little anatomy and some stats. There are 4 Rotator Cuff tendons. As we age our rotator cuff can get something called fatty infiltration which naturally weakens the tendon. 50% of 60 and 70 year olds have a small full thickness rotator cuff tear that does not cause pain or loss of function. Once you have a rotator cuff tear, in some individuals it continues to worsen or what I call a zipper effect where the tear is slowly getting bigger. By the way, if you have this zipper effect you probably have pain and worsening function. And finally the bigger the tear the harder it gets for a surgeon to surgically fix and the longer your recovery.
So what does all of this mean?
First of all, if you have a small tear that does cause pain and loss of function you have a good probability that Physical Therapy can help resolve you pain and restore function.
If you have a large tear, a PT shoulder or Sports specialist can usually tell fairly quickly and refer you to an Orthopedic shoulder specialist.
So my answer is this, if you have a small tear you can, a lot of time, avoid or prolong need for surgery with the right Physical Therapy. Medium or large tears, I refer you to an Orthopedic surgeon for a consult. And of course, ultimately the decision is yours, we only make professional recommendations.