Symptomatic Rotator Cuff Tears in Adults: A Narrative Review and Proposed ClinicalFramework for Treatment Selection, Rehabilitation, and Functional Recovery

Background: Symptomatic rotator cuff tears cause pain, weakness, sleep disturbance, and loss of function. Structural severity does not always correspond to disability, so imaging must be interpreted alongside the mechanism of injury, clinical examination, and patient goals.Methods: A targeted narrative literature search of PubMed/MEDLINE, the Cochrane Library, PEDro, professional guidance, and reference lists was conducted through 5 August 2026, with contextual and bibliographic checks through 31 August 2026. Reviews, randomized trials, cohorts, and guidelines were prioritized. Evidence was organized by clinical-anatomical profile, treatment pathway, and rehabilitation stage. Applicability was classified as direct, indirect, or mixed. The review did not use duplicate screening, formal risk-of-bias assessment, or certainty grading.Results: Education, task modification, and progressive exercise are reasonable initial care for many atraumatic tears when function and trajectory are monitored. In the original Multicenter Orthopaedic Outcomes Network (MOON) cohort of 452 participants, 115 underwent surgery over 10 years; physical therapy was considered successful in more than 70%, with success defined as avoidance of surgery. In a randomized trial of 103 patients with full-thickness tears no larger than 3 cm, 83 attended 15-year follow-up and 15 of 51 assigned to physiotherapy crossed over to surgery; intention-to-treat outcomes favored primary repair. Across 20 trials and 1,841 participants after repair, earlier rehabilitation improved early flexion without a detectable increase in retear risk, although most evidence concerned smaller primary repairs.Conclusion: Treatment selection should be preference-sensitive and should integrate symptoms, objective function, structural prognosis, healing risk, response to rehabilitation, and work or sport demands. The proposed clinical-anatomical framework is an author-developed, non-validated aid for reassessment and coordination, not a clinical guideline.