Arc Trial2022-05-17T12:46:28-06:00


The ARC study is a randomized clinical trial comparing operative and non-operative treatment for rotator cuff tears that develop over time. This study aims to find out which treatment works better and for whom, in order to help patients in the future select the best treatment for them.

Rotator cuff tears are one of the most common causes of shoulder pain in adults in the United States, accounting for 10.7 million outpatient doctor visits in 2013. Specifically, it is estimated that 65-70% of adults with shoulder pain have an underlying rotator cuff disorder. Rotator cuff injuries are common due to their degenerative nature, meaning that they occur slowly over time as a person ages, often without a distinct injury. These kinds of tears are classified as atraumatic.

The two standard treatments for atraumatic rotator cuff tears are non-operative (physical therapy alone) and operative (surgery followed by physical therapy). The percentage of rotator cuff patients treated with surgery rose from 33.8% to 40.4% from 2005 to 2012, showing an increasing tendency to treat with surgery. It is not clear, however, if this trend has resulted in more successful outcomes for patients. The purpose of the ARC Trial is to help answer this question. We are also studying whether size of tear and age influence which treatment works best. This trial is different from previous observational studies because patients are randomly assigned to a treatment group, which will allow us to better measure the differences between these two treatments without any biases. We believe this study will help patients and providers to make better and more informed decisions in the future.

Study Updates

Recruiting for the study began at Vanderbilt in January of 2018, with 11 more sites brought on board by June 2018 and 4 more at the end of 2019/ beginning of 2020, bringing us to a total of 16 sites currently recruiting. There are two more sites preparing to join the study when recruiting resumes after the COVID-19 pandemic. A couple exciting things that have happened since then; the ARC Trial Protocol was published by the JAMA Network (see our publications page for more information), and we have surpassed 10,000 patients screened and 100 patients enrolled.

Here’s the update as of March 19th, 2020:

  • 120 patients have been enrolled in the study and randomized to a treatment
    • 60 (50%) randomized to operative treatment (surgery), 60 (50%) randomized to non-operative treatment (physical therapy)
    • 57 % female, 43% male
    • 80% White, 12% Black/ African American, 4% Missing data, 1% Asian, 1% American Native
  • Patients who have reached follow-up time points
    • 3 months = 105
    • 6 months = 96
    • 12 months = 66
    • 92% of sent questionnaires are successfully filled out and returned
  • Tear size representation:
    • 69% Less than 2cm
    • 31% Greater than or equal to 2cm
  • Age representation:
    • 55 % less than 65 years old
    • 45% greater than or equal to 65 years old


  • People 40-84 with rotator cuff tears ages who meet all eligibility criteria may participate in this study.
  • You will need to see an ARC shoulder study specialist who can diagnose your shoulder pain and evaluate your eligibility for the study.


Please click on the site name below or its location on the map for more information!


Will I be withdrawn from the study if I do not have my assigned treatment?2019-07-17T09:36:29-06:00

No, we will continue to follow you as planned even if you switch treatment groups or do not pursue treatment at all.

Whom should I contact if I have a question about the study or no longer want to be part of the study?2019-07-17T10:30:12-06:00

Please contact the ARC Trial research team at Vanderbilt: [email protected] / (629) 777-8022.

How will I know the results of the study?2019-07-17T10:29:39-06:00

A summary of the study results will be made available on our website: Information about the trial can also be found at

Do these additional treatments need to be reported?  2019-07-17T10:28:53-06:00

Yes. There will be questions that ask about these treatments on each follow up questionnaire.

Can I pursue other treatments in conjunction with my assigned treatment?2019-07-17T10:28:02-06:00

Yes, other nonsurgical treatments, such as cortisone injections, pain medications, acupuncture, etc., can be utilized while undergoing your assigned treatment for the study.

Can I complete my study questionnaires electronically?2019-07-17T10:27:15-06:00

Yes, you can choose whether you prefer to complete your questionnaires on paper or electronically (via computer or tablet). If you choose to complete them electronically, a unique link to your questionnaire will be sent to you via email at each follow up.

Is there a way to complete my Physical Therapy Diary electronically? 2019-07-17T10:16:55-06:00

Yes, there is a special MyCap app that will allow you to complete your Physical Therapy Diary using your smartphone. Our research staff will help you install and set up this app before you leave the clinic. The MyCap app is currently available for both iPhones and Androids.

Where can I get another copy of the physical therapy home exercise program booklet or physical therapy diary, if I lose mine?2019-07-17T10:16:01-06:00

Copies of these documents can be found on our website in the patient section for the ARC Trial (www.

How long to I need to keep track of my physical therapy visits and home exercises?2019-07-17T10:15:06-06:00

Complete your diary each day any time that you are attending formal physical therapy for your enrolled shoulder during the first year of the study. This means you should complete the diary daily for each course of shoulder PT – from the first physical therapy visit until the last – even if you switch treatment arms or go back to physical therapy a second time later on.

How often will I need to do exercises at home?2019-07-17T10:14:17-06:00

You should perform home exercises 2-4 times a week, as instructed by your physical therapist. Your home exercise program should take approximately 30 minutes a day to complete.

What exercises will I need to do at home?2019-07-17T10:13:47-06:00

Your physical therapist will assign specific exercises for you to do at home each week. Bring your ARC Rotator Cuff Home Exercise Program booklet with you to each visit, so your exercise assignments can be updated each time.

How will my privacy be protected?2018-01-08T10:22:27-06:00

We take protecting your confidentiality very seriously. You will be assigned a study ID which will be used instead of your name during the course of the study. Participant information will be stored in locked cabinets and secure, password-protected research servers, accessible only to authorized study personnel.

Who will have access to my information during the study?2018-01-08T10:21:39-06:00

Your information will only be accessed by authorized personnel for study purposes, including study staff, research monitors, auditors, and federal regulatory agencies, as needed.

Will the study pay for treatment of my shoulder?2019-07-17T09:45:40-06:00

No, the ARC study will not pay for the cost of your shoulder treatment. Your insurance company will be billed as it normally would for any surgery or physical therapy as well as follow-up doctor visits related to treatment. However, you will NOT have to pay for any tests or treatments done only for research purposes.

How will my physical therapist know that I am participating in this study?2019-07-17T09:44:15-06:00

A physical therapist with the ARC trial will contact your treating physical therapist to make sure they know about the study and receive the appropriate treatment instructions. You will also be given a packet with information about the study to take with you to your first physical therapy visit.

Can I use my own physical therapist or do I need to go to a study physical therapist?2019-07-17T09:43:17-06:00

You can go to the certified physical therapist of your choice. If you do not already have a preferred physical therapist, our research staff can help refer you to one near you.

Can I tailor the number of physical therapy visits based on my needs and insurance coverage?2019-07-17T09:38:35-06:00

Yes, you and your physical therapist can determine how many physical therapy sessions you need to attend over the course of your treatment and how frequently.

How often will I need to attend physical therapy?2019-07-17T09:37:32-06:00

The usual recommended physical therapy program is 1-2 times a week on average for 3 months (for non-operative treatment) or for 4 months (following surgery).

Can I pursue a different treatment after 6 months?2019-07-17T09:33:28-06:00

Yes. For example, if you are assigned to the non-operative (physical therapy) treatment group and later wish to have surgery on your shoulder, you can. We just ask that you wait 6 months before doing so, so we can accurately measure the effectiveness of your initial assigned treatment.

How long do I need to stick with my assigned treatment?2019-07-17T09:32:56-06:00

It takes 6 months for either treatment to be fully effective. Therefore, we ask participants to stick with their assigned treatment for at least 6 months.

How soon do I need to start treatment for my shoulder?2019-07-17T09:32:19-06:00

We ask that you begin treatment within 8 weeks of enrolling in the trial. If there is too much difference between when people start treatment, it makes it difficult to accurately compare treatment results among participants. However, if for some reason you are unable to begin treatment within 8 weeks (2 months), you will still be part of the study.

Can I choose which treatment I receive?2019-07-17T09:31:45-06:00

This is a randomized controlled trial, which means that if you choose to participate in the study, you will NOT choose which treatment you receive. You will be randomly assigned to either operative (surgery + physical therapy) or non-operative (physical therapy without surgery). There is a 50-50 chance of being in either group, regardless of whether you have previously had physical therapy for your shoulder.

Can I participate in this study if I am currently part of another study?2019-07-17T09:31:01-06:00

It depends on what kind of study you are already participating in. If it is not related to your shoulder treatment, then the answer is most likely yes. Be sure to mention it to our research staff to make sure before enrolling in the ARC trial.

Can I be in the study if I have already had physical therapy for my shoulder?2019-07-17T09:30:14-06:00

Yes, you can still participate in this study even if you have already had physical therapy for your shoulder.


Eric McCarty, MD
Nitin Jain, MD, MSPH
Keith M. Baumgarten, MD
Edwin E. Spencer, Jr., MD
Andrew Nevaiser, MD
John D. Kelly, IV, MD
C. Benjamin Ma, MD
Matthew Smith, MD
Michael Khazzam, MD
Scott Mair, MD
Bruce S. Miller, MD, MS
Brian R. Wolf, MD, MS
Xinning (Tiger) Li, MD
Joseph DeAngelis, MD
John M. Tokish, MD
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