Will my rotator cuff tear get worse if I don’t have surgery?

Will my rotator cuff tear get worse if I don’t have surgery for it?

The short answer to this question is “Maybe”, but there is some new research out that gives us clarity on this topic.

Rotator cuff tears are generally degenerative in nature, meaning that the tear occurs over time from wear. When I explain this to patients I like to use an analogy I’ve borrowed from Dr. Rick Matsen. The rotator cuff is like a pair of blue jeans, if you wear them long enough they get ratty in spots and eventually a hole may form. In essence, this is just part of aging. In fact, 20% of 60 year olds have rotator cuff tears and 50% of eighty year olds!

The good news with rotator cuff tears is that most of them can be successfully managed with non-operative treatments such as physical therapy and cortisone injection. Research shows that this will provide relief for upwards of 75% of patients. However, the tear will still be present. A rotator cuff tear cannot heal itself without surgery.

This brings us to a common scenario I face in the office. A patient has a rotator cuff tear, she responded well to physical therapy and generally are feeling fine but she asks me “If I don’t have surgery for this tear will it just get bigger and require surgery in the future?”

A new research study from Washington University has shown that there is a roughly 50% chance that the tear will get bigger over a five year time period, and there is also a roughly 50% chance that the tear will cause future pain.

So if you have responded well to PT and your shoulder does not hurt should you consider surgery to prevent the tear from getting worse in the future? Generally, speaking my advice to these patients is NO. If it doesn’t hurt, don’t mess with it. If the pain returns in the future you may be forced to deal with it, but based on this research you have a 50% chance of avoiding surgery.

This recommendation may vary based on the patient’s age, tear size, activity level and other factors.