There are four muscles that make up the “rotator cuff” of the shoulder. The four muscles work together to move the shoulder and stabilize the shoulder. Each of these four muscles have a tendon by which it attaches to bone. When a tear occurs in one of the rotator cuff muscles, it happens in the tendon.
Most tears in the rotator cuff tendons occur from a gradual wearing down of the tendon. This may occur during impingement (or pinching) of the shoulder tendon.
Tears can be “partial” which means the tendon is damaged but not completely severed. Tears can also be complete, which often means the tendon is torn from where they are attached to the bone.
Many rotator cuff tears will not heal. The ability to heal can depend upon the severity and size of the tear. Tears in which the tendon is detached from the bone will not heal on their own. Massive tears are also unlikely to heal. Age can also play a role. The older you are the more difficult healing becomes.
In addition, if the same conditions remain in place the tear may get worse. For example, if the initial tear was caused in part by an impingement AND the impingement continues, the tear could get worse.
But also consider this. Some tears will not heal properly even with surgery. This is a discussion you should have with your surgeon. “What is the likelihood my shoulder will heal, and I regain normal function after surgery?”
A recent study in Finland involving 167 patients with nontraumatic rotator cuff tears found physical therapy treatments alone produced results equal to those experienced by those who had arthroscopic surgery and open surgical repair on the shoulder. This study was published in the January 2020 Journal of Bone and Joint.
So, your rotator cuff tear may not heal. But you still can possibly regain normal pain-free motion and strength if you participate in physical therapy treatments. So, for most rotator cuff injuries, the recommendation is to try a conservative approach of physical therapy and see how you do.
How will you know if your rotator cuff tear is getting worse? There seems to be a relationship between increasing shoulder pain and the original rotator cuff tear getting larger in size.
When should you have rotator cuff repair surgery?
The need for surgery needs should be decided after a detailed discussion with your orthopedic physician. Points to keep in mind. In the case of large rotator cuff tear or sudden injury leading to significant shoulder weakness, early surgical repair may be indicated. Other circumstances may also lead to surgery. Are you active and use your arm for overhead work or sports? Do you have persistent pain or weakness in your shoulder that has not improved with nonsurgical treatment? Are you having pain at night and difficulty using the arm for lifting and reaching? Are you experiencing ongoing symptoms despite several months of physical therapy and medication?
This video is part of a series of videos for how to treat Shoulder Pain. Check the full series of videos along with the downloadable guide sheets for each video on our website here: http://bobandbrad.com/programs