A rotator cuff tear is a very common source of shoulder pain however it’s also commonly misunderstood.
Rotator cuff tears can get worse without surgery however you should almost always try non-operative exercise-based treatment first.
I will expand further on this article as it’s a common question that I get from my clients.
What Do We Mean By “will a rotator cuff tear get worse without surgery?”
There are two directions that you can go with this question.
If I don’t get surgery will I cause more damage to the rotator cuff?
It’s very common for rotator cuffs, along with other structures, to degenerate over time. But, here is a very important point; degeneration does not mean pain. There are many people, in fact, the majority of people over 65 who have full-thickness rotator cuff tears and don’t even know it.
So yes, while it’s very possible for the “damage” to increase, this damage isn’t necessarily a bad thing. Now, if the damage is increasing and you are now unable to lift your arm up overhead due to pain and weakness, that’s a different story.
And this leads us to the second thing people mean when they ask about their RTC getting worse…
Will my symptoms continue to get worse if I don’t take care of this?
The answer is maybe but maybe not.
Many people will be able to go through physical therapy and other non-operative treatments and fully recover.
Others will need the surgery.
An important article for you to read would be from Boorman et al, 2018.
You can read that here:
https://www.sportsandspinalphysio.com.au/wp-content/uploads/2019/06/Cuff-tears.pdf
The takeaway is that after 5 years, people who had RTC surgery or didn’t have RTC surgery had the same exact outcome.
If I have a torn rotator cuff and the pain goes away with surgery does the tear heal?
No, the tear likely will not heal.
But the good news is that the tear doesn’t need to heal. What matters is that your function improves and your pain levels go down.
You might be wondering how in the world this is possible, but just take it from several of my clients who have had this outcome, it’s true.
Am I at risk of having recurring symptoms if I don’t get surgery?
To my knowledge, there is no published research on this question. My answer to clients who ask this question is that it’s my professional opinion that you are not at risk of recurrent symptoms if you don’t have the surgery and if the tissue doesn’t heal.
Our body is incredibly skilled at healing and adapting to changes that happen within our body.
If you do end up having recurring symptoms and you are unable to tolerate this, then you may be a candidate for surgery.
Key Takeaways
- It’s not a guarantee that a rotator cuff tear will get worse without surgery.
- It’s very possible that your rotator cuff tear will not need surgery and that symptoms will go away with non-operative management
- If you have a torn rotator cuff tear and you don’t repair it, the tear itself will not heal but this does not mean that you are at future risk of increased pain or disability
- Many people have RTC tears and don’t even know it.
