Many people suffer from shoulder pain due to rotator cuff tears. Many small rotator cuff tears are managed very well without surgery. While the tear might not have healed, you have very little residual pain and you are working and pleased with your quality of life. Despite the fact that you feel better, many will worry that their rotator cuff tear will become larger over time.
In the back of your minds, most of you worry that your rotator cuff tear might become larger, or that your pain might return. The questions that I most frequently receive are:
- Will my rotator cuff tear become larger without surgery?
- Will I have a functional shoulder with a small tear?
- When will my tear become larger
Rotator cuff tears can become larger over time. In a recent study of 224 tears followed for 5 years 49% of tears became larger. In that same group though… only 46% developed shoulder pain. Therefore, many tears are present and do not bother patients, and many rotator cuff tears might become larger over time and still do not bother you. It’s confusing.. how can I have a tear and it doesn’t bother me?
The preferred initial management of these degenerative rotator cuff tears remains controversial, but most prefer non-surgical management. That usually means trying physical therapy and perhaps an injection to see if you do well without having to consider surgery at this time. Some recent articles reveal that patients might do just as well with PT as with surgery, yet other papers show that the surgery group might perform better. The bottom line is that we are not sure what is best at this time. The American Academy of Orthopedic Surgeons recommends non-surgical management of small degenerative rotator cuff tears. What is important to understand is that these tears can enlarge over time and therefore you need to see your shoulder doctor annually if you are going to continue with non-surgical management. That way we can watch you and make sure that your tear is not progressing or becoming larger. If your rotator cuff tear becomes larger and remains bothersome, then surgery might prove to be a good alternative for you to consider.