Rotator cuff tears are very common and are a common source of shoulder pain. The chance of you having a rotator cuff tear increases with age because the rotator cuff can simply wear out over time. Many rotator cuff tears, especially “degenerative” tears often do not require surgery. Therefore, one of the most common questions you will have when you are considering treatment options is whether or not your rotator cuff tear can become larger over time?
The most common cause of rotator cuff tears is degeneration or a process we call tendinopathy. Think of your favorite pair of blue jeans. That hole around the knee wasn’t there years ago… now it gets larger every time you wear them.
Because degeneration is the most common cause of tearing, then it naturally follows that as the degeneration progresses your rotator cuff tear may become larger over time.
A recent study in one of our major journals studied this and found that rotator cuff tears will generally become larger over time. They also may become more symptomatic, or painful over time. Studies to determine if surgery will prevent the rotator cuff tear from recurring (due to persistent degeneration) have not been adequately performed. That means that even if we operate to repair the rotator cuff tear, the tear might occur once again because surgery doesn’t halt the degenerative process.
Relax. Rotator cuff tears do not become larger overnight. It can take many years for a rotator cuff tear to become larger. As we have discussed elsewhere in this blog, physical therapy can be very effective at alleviating the pain due to small rotator cuff tears. Physical therapy has also been shown to be as equally effective as surgery at treating the pain due to small rotator cuff tears. So if you have a small degenerative rotator cuff tear then it is possible to adopt a wait and see attitude about having surgery to repair the tear. But keep in mind… the larger the tear becomes, the more difficult it might be to fix, and the worse the prognosis may be with surgery. That means that if you chose not to have your rotator cuff tear repaired, you should follow up with your orthopedic surgeon every 6 months or so to be sure that your rotator cuff tear is not becoming larger.
Jen says
Hello. I am a 38 year old female, and consider myself moderately active (exercise 1 to 3 hours daily). I have been struggling with pain in my dominant shoulder for years (started with a ski crash in my twenties) & it became markedly worse after a heavy overhead press in January 2016. Mri shows a tear of supra and an intrasubstance tear of infraspinatus. I am looking for as full a recovery as possible as I am unwilling to modify current activity (mountain biking-enduro racing, horse back riding, skiing, heavy lifting). In your opinion, is surgery a better option than rehab in this scenario?
Howard J. Luks, MD says
Not something I can answer in this format. If the tear is many years old it may not have a great chance at being repaired… i can’t say for sure without actually seeing the MRI and examining you too.
Good Luck !
Patrick Donnelly says
I am 63 had both rotator cuffs done aprox 15 years ago. For the last 6 months or maybe longer severe pain in left one had 2 cortisone shots only helps for short time.does it sound like it is return?
Howard J. Luks, MD says
perhaps :-(
Richard says
Dr luks, I have been diagnosed with rotator cuff tendinopathy in both shoulders, as well as in the biceps.
A few questions for you:
1- I am 25. Is this fairly unusual for my age?
2- can you recommend a doctor in the Pittsburgh area that can give me a second opinion?
Your input would be greatly appreciated
Howard J. Luks, MD says
It is possible… but may be more of a reactive type– perhaps due to a certain workout regimen?
UPMC has many first class docs. I would see who is on their shoulder team.