Does rotator cuff tendinosis progress?
Since rotator cuff tendinosis represents a(n) (age related, genetic or post-traumatic) degenerative condition, and degenerative conditions by definition usually progress, the unfortunate answer is yes. However, that does not always correlate with worsening of your pain or symptoms. Some people can have severe tendinosis and insignificant pain. Also, the rate of progression is not very rapid. When I describe rotator cuff tendinosis to people I liken it to their favorite pair of jeans — where the area around the knee is wearing away. With time you will eventually have a hole there. That is what we refer to as a degenerative rotator cuff tear. Again, this is not a rapid progression. Trauma, falls, etc can hasten the progression, but this is not typical. Once the tendinosis progresses to the point where some of the rotator cuff has separated from the bone, you now have a partial thickness rotator cuff tear.
Do partial rotator cuff tears progress?
Great question — and a controversial question too. Some older scientific studies show that nearly 50 percent of partial thickness tears can progress to full thickness rotator cuff tears, however, more recent studies call that into question. Given the scientific literature that exists, you should probably NOT consider surgery to prevent a partial tear from becoming a full tear.
If you suffer from rotator cuff tendinosis or a partial rotator cuff tear — you were treated and your symptoms resolved — what next? A repeat MRI or ultrasound study in a year or so to visually examine the rotator cuff and be sure the tear has not progressed. Pain or lack of pain is not an indication of progression since many other structures within the shoulder can hurt — such as the biceps tendon, the bursa, the other muscles, etc.
Shirley Dorland
I am a 83 year old swimmer. I am experincing shoulder and upper arm pain at night. I swim laps for an hour three times a week. Should I stop swimming?
HI Shirley …
Kudos for staying so active.
Many people with rotator cuff or shoulder pain who are in their 80s have age-related degenerative changes. ~75% of people in this age group have enough fraying and degeneration of the rotator cuff that a “tear” might show up on an MRI (And these “tears” do not require surgery). This is not meant to scare you… bear with me. The point is that our parts wear out. Your swimming is not causing those changes to worsen. If anything, your activities are helping to keep your muscles in great shape. Exercise has so many benefits for our health. For that reason, I almost never ask my own patients to stop an activity they enjoy. Pain does not often mean that you are causing harm.
Ava Trillo
In April 2017, I was having some mild pain in my left shoulder. I went to Orthopedic surgeon, who gave me a cortisone injection and told me to go to PT. It cleared up 100% and only went to PT twice. In October it was back with night pain and some loss of ROM. Did PT and received another cortisone injection, after 10 sessions I requested an MRI. The MRI showed a high grade tear of the mid to posterior surpraspinatus tendon 11 mm extending to the junction of anterior infrinatus. Mild proximal long head bicep tendinosis. Bottom line I went back to doc and he said to manage conservatively no surgery no PT. I got second opinion and he wants to do surgery. I have very little discomfort. Should I get third opinion and could I wait 7 months for surgery. I am a 69 year old female. Just don’t understand the drastically different opinions
These small areas of rotator cuff degeneration are very common. Even the American Academy of Orthopedic Surgeons doesn’t recommend surgery on small degenerative rotator cuff issues. Typically, with degenerative rotator cuff disease the initial treatment is PT. If people do not respond to PT and their quality of life is poor then we might recommend surgery. We typically do not recommend surgery for tendinosis and partial tears without attempting physical therapy.
Mom
Son 15 years old has small, low-grade articulate surface partial thickness tear of the supraspiatus tendon. What causes this and will it get better without surgery? Should he get cortisone injection or debridement?
Good question … these tears in children are usually seen in overhead athletes. The rotator cuff injury is usually secondary to subtle instability where the shoulder ligaments are little loose from overhead activities. Therapy is usually the answer for a 15 year old… cortisone injections frowned upon in this age group. Surgical debridement rarely necessary… and then only if PT fails and the doc is sure that instability is not an issue.
Cameron
Hi there i had a latarjet procedure on my right shoulder 5 months ago and i noticed some popping in my subscapularis when i do certain exercises. It doesn’t hurt at all and i am in no pain with almost full range of motion. I was just wondering that if i have a tear in my subscapularis would i be in pain or without range of motion? If you could give me some advice that would be great thanks?
Doris
Thanks for your prompt reply Dr. Luks. Approx how many weeks or sessions of PT before concluding that PT is not working? Also, what should I expect the PT sessions to include? Thanks!
Fran
Good evening.
I am after some advice, if that is okay. I train for triathlon, mainly long distance. I have a coach and training is usually very structured with large gains in intensity/load avoided.
I was swimming last night, front crawl and I went to accelerate past someone and I felt a small ‘pop’ with immediate pain in the front of my shoulder. I tried to swim it off, but no such luck, so I got out the pool. I iced my shoulder and took some pain killers. The next day, I seem to get most of my pain in the armpit region with a little referral down the arm, but only in aggravating movements. Int shoulder and add I am not keen on and gurbers test provokes my pain. No bruising or sig swelling but can feel a little stiff.
I am wondering if I have partially torn subscap? If so, what would you recommend with regards to management and length of time away from swimming?
Thank you for your time
Fran
Hi Fran ..
Given that you are a high level athlete I would seek out a good Shoulder doc for a thorough exam and if needed either an ultrasound or MRI. No need to rest and decondition if you don’t have to.
Doris
I am 68 and fell in December 2014 and have been experiencing shoulder pain since. I saw a shoulder orthopedic specialist and after MRI he advised I have a partial rotator cuff tear. He said PT will not help and recommends surgery. He is so busy that I have been unable to get scheduled for surgery yet. I asked for PT which he prescribed for 6 visits. I would like to know, I get popping with pain when I do some of the exercises. Could this increase the tear? Thanks
Hi Doris…
Please read our “Expert Series” on the rotator cuff in the blog section of my site. The initial treatment for partial tears is therapy. It is almost never surgical. PT is successful at alleviating the pain for many. Surgery is considered only after the failure of a non-surgical regimen. Some partial tears do progress… but as you will see in the blog, even small degenerative full tears are treated with PT as well.
Good Luck to you.
Howard Luks
Mike
I had SAD nearly 5 weeks ago with some minor infraspinatus debridement and a fair amount of labral debridement, probably a type 1 tear from anterior/superior to about 7:00 posterior. The shoulder has gotten fairly loose in flexion and abduction. There are a few tweaks here and there but it seems to be getting better overall. I get a fair amount of pain below the deltoid insertion doing a belly press and get a sharp tweak in the same location with external rotation when abducted more than a little bit. I can’t get internally rotated enough to do the lift off test. There’s no difference from pre-op for internal and external rotation other than a bit more pain free ER with no abduction and shoulder blades pulled together.
If I remember correctly the radiology report attributed anything around the subscapularis as iatrogenic from the contrast injection and the post op report didn’t mention the subscapularis. The biceps tendon was in the groove.
Is it too early to think the real culprit may be a subscapularis tear of some degree? I’m hoping it is contact with a still sensitive labrum but I’d expect a bit more improvement by almost 5 weeks. As of now, I plan to continue with PT, although I’ll mention the possibility, and see the surgeon at about 8 weeks post op.
Thanks,
Mike
Good luck with your continued progress Mike. Sometimes the recovery from surgery is a lot longer than any of us want it to be.
Dawn
Thank you for your prompt answers!
With a partial tear of the subscapularis tendon, what type of symptoms should I look for?
Thanks again!
Dawn
Thank you for your honest answers!
Can adhesive capsulitis affect my neck muscles resulting in jaw popping on the other side of my face?
Thanks!
Dawn
I avoided a fall down a flight of stairs about 9 myths ago. My MRI revealed a subscapularis full thickness tear. During the first 3 mths, I developed adhesive capsulitis and underwent a capsular release about 8 wks ago with no repair of the tendon. My surgeon told me that it appeared on MRI as a full thickness but as he cleaned out the scar tissue it was more partial. I work a physical job and workout regularly. I have severe pain behind the shoulder blade along with weakness, putting hand on hip, reaching from one shoulder to the other and pressure on my stomach.
Will this subscapularis tear heal or progress and eventually need surgical intervention?
What would be a good indication of whether my symptoms are from the tendon tear or frozen shoulder?
Thanks for your help!
Hi Dawn… I can not answer you without examining you. In general, subscapularis tears require a repair. But complications like a frozen shoulder can be a problem be surgery can make a shoulder even more stiff. If you have any specific questions that have yet been answered I suggest you seek out a second opinion.
Good Luck
Howard Luks
Susan … I’m sorry you are in so much pain. Perhaps a second opinion by an upper extremity or sports medicine physician who specializes in shoulders is in order.
Generally speaking — Not all tears hurt. Not all pain in and around the shoulder is due to a tear. Most people do not even know they have a tear.
Good luck on your search…
Susan Chouteau
second injury and third surgry on right shoulder. Surgry number 3 was to go in and fix a tesr in the rotor cuff, but the doctor said that the tear was not significate enough to fix, now I cannot lift with right arm, upon trying to lift right shoulder fill up with fluid and sells double the size. He released me after 3.5 weeks after surgry with no restrictions. What do I need to do?