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.
Mike says
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
Howard J. Luks, MD says
Good luck with your continued progress Mike. Sometimes the recovery from surgery is a lot longer than any of us want it to be.
Doris says
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
Howard J. Luks, MD says
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
Fran says
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
Howard J. Luks, MD says
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 says
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!
Cameron says
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?