What happens if you have a rotator cuff tear and the tendon is not repaired? Several shoulder surgeons have dedicated their academic careers to answering this question, and through their diligent research spanning many years, we now know the following:
- Complete rotator cuff tears have never been observed to heal themselves in humans.
- Most rotator cuff tears will become bigger over time. Certain studies point to lifestyle, pain associated with the tear, hand dominance, and job type being risk factors for tear enlargement
- Some tears get so big they cannot be repaired. These are called massive irreparable rotator cuff tears.
- Some people with neglected rotator cuff tears lose the ability to lift their arm. Shoulder surgeons refer to this as “pseudoparalysis” because the inability to lift the arm makes it seem paralyzed (even though it is not).
- Many neglected rotator cuff tears give rise to “cuff tear arthritis,” a painful type of shoulder arthritis often treated with reverse shoulder replacement.
Does this mean that every rotator cuff tear ought to be repaired? Definitely not. It’s hard to make an argument for surgery if the patient has no shoulder pain or symptoms that are so minor that they do not negatively impact quality of life. In young patients with no or minor symptoms, the rotator cuff tear can be followed with a repeat MRI to see if it is getting bigger or staying the same.
Furthermore, rotator cuff tears in the more mature population can often be successfully treated with physical therapy, oral medication, or a steroid injection. Some partial tears can improve with PRP. Some tears in patients have such little chance of successfully healing after repair that surgery may no longer be worthwhile. The key is to address the problem before it gets to this point. Schedule a consultation to learn more about what you can do to keep your shoulder healthy or if you have symptoms of a rotator cuff tear.
