Tears of the rotator cuff are an extremely common source of shoulder pain in adults over the age of 40. Tear size can range from incomplete or partial to complete tears ranging from small to very large. Treatment options range from non-operative management consisting of physical therapy and/or injections to surgical repair. While non-operative treatment can be very successful in controlling symptoms, none of the non-surgical treatments result in actual healing or reconnection of the tendon to the bone. This leaves both patients and clinicians with the unanswered question of what will happen over time if the torn tendon is not repaired surgically. Until recently the natural history of rotator cuff tears has been undocumented. Recent research in the Journal of Bone and Joint Surgery has for the first time quantified the risk of tear enlargement of a documented rotator cuff tear over time. Yamaguchi et al. evaluated the risk of symptom progression in a group of 241 patients with asymptomatic rotator cuff tears over a period of 5.1 years. They found that in almost half of the cases the tears did enlarge over an average of 3 years. This included both complete as well as partial rotator cuff tears. Neither the subject age nor sex was related to the risk of tear enlargement. There was, however, a significant association with whether the tear was in the dominant extremity. Tear progression was seen in 63% of dominant shoulders but only 42% of non-dominant shoulders. There was a slight tendency of complete tears to progress more frequently than incomplete or partial tears. Progression of tear size was also accompanied by an increase in symptoms in many patients.
The authors were the first to actually quantify the risk and prognostic factors associated with tear enlargement and this provides extremely valuable information to both patients and clinicians. While this study showed that there is substantial risk of tear progression it does not advocate for a surgical approach in all cases. Clinical management must be individualized based on numerous patient factors including age, activity level, and most of all presence of symptoms. However, this study provides an important tool in effectively counseling patients on the risk of tear enlargement with nonsurgical care. When non-surgical management is chosen it appears that new onset pain or worsening pain may well be associated with tear progression.
So before having rotator cuff surgery, it would be worth your time to have a second opinion by a shoulder specialist like Dr. Steven Struhl, Orthopedic Surgeon in NYC. Dr. Struhl’s advance techniques in both non-operative and shoulder surgery allows him to recommend the best procedure to alleviate your shoulder pain due to your rotator cuff injury.
