Natural History of Rotator Cuff Tears

The rotator cuff is a series of four muscles and tendons around the shoulder and tears of the rotator cuff is the most common tendon injury in adults. Rotator cuff tears usually cause pain and weakness around the shoulder and can even cause pain at night. Rotator cuff tears can go partway through the thickness of the tendon (partial-thickness tears) or go all of the ways through the tendon, thus creating an actual hole in the tendon (full-thickness tears).

By doing an analysis of previously performed research studies on full-thickness rotator cuff tears (a meta-analysis of randomized controlled trials), this study concluded that patients can achieve good improvement in their shoulders with full-thickness rotator cuff tears either with or without surgery when assessed up to 1 year after treatment. However, while patients improved with or without surgery, the greatest improvements were seen in patients undergoing rotator cuff repair.

Regrettably, only a handful of the non-operative treatment groups in the study were followed for more than a year. This is unfortunate because one of the risks of full-thickness rotator cuff tears is that they are known to enlarge over time if not repaired. If the tears become big enough, they become irreparable and the affected shoulder will typically deteriorate.

However, this study was not designed to include this type of outcome in its analysis, so these problematic outcomes from non-operative care would not be reflected in the study’s results.
While there is much for the scientific community to still learn about the treatment of rotator cuff tears, this study helped outline how patients can do well either with or without surgery for the first year after getting treatment for a full-thickness rotator cuff tear.

SimpleTakeaway™
Persisting shoulder pain warrants an evaluation by a physician as a rotator cuff tear
could be present. If present, both operative and non-operative treatments will be
discussed. An individual patient’s characteristics and the precise nature of any
given tear will help the doctor determine whether to recommend operative or non-
operative care for that patient and their rotator cuff tear.

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Commentary by Dr. Russell Nord, M.D.

Dr. Russell Nord, M.D., is on the SimpleTherapy Clinical Advisory Board, the Orthopaedic Surgeon and Medical Director of Washington Hospital’s Sports Medicine Program and Orthopaedic Surgery Section Chair at Washington Hospital.