What can happen if a rotator cuff tear isn’t repaired?

Rotator cuff tears are prevalent. Over 30% of people older than 70 will have a rotator cuff tear. The word “tear” denotes a traumatic nature with the idea that the tendon rips away from the bone. The vast majority of people with rotator cuff “tears” have a degenerative rotator cuff; a cuff subject to long term “wear and tear”. There is a broad range of rotator cuff pathology. Early in the disease process, the tendon degenerates (also called tendinopathy or tendinitis). The damage can progress to partial, then to full-thickness tears. Over the years the tears can become massive, leading to arthritis of the shoulder (aka “cuff tear arthropathy”).

Many people live unknowingly with the tear. That is, the damage does not produce any symptoms. It’s not until an accident such as a fall or excessive use of the arm that it causes symptoms. By imaging the rotator cuff with X-Rays, ultrasound and especially MRI, we can tell if the injury is a fresh one or whether it’s pre-existing one now painful because of the fall or the like. If the tear is most likely chronic, I work on the assumption that if it wasn’t previously causing problems, then most likely the shoulder will settle down with rest, time and supportive treatment.

For more acute tears, surgical repair is often a good option. A study was published last year from a group of surgeons from Norway(1). In a randomised controlled study, they compared the ten-year results of repair versus physiotherapy. They found that those patients with surgery had a better functioning shoulder and that 70% of patients had a “good-to-excellent” shoulder compared to 40% in those that didn’t have a repair. Also, about a third of the patients who didn’t have surgery initially, subsequently had it mended. When patients didn’t have surgery, the tear size increased by an average of 10 mm over that period. The conclusion supports rotator cuff repair in younger and active people.

[1. Moosmayer S et al. Tendon repair is superior to physiotherapy in the treatment of small to medium-sized rotator cuff tears. J Bone Joint Surg Vol 101-A (12) June 19, 2019]