Is physiotherapy with surgery as back-up a good plan to heal from a full-thickness tear of my rotator cuff?

Q: What are the chances I can heal from a full-thickness tear of my rotator cuff?  Only the supraspinatus tendon was damaged. Right now they are recommending physiotherapy with surgery as a back-up plan.

A: Many adults who have a rotator cuff tear consider waiting to see if the shoulder will heal on its own without surgery. There has always been a question whether rotator cuff tears can heal without surgery.

It is clear that painful symptoms can be treated effectively without surgery. But does the torn tendon actually regenerate itself? And if the tear does heal (or at least decrease in size) -- is the tissue quality of the healing site normal tendon tissue or scar tissue?

A recent study was done to observe over time what happens to full-thickness rotator cuff tears that are treated conservatively (nonoperative treatment). This study does not look at the quality of tissue repair but does evaluate size of the tear over time. For those who are trying to decide what type of treatment is best, the findings from this study might help you.

Ultrasound imaging was used to diagnose 61 tears in 51 adults 60 years old and younger. Follow-up ultrasounds were taken two to three years later. Patient age, sex (male or female), size of the tear, and patient symptoms were compared with the results of the ultrasound.

They found that half of the tears got worse (larger in size) over time and that an increase in tear size was accompanied by increased shoulder pain. One-fourth of the total group developed a second full-thickness rotator cuff tear. The rest of the group (26 tears accounting for 43 per cent of the total) were unchanged (not better or worse).

Analysis of the data did not show any link between the change in tear size and patient age, trauma as a cause of the initial problem, or size of the original tear. There did not appear to be any correlation between new tears and sex or trauma as a cause of the first tear. There was a clear relationship between increasing shoulder pain and the original rotator cuff tear getting larger in size.

The authors suggest that based on their findings, it looks like rotator cuff tears can get better -- but most do not. Younger, more active adults with rotator cuff tears may want to consider surgery early on for full-thickness tears.

Conservative care (shoulder rehab) under the supervision of a physiotherapist is a good way to get started. Failure to improve (reduce pain, increase motion, restore function) is another indication that surgery may be needed.

Reference: Ori Safran, MD, et al. Natural History of Nonoperatively Treated Symptomatic Rotator Cuff Tears in Patients 60 Years Old or Younger. In The American Journal of Sports Medicine. April 2011. Vol. 39. No. 4. Pp. 710-714.