Rotator cuff tears are commonly found in both painful and pain free individuals and often are found in equal prevalence between the involved and uninvolved sides of the same patient. Tears found on MRI can be secondary to trauma, including falls, or secondary to the aging process. Importantly, researchers have not found a significant correlation between most rotator cuff tears on MRI and a patient’s pain or function. Many patients can avoid surgery and improve their pain, strength, and function working with a Physical Therapist for their rotator cuff tear. A trial of supervised, evidence based Physical Therapy helps identify the smaller percentage of patients who require surgery for their rotator cuff tear. Unfortunately, many patients are not provided early Physical Therapy secondary to fear of tear progression or worsening despite evidence showing very few tears progress over time when managed conservatively.
A recent study published in the Journal of Shoulder and Elbow Surgery reported on the impact of shoulder activity on progression of rotator cuff tears (Keener et al. 2017). Authors followed 346 patients with non painful rotator cuff tears and documented their physical activity levels and MRI changes over an average of 4 years. Authors reported close to half of the initial cohort of patients reported pain at some point over the follow up period. Interestingly, shoulder activity level and occupational demand (blue vs. white collar work) was not associated with tear progression. Further, authors reported those with higher levels of activity were more likely to have less painful shoulders than those who remained or became sedentary over the study period. In short, exercise may have helped individuals feel less symptoms from their rotator cuff tear. Authors concluded, “shoulder activity level was not related to tear progression risk”.