Physical Therapy has been shown to be equally effective to surgery for some types of rotator cuff tears up to 5 years after diagnosis. In our Boulder Physical Therapy practice, many of our patients with rotator cuff tears do very well without surgery and are able to return to full function after treatment. Patients with larger rotator cuff tears and high levels of disability after Physical Therapy require surgical repair of their rotator cuff tears. A common question from patients who do not receive surgery regards tear progression. Will my rotator cuff tear get worse if I don’t have surgery. Prior authors have found tear progression rates between 10-20% for all types of rotator cuff tears but a recent study highlights which tears may be more at risk of tear progression without surgery.
Frandsen and colleagues published their findings on a retrospective analysis of tear progression among conservatively treated patients with rotator cuff tears (Arthrosc Sports Med Rehabil. 2022). Authors followed 206 patients from the Veteran’s Affairs healthcare system between 1999-2000 who remained symptomatic after diagnosis and conservative treatment. They reported 61% of rotator cuff tears had progressed in size over time up to an average of 3.2 years after diagnosis. Greater risk of tear progression was found among patients who had subscapularis involvement, full thickness tears, and larger tear sizes.
This study reported significantly higher rates of tear progression compared to prior authors. This is possibly due to only including patients with symptomatic shoulders compared to those who became pain free or did not seek further healthcare utilization after their conservative treatment including Physical Therapy. Selecting this patient population for analysis likely includes many shoulders who required surgical intervention due to lack of improvement with conservative care.