How does a rotator cuff tear heal?

From the Guidelines

Rotator cuff tears typically do not heal on their own, especially complete tears, and often require surgical repair for proper healing. The decision to operate is based on the size and location of the tear, as well as the patient's overall health and activity level. Small, partial tears may heal with conservative treatment including rest, ice, anti-inflammatory medications (like ibuprofen 400-800mg three times daily or naproxen 500mg twice daily for 1-2 weeks), physical therapy, and possibly corticosteroid injections 1. For larger or complete tears, surgical repair is often necessary for proper healing, and a systematic review by the PROSPECT Working Group provides recommendations for pain management after rotator cuff repair, emphasizing the importance of a multimodal analgesia approach 1.

The healing process after surgery takes approximately 4-6 months, with physical therapy being crucial for recovery. During this time, patients progress through phases of immobilization, passive motion, active motion, and strengthening exercises. The rotator cuff has limited blood supply, particularly in the "critical zone" near the tendon insertion, which contributes to its poor natural healing capacity. Age, tear size, tissue quality, and patient compliance with rehabilitation also influence healing outcomes. Even with proper treatment, some tears may not heal completely, but symptoms can still improve significantly with appropriate management. Key factors to consider in the treatment of rotator cuff tears include:

• The size and location of the tear
• The patient's overall health and activity level
• The use of anti-inflammatory medications and physical therapy in conservative treatment
• The importance of a multimodal analgesia approach in surgical repair, as recommended by the PROSPECT Working Group 1.

Effective pain control is essential for early postoperative rehabilitation and long-term outcomes, and a unified approach to pain management can help reduce variations in analgesic protocols and improve patient outcomes 1.

From the Research

Rotator Cuff Tear Healing

• Rotator cuff tears affect many people, and the natural history and evidence for non-operative treatment remain limited 2.
• Complete rotator cuff tears may be effectively treated with injections and exercise in the short and intermediate terms, respectively 2.
• The negative effect of corticosteroids on rotator cuff tissue has not been demonstrated 2.

Conservative Treatment

• Conservative treatment often works for patients with well-preserved function of the supraspinatus and infraspinatus muscles 3.
• Physical examination is extremely important to evaluate the presence, location, and extent of a tear, as well as to understand the mechanism of pain 3.
• Rehabilitation protocols for rotator cuff disease should be tailored based on the different phases of tendon healing 4.

Pharmacologic Treatment

• Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are commonly used for pharmacologic treatment of rotator cuff-related shoulder pain 5.
• Ibuprofen and acetaminophen provide benefits to patients suffering from rotator cuff-related pain, but the type of improvement perceived by patients differs between these two medications 5.
• Oral anti-inflammatory drugs, such as an association between Paracetamol and either Codein or Ibuprofen, can lead to better outcomes in terms of pain reduction and early recovery of passive range of motion 6.

Rehabilitation and Recovery

• Wearable technologies are becoming a revolutionary tool for movement and posture monitoring in the rehabilitation of rotator cuff disease 4.
• Immediate passive mobilization of the operated shoulder is allowed, and pain management protocols can be effective in reducing pain and improving functional outcomes 6.
• Post-operative pain is influenced by the surgical technique used, and transosseous techniques may be more painful in the first 15 days after surgery 6.