From the Guidelines
A rotator cuff tear is unlikely to heal completely on its own, especially for moderate to severe tears, as evidenced by the progression of tear size, muscle atrophy, and fatty infiltration over time with nonsurgical management 1. When considering the management of rotator cuff injuries, it's crucial to understand that while physical therapy can improve patient-reported outcomes (PROs) in symptomatic patients with full-thickness rotator cuff tears, the underlying tear may not heal spontaneously.
- Key factors influencing the potential for healing include the size of the tear, the presence of muscle atrophy, and the degree of fatty infiltration.
- Small, partial tears may show some improvement with conservative treatment, which typically includes rest, ice, over-the-counter pain medications, and physical therapy focusing on gentle stretching and progressive strengthening exercises. However, the most recent and highest quality evidence suggests that nonsurgical management may lead to progression of the tear and associated complications over 5 to 10 years 1.
- For larger tears or complete tears, surgical repair is often necessary to achieve proper healing, as the natural environment of the rotator cuff does not favor spontaneous reconnection of the torn tendon edges due to constant tension and poor blood supply.
- Delaying treatment for significant tears can result in further complications, including tear progression, muscle atrophy, and permanent loss of function, highlighting the importance of timely and appropriate intervention based on the severity of the tear.
From the Research
Rotator Cuff Tear Healing
- A rotator cuff tear can heal on its own in some cases, but the likelihood of this happening depends on various factors, including the size and location of the tear, as well as the patient's overall health and age 2.
- Nonoperative treatment, such as physical therapy and activity modification, can be an effective option for managing rotator cuff tears, with approximately 75% of patients remaining asymptomatic and not requiring surgery at 5-year follow-up 2.
- Platelet-rich plasma (PRP) injections have been shown to be a safe and effective treatment for rotator cuff injuries, with improved outcomes in terms of pain relief and function compared to corticosteroid injections 3, 4, 5.
- The use of PRP injections can lead to significant improvements in short-term pain relief and function, although the long-term benefits are still being studied 5.
- Some studies suggest that PRP injections may be more effective for patients with partial-thickness rotator cuff tears or tendinopathy, while others have found that corticosteroid injections can provide short-term relief for pain and function 4, 5.
Factors Affecting Healing
- The size and location of the tear can affect the likelihood of healing, with smaller tears being more likely to heal on their own 6.
- Patient age and overall health can also impact the healing process, with older patients and those with underlying health conditions being more likely to experience complications or require surgical intervention 6, 2.
- The type of treatment used can also influence the healing process, with PRP injections and nonoperative treatment being potential options for managing rotator cuff tears 3, 4, 5, 2.