A rotator cuff tear will not reattach or heal on its own. However, pain can subside and function can be normal even with a small or large tear.
A rotator cuff tear does not mean you will automatically need a surgical procedure to fix it.
- A rotator cuff tear will likely not reatttach on it’s own
- Pain can subside even if the rotator cuff is completely detached from the bone
- Your first line of defense should almost always be physical therapy and not an MRI or surgery.
- Surgery can be effective but you should be a good candidate for it. I’ve written another article on what the proper classification is for who should get surgery vs. not.
- You can always get surgery and there is no rush
Will It Heal On Its Own?
As I shared above, no, probably not.
Each of the rotator cuff muscles, infraspinatus, supraspinatus, teres minor, and subscapularis, their tendons aren’t going to magically reattach (most likely). As an aside, I wonder if they do actually heal because there is now evidence showing that even ACL tears of the knee have the ability to heal on their own (reattach) without surgery. That’s pretty crazy.
But, as I also shared, healing can mean a few different things.
Even if you have a large tear there can be an absence of pain. Or, even if you are having severe pain, it is very possible that your symptoms will improve with physical therapy over the course of a few months.
For clients that I work with on a regular basis, I recommend giving this condition a 3-6 month time period or longer to allow for the body to heal itself (less pain).
Too often, people only give physical therapy and exercise-type therapies 6 weeks or less and then they throw their hands up and say “it didn’t work.”
The problem with this way of thinking is that you didn’t give it enough time. If it’s going to take 6 months to improve and you only give it three weeks, you’ll fail and be frustrated every time.
What are non-surgical treatment options for rotator cuff tears?
In the majority of cases, non-surgical treatment for a rotator cuff tear is the gold standard.
Additionally, contrary to popular belief, receiving an MRI before physical therapy is actually the WRONG decision and can lead to worse outcomes and more unnecessary surgeries.
Said another way… if you want a higher chance of having surgery (because who doesn’t like getting cut open), then you should definitely get an MRI before going through other non-surgical options.
Okay, sarcasm aside, here are a few treatment options:
- Physical therapy: Your physical therapist will do a comprehensive physical evaluation of the shoulder assessing strength, range of motion (flexibility), pain, and side-to-side differences. If you are able to lift your arm overhead without assistance, then congratulations you are likely a good candidate for PT.
- Massage: This isn’t necessarily going to solve the problem however it’s a good way to help reduce some pain, given your massage therapist is listening to you and making sure that the pressure they are applying is not causing more pain.
- Passive modalities: Things like TENS, ultrasound, ice, and heat, are really just pain modifiers. They don’t do anything magical. Ultrasound is 100% placebo and you’d likely be better off just going to PT, going to your massage therapist, and icing/heating to control symptoms.
- NSAIDs: Anti-inflammatory medications like Tylenol, Ibuprofen, Aleve, etc, can be helpful in reducing symptoms in the short term. These shouldn’t be taken over a long period of time without discussion with your doctor as there are risks to long-term use of anti-inflammatories, particularly on your gut function.
What are the different surgical treatment options for rotator cuff tears?
The most common rotator cuff muscle to be completely torn and require surgery is the supraspinatus tendon.
The surgery that is done is called a rotator cuff repair, and more specifically a supraspinatus repair.
If you are interested in what the repair entails, exactly, then check out this article from the Hospital For Special Surgery (HSS) out of New York City.
What are the different muscles of the rotator cuff?
The infraspinatus sits on the posterior aspect of the scapula or “back” of the scapula right under the spine of the scapula.
The supraspinatus is the most commonly torn muscle group and it sits right above the spine of the scapula in the suprascapular fossa.
The subscapularis sits on the anterior surface of the scapula and is sometimes torn in conjunction with the bicep tendon.
The teres minor runs along the lateral aspect of the shoulder scapula.
What are the types of rotator cuff tears?
Partial thickness tear
With a partial thickness tear, this just means that some of the fibers of the tendon are torn. This can occur at the mid substance of the tendon or it can happen at the attachment point of the tendon to the bone.
Full thickness tear
A full-thickness tear means that the tendon has completely detached from the bone. This sometimes requires surgery but sometimes it does not.
Common Shoulder Issues That Could Be Mistaken For A Rotator Cuff Tear
Biceps tendonitis, tendinosis, and tendinopathy
Biceps muscle or tendon pain can be felt in the bicep muscle itself and at the attachment point of the bicep which can be at the front of the shoulder at the intertubercular groove, or at the coracoid process (where the short head of the bicep attached). It’s more common to have pain at the anterior (front of the shoulder).
This pain can be confused with many different types of tendinopathies as there are several structures that attach to a very similar point. A few of those structures include the pectoralis major and the latissimus dorsi muscles.
SLAP stands for superior labrum anterior-posterior, meaning that there is a labrum tear of the shoulder running from front to back. With a tear like this, there is usually a long head of the bicep tendon tear as well.
AC Joint pain
Your AC joint (acromioclavicular) is at the top of your shoulder. This is where your clavicle connects to your scapula. This usually becomes painful from a fall and is rarely injured from regular daily activities.
Labral tear (non-slap)
You can also have different types of labral tears that are not considered SLAP tears as they occur inferiorly (below), or in a different location of the glenoid fossa (shoulder socket).
I hope you learned something new and useful from this article.
I’ve written many other articles on this topic including whether you should get surgery or not.
If you need some expert advice on what to do about this, whether it’ll heal, etc. just reach out to me by submitting this form and we’ll chat!