I have noted in other posts that rotator cuff tears can cause a lot of confusion.
Let’s assume that your doctor has diagnosed you with a rotator cuff tear. He or she presents you with a few options: physical therapy, injections, surgery. You have a small tear. You are in a lot of pain, but you really haven’t tried any treatment yet and you’ve got a busy next couple of months coming up at work and your daughter is getting married in a month. So you would like to avoid surgery at all costs right now.
“Doctor,” you ask, “will this tear get bigger with time if I don’t surgery right away.
Thankfully we have we have some research to guide us on this question.
As it turns out “degenerative” rotator cuff tears, those arising with aging, do on average get bigger with time. And the size of the tendon tear that you start with often dictates the likelihood that your tear will get bigger or stay the same.
In other words rotator cuff tears do tend to get bigger. And the bigger yours is from the start, the higher chance you have of it tearing more.
Why is this important?
We know that very large tears show more signs of degeneration. Think of your rotator cuff tendons as fabric. Larger tears are not only larger but often more “thread-bare” or worn out. Worn out tissue doesn’t heal as well.
So we can make a good case that smaller tears heal better and are more repairable or fixable were we to choose surgery. It’s not to say that you have to have surgery. It’s just that if you do choose that route, it may be more feasible when the tendon tear is smaller.
What about timing? Do rotator cuff tears enlarge right away or over years?
On average rotator cuff tears enlarge over about 2 years. Of course not everyone is average. But it’s a decent rule of thumb.
So yes these tears often get bigger, but you do tend to have some time until they do.
Below are some conclusions from the study cited above.
- Patients with larger tear size on average had worse functional scores (different than pain, function means how well you move or how much strength you have).
- Patients with larger tear sizes did not necessarily have higher pain scores compared to patients with smaller tears
- 49% of tears enlarged with time with median time to enlargement of 2.8 years.
- Final tear type predicted the probability whether a tear would get bigger. 61% of full thickness tears enlarged, 44% of partial thickness tears enlarged and 14% of controls went on to develop tears.
Dominant shoulders with cuff tears had a higher chance of enlarging than non-dominant shoulders (63% to 42%)
- 100 shoulders, 46% developed new pain with average time to develop pain at 2.6 years.
- Tear enlargement is a risk factor for the development of pain (if you are getting pain again in your rotator cuff, and you have a known tear, it might be getting bigger).