Rotator cuff tear pain can be challenging to treat. One frequent question I get from my patients is “can a rotator cuff heal itself? Or does it always lead to surgery?”
Well, it’s hard for rotator cuffs to heal on their own. See, the speed at which a specific body part heals depends on its blood supply. And rotator cuff tendons don’t have much blood supply.
But, this doesn’t mean it needs surgery to heal. In fact, this is rarely the case. (1)
In this article, I’ll discuss 5 key things you need to know to heal your rotator cuff. Tap on the question to go straight to the answer:
- Can a rotator cuff tear repair itself?
- What’s the average recovery time for a rotator cuff?
- How can a rotator cuff injury heal without surgery?
- When do you need surgery for a rotator cuff tear?
- What are the surgical options available?
Let’s jump right in.
1) Can a torn rotator cuff heal itself?
Sadly, a rotator cuff tear cannot heal on its own. This is true for any tear, from minor to a complete one.
See, rotator cuff tears happen on the enthesis of our upper arm bone. This is the transition zone between your tendon and bone. Unfortunately, this area has a poor blood supply, making it harder for repairing cells to reach the tendon. (2)
That’s why getting medical treatment is key to getting your shoulder better. And no, surgery is not always the go-to solution for rotator cuff tears. Up to 80% of patients do well by trying different conservative treatments. (1)
2) What is the average recovery time for rotator cuff injuries?
It can take about 3 to 18 months of conservative treatments to get your shoulder better without surgery. The huge gap is dependent on your age, symptoms, and size of the tear.
For rotator cuff surgery followed by rehab, most recovery can be achievable after a year.
3) How can a rotator cuff tear be healed without surgery?
You can still have a functional shoulder and be pain-free with conservative treatment. Here are some of the most common types:
A corticosteroid is a type of anti-inflammatory medication. It is injected underneath the shoulder blade.
It helps increase your range of motion instantly and provides pain relief for up to 6 months. (3)
But the more you use corticosteroids, the higher the chance of increasing the size of your tendon tear. So, use this treatment sparingly due to its potential drawback.
Platelet-rich plasma therapy
This therapy may be new but it shows a promising future about shoulder recovery.
The concept is simple: plasma contains tons of growth and healing factors. Injecting it directly to your injured shoulder can potentially speed up your healing.
To do this, blood is drawn out from your upper arm by a specialized doctor. Plasma is separated, matured, and injected into your rotator cuff.
Physical therapy is a mainstay treatment for rotator cuff tears. In as little as 6 weeks, shows great improvement in pain level, range of motion, and function. (6)
The goal of physical therapy is to fix any impairments that may have caused your injury.
By doing so, you’re increasing your shoulder’s capacity while also decreasing pain and inflammation. This is through:
- Improving shoulder blade movement
- Restore the strength of other shoulder stabilizing muscles
- Boosting upper arm motion
- Enhancing your body awareness
4) At what point does a rotator cuff tear need surgery to fix it?
Chronic shoulder pain may lead you to consider shoulder surgery. And that’s fine as not all rotator cuff tears respond favorably or quickly with conservative treatment.
So aside from severe pain, here are a few things that may tell that surgery is your next best option (7) :
- Young, active individuals
- Full-thickness tear
- Failure to improve with different conservative treatments
- Progressive shoulder weakness
- Difficulty sleeping due to rotator cuff pain
- Work that needs repetitive, overhead movement
- Struggling with daily activities
Further reading: How long does it take for a rotator cuff tear to heal with surgery?
5) What options are available for surgical repair?
Arthroscopic rotator cuff repair
Arthroscopic repair is a minimally-invasive procedure. This is an outpatient treatment that goes well for partial tear injury.
Your orthopedic surgeon will make small incisions to allow the arthroscope inside your shoulder joint. This is so that your doctor has a view of the structures inside your joint.
Using other small instruments, your surgeon can repair your torn rotator cuff.
Open tendon repair
Your surgeon will make a large incision over your shoulder joint, exposing your rotator cuff muscles.
Aside from repairing your tendons, your surgeon may also remove any bone spurs or shave off the tip of your shoulder blade. This is so to prevent further irritation to your rotator cuff.
Mini open repair
Many surgeons consider this to be the gold standard of shoulder surgery. (8) As it provides a better visual of your damaged tendons among the other options.
With a small incision, your surgeon uses a small arthroscopic camera to enter your shoulder capsule. Using small instruments, your doctor repairs or re-attaches your rotator cuff.
A larger incision may be necessary to get a better look at your shoulder muscles.
If I have a painful rotator cuff and keep using it, will this cause further damage?
The tear can get larger the more you use your arm. Besides, being in pain is already a sign that you should get medical treatment.
What are some common rotator cuff injury symptoms?
Constant arm pain and swelling, difficulty moving your arms overhead, arm muscle weakness.
What should you not do with a rotator cuff injury?
Don’t sleep on your affected shoulder, raising your arm overhead. Also, avoid repetitive shoulder activities.
Is it OK to exercise with a torn rotator cuff?
Yes, but with caution. Prioritize doing aerobic exercises such as walking or jogging instead.
Sitting and waiting won’t do any good to your rotator cuff. Consult with your doctor to learn which treatment route is best for you.
- Edwards, Peter et al. “EXERCISE REHABILITATION IN THE NON-OPERATIVE MANAGEMENT OF ROTATOR CUFF TEARS: A REVIEW OF THE LITERATURE.” International journal of sports physical therapy vol. 11,2 (2016): 279-301.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827371/
- Zumstein, M-A et al. “The biology of rotator cuff healing.” Orthopaedics & traumatology, surgery & research : OTSR vol. 103,1S (2017): S1-S10. DOI: 10.1016/j.otsr.2016.11.003
- Liu, Chung-Ting, and Ten-Fang Yang. “Intra-substance steroid injection for full-thickness supraspinatus tendon rupture.” BMC musculoskeletal disorders vol. 20,1 569. 27 Nov. 2019, DOI: 10.1186/s12891-019-2952-y
- Mei-Dan, Omer, and Michael R Carmont. “The role of platelet-rich plasma in rotator cuff repair.” Sports medicine and arthroscopy review vol. 19,3 (2011): 244-50. DOI: 10.1097/JSA.0b013e318227b2dc
- Schneider, Andrew et al. “Platelet-rich plasma and the shoulder: clinical indications and outcomes.” Current reviews in musculoskeletal medicine vol. 11,4 (2018): 593-597. doi: 10.1007/s12178-018-9517-9
- Baumer, Timothy G et al. “Effects of Rotator Cuff Pathology and Physical Therapy on In Vivo Shoulder Motion and Clinical Outcomes in Patients With a Symptomatic Full-Thickness Rotator Cuff Tear.” Orthopaedic journal of sports medicine vol. 4,9 2325967116666506. 26 Sep. 2016, doi: 10.1177/2325967116666506
- Oh, Luke S et al. “Indications for rotator cuff repair: a systematic review.” Clinical orthopaedics and related research vol. 455 (2007): 52-63. DOI: 10.1097/BLO.0b013e31802fc175
- Cho, Chul-Hyun et al. “Anterolateral approach for mini-open rotator cuff repair.” International orthopaedics vol. 36,1 (2012): 95-100. doi: 10.1007/s00264-011-1305-8