Q: If I have a rotator cuff tear but it doesn't bother me, what are the chances it will just go away?

A: The rotator cuff is a group of four muscles and their tendinous attachments that surround the shoulder in the socket. They provide both stability (to hold the head of the humerus in the socket) and strength for smooth and controlled movement.

Unfortunately, tears of tendons and especially of the rotator cuff don't "go away". The body does initiate a healing response. Although the tendon can't repair itself with normal tendon tissue, scar tissue does form around the tear and tries to patch things up.

Tears that are too large to fill in with scar tissue often fill in with fat cells. This process is referred to as fatty infiltration. Fat doesn't have even the strength of fibrosis (scar tissue), so it doesn't lend any strength or stability to the rotator cuff.

A recent study at Washington University School of Medicine in St. Louis followed a large group of older adults (60 years old or older) with painfree rotator cuff tears. They wanted to see if it is possible to predict who will get worse and who won't. They thought perhaps this type of information would help them direct treatment in order to prevent worsening of painful symptoms and decline in function.

They discovered that the larger the tear when first diagnosed, the more likely the patient would end up with pain and loss of motion and function. Patients who had a rotator cuff tear of the dominant hand were also more likely to develop worsening symptoms over time.

They also noticed that fatty infiltration was not a sign that shoulder pain would begin. Changes in the way the shoulder moves (called arthrokinematics were noticed more often in patients with advanced stages of rotator cuff tears. Arthrokinematics were more likely to be disrupted when the infraspinatus muscle (one of the four rotator cuff muscle/tendons) was torn.

Your best bet is to see an orthopedic surgeon for an evaluation and recommendations about what might be best for you and your particular situation. If nothing must be done right now, close follow-up over time is advised to recognize early signs of change that might indicate the need for more direct intervention.

Reference: Nathan A. Mall, MD, et al. Symptomatic Progression of Asymptomatic Rotator Cuff Tears. In The Journal of Bone and Joint Disease. November 17, 2010. Vol. 92A. No. 16. Pp. 2623-2633.