How common are rotator cuff injuries?
Many studies over the years have investigated the prevalence of rotator cuff injuries in the general population. A common finding in the majority of these studies is that a large percentage of the population has a rotator cuff tear; one study found up to 64% of the population (Yamaguchi 2001). Additionally, many of these studies are similar in the fact that a large percentage of those with a rotator cuff injury are asymptomatic. In fact, up to 46% of those with rotator cuff tears seen on MRI have reported no symptoms (Lawrence 2020).
These articles beg the question: if so many people with rotator cuff tears don’t have symptoms, is the rotator cuff tear itself the reason some people do have symptoms?
Certainly rotator cuff tears can be the cause of pain, however there is compelling evidence that simply because a tear exists does not mean that pain must also exist.
With that being said, if I have a rotator cuff tear with symptoms, does my rotator cuff need to be repaired for my symptoms to go away?
Evidence argues that for those with full thickness rotator cuff tears, three months of physical therapy reduces pain, improves range of motion, and improves overall function of the shoulder (Karasuyama 2020). These results are for full thickness tears, while partial thickness tears tend to respond even better to conservative management in physical therapy.
Does this mean I shouldn’t get surgery for a rotator cuff tear?
While physical therapy is the best first line option for treatment of a rotator cuff tear, surgical management may still be the best option in certain scenarios.
Whether or not an individual should have surgery depends on their age and functional demands. Evidence suggests individuals under the age of 40 with acute full thickness tears are most likely to benefit from surgical intervention (May 2023). However, consensus remains that the vast majority of individuals would benefit from seeking conservative management through physical therapy first. The majority of patients will make significant progress through physical therapy. Those who do not make the progress they had hoped will still have the option to pursue surgery, and the improvements in strength, range of motion, and function they gained in physical therapy will only make their recovery from surgery easier.
So if your recent MRI results show a rotator cuff tear, don’t panic! Remember that more than half of the population also likely has a rotator cuff tear. Despite the tear, you’re likely to make significant progress in physical therapy, and if you don’t, the progress you make in therapy will only make your recovery from surgery that much smoother if you choose to go that route.
