Dr. Louis Rizio

Advice from Shoulder Specialist in NJ

When the rotator cuff is torn, the connection of the muscle to bone is lost. Much like the chain on a bike being detached from the wheels. The lack of connection leads to muscle atrophy and fat infiltration of the muscle. Basically, lack of connection of the muscle/tendon to bone creates a loss of active stimulation and force; disuse or lack of use atrophy. In general the larger the tear the more likely this is to happen.^2,6 However, tear enlargement is not consistently correlated with pain development. Therefore, it is important to adequately follow tear progression in patients with partial and full-thickness tears that are currently asymptomatic or when non-surgical management is chosen.

Tear enlargement occurs in about 50% of patients when there is a complete tear and 35% when the tear is partial over 5 years.⁶ The longer a tear is left untreated the more muscle atrophy/fat infiltration occurs. There is a trend toward more progression the larger the tear is when first identified. Its important to consider what effect does tear size and age have on healing and success after surgery. Multiple studies have shown that smaller tears, younger age (<70), good bone density and less fat infiltration leads to higher healing rates after a repair. Therefore, delaying surgery could compromise a successful outcome from surgery. In support of this, tears that occur from injury treated within 3-4 months of the injury have better outcomes and functional recovery; presumably because there has been less time for atrophy and fat infiltration to set in.^7-16

My approach to manage each tear and patient individually based on their goals, activity level, associated health conditions, symptom level and tear pattern. In general, patients who are younger, active, who perform physical labor or exercise vigorously who have a complete full thickness tear I recommend surgery. I also recommend surgery for patients of any age who have pain, weakness and motion trouble that fail therapy. I don’t base the choice to repair tears surgically on age alone. Research shows high rates of patient reported success and satisfaction from surgical repair regardless of age. For my patients with minimal symptoms or no symptoms, partial tears, lack of functional limitations I follow closely and routinely order a follow up MRI in 1-2 years to look for tear progression.

My goal is to preserve motion, strength and eliminate pain so patients can go back to being active and in some cases just get a good night sleep.

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2. Keener JD, Galatz LM, Teefey SA, Middleton WD, Steger-May K, Stobbs-Cucchi G, Patton R, Yamaguchi K: A Prospective Evaluation of Survivorship of Asymptomatic Degenerative Rotator Cuff Tears. J Bone Joint Surg Am 2015;97:89–98. [PubMed: 25609434]
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12. Tashjian RZ, Hung M, Burks RT, Greis PE: Influence of preoperative musculotendinous junction position on rotator cuff healing using single-row technique. Arthroscopy 2013;29:1748–1754. [PubMed: 24209672]
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15. Tan M, Lam PH, Le BTN, Murrell GAC: Trauma versus no trauma: An analysis of the effect of tear mechanism on tendon healing in 1300 consecutive patients after arthroscopic rotator cuffrepair. J Shoulder Elbow Surg 2016;25:12–21. [PubMed: 26264504]
16. Petersen SA, Murphy TP: The timing of rotator cuff repair for the restoration of function. J Shoulder Elbow Surg 2011;20:62–68. [PubMed: 20675154]
17. Meng C, Jiang B, Liu M, Kang F, Kong L, Zhang T, Wang C, Wang J, Han C, Ren Y. Repair of rotator cuff tears in patients aged 75 years and older: Does it make sense? A systematic review. Front Public Health. 2023 Jan 17;10:1060700. doi: 10.3389/fpubh.2022.1060700. PMID: 36733288; PMCID: PMC9887178.