Rotator cuff tears are tears in the tendons of the shoulder. Most people know about rotator cuff tears, but are surprised to learn that having a rotator cuff tear is not always painful. Most tears happen slowly over time. These tears are called "degenerative" tears because they occur slowly and are not the result of a single injury. On top of that, they are often not painful. Most people don't even know they have a tear until it starts to bother them. They may notice a loss of strength but no pain, and many do not seek treatment because the process is so slow. Recently, researchers in Norway did a study that asked the question: "If a person has a rotator cuff tear that doesn't hurt, what happens to it over time?" This question is important to answer in order determine the right course of action for people with a torn rotator cuff. If tears don't get any worse with time, then maybe surgery can be avoided.
In this Norwegian study, researchers did MRI scans on people with no shoulder pain. They found 80 people with a rotator cuff tear that was not painful. These people did not even know they had a tear, it was only found because they were in a study. The researchers then followed along, without doing surgery, for three years. During that time, about 40% of the people began to feel pain, and many of them had tears that increased in size and severity. In other words, many people got worse and their tears got worse. This information is important, because it suggests that when a tear is found, it ought to be fixed to give a person the best chance of healing and to prevent the tear from getting larger.
There are limitations to studies like this, but it suggests to me that younger patients (less than 65 years old ) with rotator cuff tears should strongly consider surgery, because the tear has a good chance of worsening with time. Doing nothing is not going to get the tear to heal. This is why I most often recommend rotator cuff repair for my active patients younger than 65 years old.
Here is a video of a rotator cuff repair: