The Natural History of Rotator Cuff Disease: Evidence in 2016

Significant advancements have been made in the understanding of the natural history of symptomatic and asymptomatic rotator cuff (RC) tearing as well as the indications for their treatment. RC tears have a significant predilection toward tear enlargement. Risk factors for tear enlargement include the initiation of pain, higher degrees of muscle degeneration, older age, longer duration of follow-up, and increased tear severity (full-thickness vs. partial-thickness). It is still unclear if larger tear size (width) predisposes toward a higher risk for tear enlargement. Increased tear retraction appears to be associated with further retraction with a critical threshold of about 1 cm. The treatment of tears can be triaged based upon age, tear size, muscle quality, arthritic changes, and tear chronicity. Initial nonoperative treatment is reasonable for patients with tendonitis, partial-thickness RC tears, small full-thickness tears (<1 cm), chronic irreparable tears in any age group, and chronic tears of any size in older patients (>65 y). Early surgical repair is indicated for acute tears in any patient and larger (>1 cm) full-thickness chronic tears in younger (<65 y) patients. Further research is required to identify possible biologic and genetic markers for tear progression as well as healing to improve treatment indications.