Rotator Cuff Tears: Can They Heal on Their Own?

If you’ve ever had shoulder pain that just wouldn’t go away, there’s a chance the culprit might be a rotator cuff tear. The rotator cuff is a group of four small but mighty muscles and tendons that stabilise your shoulder joint and allow you to lift, reach, and rotate your arm. Tears in this structure are surprisingly common, especially as we get older. But the big question patients often ask me is: “Can a rotator cuff tear heal on its own?”

The answer is… not as straightforward as many would hope. Let’s unpack the evidence.

What happens when the rotator cuff tears?

A rotator cuff tear can occur suddenly from an injury — such as a fall — or develop gradually from wear and tear over time. The tear may be partial, where the tendon is damaged but not completely severed, or full-thickness, where the tendon is fully detached from the bone.

Unfortunately, tendons have a limited blood supply, and once torn, the tissue often doesn’t “knit” itself back together the way skin or bone can. This means that while symptoms can improve, the physical tear may persist.

The natural history: what the research says

Several studies have looked at what happens if a rotator cuff tear is left untreated. Here’s the general pattern:

• Small, partial tears can sometimes become painless and functional over time with the right rehabilitation — but they don’t usually heal completely at the tendon level.
• Full-thickness tears tend to remain torn and may even enlarge over the years, especially if the shoulder is subjected to ongoing strain.
• Muscle fibres attached to the torn tendon can weaken and undergo fatty infiltration (where muscle tissue is replaced by fat), which is often irreversible.

A 2013 study in the Journal of Bone and Joint Surgery found that about half of asymptomatic rotator cuff tears became painful over a five-year period, and some enlarged. This highlights why regular monitoring is important.

When rehabilitation makes sense

While the tendon may not “heal” in the strictest sense, many people can achieve excellent function and pain relief through non-surgical management.

Rehabilitation focuses on:

• Strengthening nearby muscles to compensate for the damaged tendon
• Improving shoulder mechanics to reduce stress on the tear
• Maintaining flexibility to prevent stiffness and frozen shoulder

Physiotherapy, combined with activity modification and anti-inflammatory measures, can be surprisingly effective — especially for partial tears or older patients who have lower physical demands.

For example, I’ve seen patients in their 60s return to gardening, golf, and swimming after a few months of dedicated physio, without surgery.

When surgery might be the better option

Surgery is not automatically the right choice for every rotator cuff tear, but there are situations where it’s strongly considered:

• Acute traumatic tears in younger or active patients
• Large or progressive tears that are limiting daily activities
• Failure of non-surgical treatment after 3–6 months
• Loss of strength in lifting or rotating the arm
• Risk of irreversible muscle changes if left too long

Modern arthroscopic (keyhole) techniques allow surgeons to reattach the torn tendon to the bone. However, recovery is not instant — it often takes several months of post-op rehab.

Factors influencing outcomes

Whether you recover well without surgery depends on a mix of personal and tear-related factors:

1. Size and type of tear – Smaller, partial tears respond better to rehab than large, full-thickness tears.
2. Age – Younger patients generally heal and regain function more effectively, while older patients may have more degenerative changes.
3. Activity level – A carpenter or tennis player may require more robust shoulder function than someone with a desk job.
4. Time since injury – Early treatment (surgical or non-surgical) can improve results.
5. Overall health – Conditions like diabetes or smoking can slow tendon healing.

What patients often get wrong

It’s a common misconception that resting the arm completely will help it heal. In reality, prolonged immobilisation can make things worse, leading to stiffness and muscle wasting. The key is guided, progressive movement — just enough to maintain strength without aggravating the tear.

Another misconception is that every rotator cuff tear needs urgent surgery. Many tears never require an operation and can be managed very successfully without it.

Evidence-based approach

In my practice, I recommend a stepwise approach:

1. Accurate diagnosis – through history, examination, and imaging (often an MRI or ultrasound).
2. Trial of non-surgical management – physiotherapy, activity changes, anti-inflammatories, sometimes a cortisone injection for pain relief.
3. Reassessment – if after 3–6 months the shoulder is still painful or weak, we discuss surgical options.

This approach balances the risks and benefits, avoids unnecessary procedures, and gives the tendon the best chance to be rehabilitated naturally if possible.

Key takeaways

• Rotator cuff tears rarely heal completely on their own at the tendon level, but symptoms can improve greatly with proper rehab.
• Physiotherapy is first-line treatment for most tears, especially in older or less active patients.
• Surgery is best reserved for specific situations — acute tears, large tears in active people, or failed conservative care.
• Early assessment is essential to prevent tear enlargement and irreversible muscle changes.

Frequently Asked Questions

1. How do I know if my rotator cuff tear is getting worse?

You might notice increased shoulder pain, especially at night, greater weakness when lifting your arm, or reduced range of motion. If these changes occur, it’s worth seeing your doctor for reassessment and possibly updated imaging.

2. What happens if I ignore a rotator cuff tear?

Some tears remain stable for years, but others can gradually enlarge and cause irreversible muscle changes. Ignoring a worsening tear may lead to persistent pain, reduced strength, and limited function.

3. Can a rotator cuff tear heal with exercise alone?

Exercise can’t “stitch” the tendon back together, but it can strengthen surrounding muscles, improve shoulder mechanics, and greatly reduce pain. Many people achieve good function this way, especially for partial tears.

4. Is surgery always better for younger patients?

Not necessarily. While younger, active patients often benefit from early surgical repair, the decision still depends on the size, type, and cause of the tear, as well as personal goals and recovery expectations.