Do Rotator Cuff Tears Heal on Their Own?

Short answer: A full-thickness rotator cuff tear, where the tendon has pulled off the bone, does not reattach on its own. The pain often settles, and many people regain good function with therapy, but the tendon stays torn and the tear can get bigger. Partial-thickness tears are different: they are less likely to progress, and a few months of non-operative care does not usually hurt the long-term result.

This is one of the most common questions I get. The honest answer depends on what you mean by "heal," and on what kind of tear you have.

Feeling better is not the same as healing

There are two different things people mean by healing:

1. The pain goes away and the shoulder works. This happens often. Physical therapy strengthens the muscles around the tear so they can compensate.
2. The torn tendon reattaches to the bone. For a full-thickness tear, this does not happen on its own. Therapy does not heal a tendon that is detached from the bone. Right now, the only way to get the tendon back down to the bone is a repair.

Both can be true at once. Plenty of people with a full-thickness tear feel fine. In a classic MRI study of people with no shoulder pain at all, 54% of those over 60 had a rotator cuff tear. A tear on a report is not, by itself, a reason to operate.

Partial-thickness versus full-thickness

The rotator cuff is four muscles whose tendons attach to the top of the arm bone. Most tears happen where the tendon meets bone.

• Partial-thickness tear: the tear does not go all the way through the tendon. The risk of progression is low, and trying conservative treatment for several months does not typically affect the long-term outcome. That said, a partial tear can progress to a full tear, so it is worth keeping an eye on.
• Full-thickness tear: the tear goes all the way through, so that part of the tendon is completely detached from the bone. This is the kind that does not reattach without repair.

What happens when a full-thickness tear is left alone

Several studies have followed tears over time without surgery:

• In one study of 23 people with tears but no pain, none of the tears had healed after 2.8 years. 39% had gotten bigger, and 51% of the people had developed pain.
• A study from Israel followed 61 painful tears treated without surgery. About 2.5 years later, 49% had gotten bigger. Among patients who still had pain, 56% of tears had grown, compared with 25% of those whose pain had gone away.
• In a 2017 study of 174 patients followed for an average of 19 months, nearly 50% of tears progressed. Medium-sized tears, full-thickness tears and smoking were linked to progression.

That second study points to something useful. Pain that persists despite good non-operative care is not proof, but it may be a sign the tear is enlarging.

The muscle matters too. When a tendon stays detached, the muscle behind it can waste away and fill with fat. Large tears and tears involving the front of the supraspinatus are more likely to do this, and that change makes a later repair harder to heal.

So why do so many people do well without surgery?

Because pain and function can improve even when the tendon does not reattach. The best long-term data comes from the MOON Shoulder Group, which followed 452 patients with atraumatic full-thickness tears through a standard physical therapy program. At ten years, fewer than 30% had undergone surgery.

The trade-off shows up over time. In a Norwegian trial, 91 patients were randomized to repair or physical therapy. At two years there was no difference between groups. At ten years, the repair group had clearly better function, motion and pain, and 27% of the therapy group had crossed over to surgery. I read that gap as the result of tears enlarging in the therapy group.

When I watch, and when I act

These are general guidelines I use, not a decision for your shoulder.

Reasonable to watch and rehabilitate first:

• A partial-thickness tear.
• A degenerative tear that came on gradually, not from an injury.
• An older patient with lower demands. For a painful full-thickness tear, I generally recommend an initial trial of non-operative treatment for patients over 70.
• Pain and function that are clearly improving with a structured program.

Reasons I lean toward earlier repair:

• A traumatic tear, for example after a fall. These typically do better when repaired within a few months rather than after several months to a year.
• A painful full-thickness tear in someone under 60. They have many years ahead for the tear to grow.
• Pain that is not improving despite a fair trial of therapy.
• Risk factors for progression, such as a medium-sized tear or smoking.

Between 60 and 70, it depends on your health, your activity and what the MRI shows. A very active 70-year-old may want a repair after only a short trial, while a 60-year-old in poor health may be better treated without an operation.

If you are heading toward repair, timing matters. I prefer to repair within about six months, because tears that wait tend to grow and their healing potential drops. I explain why in how long can I wait to have my rotator cuff repaired?

What to do next

If your tear is degenerative and you want to try non-operative care properly, start with my six-week program for a rotator cuff tear without surgery. If you are not clearly better after six weeks, get evaluated.

If you have been told you need surgery, or told you do not, and you are unsure, a second look is reasonable. See should I get a second opinion before shoulder surgery? For background on tear types, read all about rotator cuff tears.

Already have an MRI?

If your MRI shows a rotator cuff tear and you want to know whether yours is likely to get worse, I can review your actual images remotely and send you a narrated video explaining what I see and what I would do. Order a remote MRI review.

Watch: Ignoring Your Rotator Cuff Tear? Here's What Happens Next

You can also read about rotator cuff repair.

Frequently asked questions

Can a torn rotator cuff reattach by itself?

No. When the tendon has pulled off the bone in a full-thickness tear, it does not reattach without a repair. The pain can still improve with therapy.

Do partial rotator cuff tears heal on their own?

Partial tears have a low risk of getting worse, and several months of conservative care does not usually change the long-term outcome. They can progress to full tears, so follow-up matters.

How often do untreated tears get bigger?

In the studies I cite, 39% of tears grew over 2.8 years, 49% over about 2.5 years, and nearly 50% over an average of 19 months.

When should a rotator cuff tear be repaired?

I lean toward earlier repair for traumatic tears, painful full-thickness tears in people under 60, and pain that is not improving with therapy. If repair is planned, I prefer to do it within about six months.

This article is for education only and is not medical advice. It does not replace an evaluation of your own shoulder by a qualified clinician.

Related reading

• All About Rotator Cuff Tears
• Does Atrophy Improve After Rotator Cuff Repair?
• Does the Location of a Rotator Cuff Tear Affect Treatment?