Q: Without surgery, what happens to a rotator cuff with a small tear?

THC

A:  You ask a very good question, and a tricky one.  The short answer is that partial rotator cuff tears do not heal themselves.  It is also widely believed that partial tears deteriorate to become full thickness tears.  One research study showed that about 1 in 3 partial tears become full tears within one year.   At that rate, you’re almost guaranteed to have a complete tear in 5 years.  The only exception seems to be in the very young patients who have had a traumatic injury.   So, if you are a college athlete then you’ve got a chance.  If not, you should expect the defect to get worse over time.
The tricky part comes when you have to decide about going through with surgery.  The presence of a partial, or even a full, tear doesn’t mean you have to have surgery.  Many people do very well with physical therapy and can live full, productive lives with their injury.  In fact, some estimate that up to 80% of people over the age of 60 have some level of rotator cuff damage.  Most don’t have any symptoms whatsoever.  This is why it is so important for you to have a discussion with your surgeon about whether surgery is right for you.