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Charting the course of a disease or condition from beginning to end is called the natural history. No one really knows the natural history of unrepaired rotator cuff tears.
Patients who have the surgery can be followed and studied. And in fact, most people with full-thickness tears do have the surgery done. Many patients with unrepaired rotator cuff tears aren't seeing a physician over the long term for follow-up.
Some studies have been done to collect data on patients who have a pain free rotator cuff tear that eventually develops painful symptoms. That's when surgery is most often indicated and suggested.
But before surgery is done, conservative care is almost always suggested. Six-weeks to three months' treatment with a physical therapist is advised along with nonsteroidal antiinflammatory drugs. If there's been no improvement after this amount of time, then surgery should be reconsidered.
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