Types of Partial Rotator Cuff Tears
The rotator cuff is a group of tendons and muscles that surround the shoulder joint. There are four muscles of the rotator cuff that are important in the function and movement of the shoulder joint.
These muscles attach to the bone via a tendon. It is the tendon part of the rotator cuff that can become damaged when you have a rotator cuff tear.
A partial tear of the rotator cuff is an area of damage or degeneration to the rotator cuff tendons, where the tear does not go all the way through the tendons. In a partial rotator cuff injury, the tendon is damaged, but not all the way through.
The top part of the tendon is sometimes damaged, the bottom part of the tendon is damaged other times, and in some cases, the inner part of the tendon can be damaged. Some partial tears are very subtle, just some fraying of a small part of the tendon, whereas other partial tears can be just a minuscule amount of tissue away from a complete tear.
While we often compare partial rotator cuff tears as a single entity, the reality is that each tear can be a little different, and may have differences in ideal treatment.
Partial Rotator Cuff Tear Symptoms
People who have rotator cuff injuries often experience pain around the shoulder joint. Determining the source of the pain can be attained in part by a careful examination, and by using imaging studies to evaluate the rotator cuff.
Pain is not a reliable indicator of a rotator cuff tear, as many people with a structurally normal rotator cuff can experience discomfort when there is an injury or inflammation around the shoulder joint.
Diagnosis
Your examiner can perform a specific test to isolate each of the muscles of the rotator cuff. When there is diminished strength, this is a common sign of structural damage to the rotator cuff.
Imaging studies are often useful to evaluate the condition of the rotator cuff. Typically an X-ray will not show abnormalities of the rotator cuff tendon. Occasionally, bone spurs, calcification, or changes in alignment can be seen in association with rotator cuff damage, but the actual rotator cuff damage is not seen on an X-ray.
Ultrasound tests are increasingly being performed to evaluate the rotator cuff, and a technician experienced with this technique can often visualize the tendons of the rotator cuff with an ultrasound.
MRIs are the most common test used to evaluate the rotator cuff. The MRIs will show not only the condition of the rotator cuff tendon but also the muscle. MRIs are useful at determining if the injury is a partial or complete tear of the rotator cuff.
Treatment
Most patients with a partial thickness rotator cuff tear can be treated without surgery. During this time, non-invasive treatments, most importantly physical therapy, can allow shoulder function to return to normal.
Physical therapy can help to restore and maintain normal shoulder mechanics, and can often address the symptoms caused by the injury. While many people are active and strong, physical therapy can still be helpful as most patients with this type of injury have altered mechanics of the joint that may exacerbate the symptoms.
If the symptoms persist despite these treatments, then surgery may be considered for a partial thickness rotator cuff tear. Determining when surgery is necessary for a rotator cuff tear is similar for both partial and complete rotator cuff tears.
When Is Surgery Necessary?
Knowing when surgery is right can be a challenging question. Most partial thickness tears are a normal part of the aging process and do not need surgery.
If more conservative treatments are not working to relieve your symptoms, then surgery may be appropriate. Deciding whether or not a repair is necessary is usually made at the time of surgery. Only then will your surgeon have an accurate idea of how much tendon is torn, and whether or not repair should be performed.
Surgery
There are a few different ways to address a partial thickness rotator cuff tear at the time of surgery. Most often, these tears can be addressed arthroscopically, and seldom should an open surgery (with a larger incision) be necessary.
The options for surgical treatment include cleaning up the inflammation (subacromical decompression), debridement of the tear (cleaning out the torn portion), or repairing the torn rotator cuff. In addition, some combination of these procedures can be performed.
In these cases, removing the frayed and damaged tendon (debridement), as well as removing any inflammation, will often relieve symptoms. If more than 50% of the tendon has been torn, a rotator cuff repair will typically be performed.
A Word From Verywell
Partial rotator cuff tears are common findings, both on imaging tests and during surgical treatment of shoulder problems. Because they are common and often normal findings, they infrequently require surgical treatment.
In fact, the vast majority of partial rotator cuff tears can fully recover with nonsurgical treatment. Typically, surgery for this type of damage is reserved for people who cannot recover their function with less invasive treatments.
