Partial Tear of the Rotator Cuff

Nurse helping woman exercise with dumbbell
A partial tear of the rotator cuff is often a finding seen on an MRI.. Blend Images - JGI/Tom Grill/Getty

The rotator cuff is a group of tendons and muscles that surround the shoulder joint. Rotator cuff tears are a common orthopedic problem, and often these tears are so-called partial tears of the rotator cuff.  A partial tear of the rotator cuff is an area of damage to the rotator cuff tendons, where the tear does not go all the way through the tendons.

Treatment of Partial Cuff Tears

Most all patients with a partial thickness rotator cuff tear can be initially treated without surgery.

During this time, other non-invasive treatments, most importantly physical therapy, can be attempted to allow the tendon to heal.

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. Patients may resist physical therapy, thinking their job or active lifestyle is enough exercise. I often remind patients that even professional athletes can (and do) benefit from physical therapy.

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.

Surgery For Partial Thickness Tears

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.

Determining the proper surgical treatment depends on what is seen at the time of arthroscopy. If less than 50% of the tendon is torn, then the tear usually does not require repair. 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 typicallybe performed.

Repair of a partial rotator cuff tear is usually quite strong. Compared to full rotator cuff tears, in a repair of a partial rotator cuff tear, there is less stress on the repaired tendon because the disruption of the tendon is incomplete. This is advantageous for healing and lessens the possibility of the repair failing.

When Is Surgery Necessary?

Knowing when surgery is right can be a challenging question. Unlike full thickness rotator cuff tears, there is usually no urgency to perform surgery for a partial tear of the rotator cuff.

When a full thickness tear occurs, patients may permanently lose muscle strength and recovery potential if surgery is delayed. This is typically not an issue for a partial tear, and therefore it is reasonable to give a good effort at nonsurgical treatment.

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.

Sources:

Lehman RC, Perry CR. "Arthroscopic surgery for partial rotator cuff tears." Arthroscopy. 2003 Sep;19(7):E81-4.

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