Partial rotator cuff tears are a common cause of shoulder pain. It is not uncommon for most people to have an MRI report that mentions a partial rotator cuff tear. That tend to leads to a lot of fear, because most of you assume that a tear of any kind simply can’t be normal. For many of you a partial tear is a normal age appropriate change. It may or may not require treatment, and most do not require surgery. Skip down to the videos below if interested. Otherwise read on to learn more about this common shoulder condition.
Partial rotator cuff tears are far more common than full rotator cuff tears. The term partial refers to how much of the thickness of the rotator cuff is involved. The rotator cuff tendons are a thick structure. If only a portion of it is frayed or injured then we call it a partial (see image to the right or below). These images of frayed tendons can be alarming, but these are common, and mostly normal changes that occur as we age. Not all partial tears are due to aging. Some are due to a sports injury too.
Common sports related rotator cuff pain can be caused by rotator cuff tendinosis, partial thickness rotator cuff tears, and full thickness tears. Although injuries do happen and account for a small percentage of partial rotator cuff tears, the majority of you do not recall injuring your shoulder. Remember, that is because your rotator cuff has simply started to degenerate or wear out. In pitchers or overhead athletes, these tears can occur due to overload of the tendons. That means that the tendons simply started to fail due to too much stress or too much activity.
As rotator cuff tendinosis progresses or worsens, the rotator cuff can develop a partial tear. Most people with partial cuff injuries do not require surgery, however, if surgery becomes necessary, new techniques allow us to potentially heal partial tears.
As Adam Rubin reported, Jonathan Niese, the NY Mets left-handed pitcher developed shoulder pain and was diagnosed with a partial thickness rotator cuff tear. Niese’s pain began during a game last week. This is a classic case with regards to the onset of pain in an overhead athlete. Eventually the rotator cuff can not stand the strain of pitching and it starts to fray or tear.
What is a Partial Rotator Cuff Tear:
We actually refer to these as partial “thickness” rotator cuff tears, as opposed to full thickness rotator cuff tears.
The rotator cuff are a series of four muscles which come together to cover the top of our arm bone in a “cuff” of tissue … which we refer to as the rotator cuff. In time, due to aging or repetitive stress – similar to the reason your favorite jeans have holes around the knees — the tendon tissue starts to wear thin and change its internal structure. This rotator cuff degeneration can progress, and eventually the rotator cuff tissue will start to lift off from its normal attachment to the bone and a partial rotator cuff tear is borne (see image- red arrow). Given more time, all the tendon tissue might separate in a localized area producing a full thickness rotator cuff tear.
Treatment of a Partial Rotator Cuff Tear
Many partial rotator cuff tears can now be healed with a biological patch which we place during a minimally invasive or arthroscopic procedure. Recent research shows these partial tears are capable of healing and regenerating.
But many people with partial rotator cuff tears, even high level athletes will be nursed back to health with physical therapy. Certain people with partial rotator cuff tears have lost full internal rotation (the ability to reach up your back). That motion will need to be restored by your therapist if your goal is to fully recover. Some patients may choose to exercise on their own.. and products such as The Rotator might assist you if you have lost motion. In patients with persistent pain due to a partial rotator cuff tear, despite rest and therapy — an injection can be performed. Injection treatments for partial rotator cuff tears include cortisone, anti-inflammatories, as well as PRP and Stem Cells. The use of PRP and stem cells for the treatment of partial rotator cuff tears is controversial and very active research is underway in this area.
Here is video I recently did on whether or not partial rotator cuff tears can heal without surgery, and who may need to consider surgery.
Partial Tears and Bone Spurs
Many of you are told by your doctor that you have a partial tear of your shoulder because you have a bone spur. I can not stress strongly enough that this simply isn’t true. For many decades Orthopedic Surgeons felt that rotator cuff damage was caused by bone spurs. It was never proven to be true, but instead was adopted by surgeons worldwide. There has been a lot of research into this concept over the last 5-7 years. All of these studies show that the bone spur is not the cause of rotator cuff pathology, and removal of the bone spur has not been shown to be any more effective than a placebo. This video below goes into more detail about the concept of bone spurs and rotator cuff pain.
Surgery for partial rotator cuff tears
It bears repeating, the vast majority of you will not need to consider surgery for your partial tear. You will respond to physical therapy, injection or simply by waiting. There is no harm in waiting. Some research also shows that these tears can heal on their own. Some tears might progress or become larger over time. We can not predict who that will occur in. It does not happen quickly either.
If non-surgical treatments of your partial rotator cuff tear does not enable you to return to your desired quality of life, then you can consider arthroscopic rotator cuff surgery for your partial tear. During surgery, which is performed arthroscopically, the partially torn area of the rotator cuff is smoothed out, and we can place a “bioinductive” patch over the degenerative or torn region.That patch might be able to heal a partial tear. It works in some, but doesn’t work in everyone. And surgery carries risks such as infection, stiffness, a reaction to the patch, blood clots, and so on. That gives further support to our message that surgery for these rotator cuff issues should be your last choice, and should only be considered if everything else fails to improve your pain.
Over time… that patch might begin to integrate into the rotator cuff possibly leading to healing of the tear. The patch could potentially reverse the degeneration or tendinosis of the rotator cuff which could prevent your pain from coming back again.
The vast majority of people with partial rotator cuff tears will improve with physical therapy alone and not require surgery.
Laura S says
Thank you! I guess I’m going the right direction then. Waiting for therapy appt. I’m also going to request a Specialist Appt. for a second opinion (or first, in this case, since a Dr hasn’t explained them to me yet).
I received a prp injection 2 weeks ago on my rotator cuff which has a 1.5cm tear in it. From what i was told a 2 to 4 cm is considered full thickness tear. Have you seen prp heals partial tears at least to any degree? Would trying a second prp if the ultrsound shows some tissue repair be worthwhile down the road? Any input would be greatly appreciated! Thanks in advance, you have a great column here.Tim
Howard J. Luks, MD says
Hmm .. You can have a 5 mm full thickness tear or a 5+ cm full thickness tear. The size of the tear doesn’t define if it is full thickness or not. The depth of the tear does. So you can have a 2 cm long partial tear or a 2 cm full thickness tear. PRP will not heal partial tears, but it can help diminish the inflammation and pain.
Ava Dawn says
Hi Dr. Lucks,
Thank you for this post. I am a 24 year old with a partial rotator cuff tear. I’ve had symptoms since I was 15 years old and in the last two years it’s gotten worse. It is painful to move move my shoulder back, and if I do exercises that involve doing that, such as push ups, it feels as though something will snap out of place. I have neck and shoulder muscle spasms very often. The muscle spasms make it difficult to breathe and sleep at night. This happens every couple of days.
I’ve tried physical therapy, chiropractic, OMM, rest..etc. They all seem to help for a few hours but the spasms return. I’m applying to medical schools and don’t want to carry this with me through med school and residency. You mentioned that if all else fails, surgery would be the last option. I’ve tried all my options for the past 5 years. When is a good time to consider surgery? I saw an orthopedic surgeon who said he simply won’t do surgery on partial tears and to continue doing what I’m doing. Is this view generally acceptable by all physicians? And how can I find a physician who is honest in his advice but open to work with me if I elected to have surgery?
Howard J. Luks, MD says
I hope you find a shoulder physician who can assist you. keep searching.
Simon day says
Hi I have a large tear in the susprinatus tendon in my left shoulder. I fell over approx three months ago and have been suffering ever since. I struggle taking clothes off etc. My shoulder aches constantly and is especially worse on an evening. I have been unable to undertake physio due to the pain and have been taking oral morph. I would like to know if surgery would be the best route and how successful would it be after tearing the tendon over three months ago. Regards Simon day
Howard J. Luks, MD says
Hard to say… I’m very leary about operating on people already on morphine before surgery. Consider a second opinion to review your options.