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.
Nico
Hi Doctor Luks,
I’ m 35 years old and very active (I did Crossfit for some years) Last year I had a surgery to my right shoulder to repair a small full thikness tear in my supraspinatus associated with tenodesis. The rehabilitation was very though and painful developing a light capsulitis and having lots of biceps spams. Now my right shoulder is quite ok….but unfortunately MRI on my left shoulder said that I have a type II acromion and an “initial fibrillation of the supraspinatus tendon fibers” due to a partial tear of type A1 according Synder classification.
At the moment, I occasionally have only a slight discomfort (no pain with any sort of movements) near the biceps groove, but I fear that keeping on training even if avoiding any havy and “dangerous”lift especially overhead it progressively getting worse in time. Just would like your opinion about this A1 partial tear. Sorry for the long post. Many Thanks, Nico
Howard J. Luks, MD
Partial tears can worsen over time. That’s why we are very excited about the potential of the Rotation Medical Bioinductive implant … we have been using them for a while now. The research seems to show that it reverses the degenerative process and heals the partial tears before they can progress to full tears.
Harry
Dr. Luks
My name is Harry, I am a 13 year career firefighter I injured my left shoulder at work bench pressing 175 pounds. This happened 01/07/2015 I continued working until 1/25/2015 at which time the pain and range if motion caused me to go off the truck. I went to the doctor with a shoulder sprain and began therapy 2x a week for 3 weeks. After my 6th therapy session (no change possibly worse than before I started therapy) I reported back to the doctor and an MRI was ordered. Found was a Articular-sided partial thickness tear of the distal supraspinatus tendon. More diffuse fibrillation along the bursal surface of the supraspinatus. No full-thickness rotator cuff tear. Very minor marrow contusion along the lateral humeral head at the greater tuberosity. No fracture. The tear extends through 50% of the tendon thickness. I was ordered to continue therapy 2x a week for 4 more weeks no change in the pain and mild change in the range of motion. Not sure what the next step will be, I have been told by my doctor that its possible that my partial tear has become a full thickness tear, or frozen shoulder has started. The only way to know for sure is to scope it….your thoughts please and thank you!!!
Howard J. Luks, MD
YIKES .. Partial tears can certainly hurt. Most people with shoulder pain do not have a full tear. Partial tears can hurt just as much. A frozen shoulder simply means that the shoulder does not move as much as your other shoulder does .. it is a very easy diagnosis to make. We are able to repair partial tears if therapy has been unsuccessful in alleviating your pain. But these are not easy repairs so be sure to see a true shoulder specialist with a lot of experience fixing partial tears.
Tyise
I injured my right shoulder sept 2013 I was told I had partial tears in November and by January 1st I was told they had healed but I had bursitis and tendinitis which wasn’t on my original MRI I am going on 2 years post incident and all I can say is I am in pain 80% of my days my shoulder only goes about 130 degrees upward my internal rotation is poor and extremely painful i also have pain throughout my right arm and hand which I was told was from a slight bulging disc cervical spine I have done PT injection and medicine nothing has relived my pain not even a little I progressively feel worst with no explanation is it possible that my tear did not go away or could this be something else
Howard J. Luks, MD
Stiffness after an injury can lead to continued pain. Tears are not the only reason why our shoulders hurt. Most people with shoulder pain do not have full tears, or partial tears. They have inflammation and limited motion. IF PT, injections, etc have not led to any relief then you need to possibly speak with another shoulder specialist about your condition and what options are available.
Bob Zaita
I have been recently diagnosed with a partial-thickness (75%) insertional , intrasubstance tear of the supraspinatus footprint insertion, which involves the anterior aspect of the tendon. I am investigating the appropriateness of the Rotation Medical product for my case. Have you done any cases using it? If yes, have you been satisfied with the outcome(s) and do you think it might be appropriate for my diagnosis? Thank you very much. Bob
Howard J. Luks, MD
Hi Bob … i have been using this implant for a while… so far we are very happy with our results.
Most patients with partial tears will respond well to therapy, etc and not require surgery. If, however, surgery does become an option due to failure of non-surgical management then the implant does become an option.
Gloria
Dr. Luks, I had a injury a week ago that caused my arm to be pulled up very abruptly. After much pain I had an MRI 4 days later. The MRI showed a full-thickness slightly retracted tear of the anterior middle third fibers of the distal supraspinatus tendon with the fibers retracted approximately 7mm at the distal supraspinatus footprint. There is also a 5mm tear in the anteroposterior dimension from sagittial plan view. And just posterior to the area of full-thickness tearing is a moderate grade partial thickness tearing in the posterior fibers of the distal suprapinatus tendon. When there is retraction does it mean it was probably an old tear? Thank you so much for your response
Howard J. Luks, MD
It’s often hard to tell …