Partial rotator cuff tears are more common than full rotator cuff tears. The rotator cuff tendons are a thick structure. If only a portion of it is injured then the injury is called partial (see image below). Common sports related rotator cuff problems include 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 can not recall injuring your shoulder. That is because your rotator cuff has simply started to degenerate or wear out. This is what we refer to as rotator cuff tendinosis. As rotator cuff tendinosis progresses or worsens, the rotator cuff will develop a partial tear. If surgery becomes necessary, new techniques allow us to 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.
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 that these partial tears are healing and regenerating.
But many people with partial rotator cuff tears, even high level athletes will be nursed back to health with rest, and 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 some persistent pain due to a partial rotator cuff tear, despite rest and therapy — an injection can be performed. Injection treatments include cortisone, anti-inflammatories, 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.
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.
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.