Partial Thickness Rotator Cuff Tears

ROTATOR CUFF CONDITIONS

Definition

Rotator cuff tears of the shoulder can be divided into partial-thickness (incomplete) and full-thickness (complete) tears. While surgery is generally indicated for full-thickness cuff tears that are associated with functional impairment, the management of partial thickness tears is more debatable. A partial-thickness rotator cuff tear is also known as an incomplete tear, because the tendon is not completely torn or detached from its insertion on the humeral head. New modalities such as stem cell therapy and collagen-based bioinductive implants are bridging the gap in our techniques to treat this incompletely understood pathology.

Anatomy

The rotator cuff is a musculotendinous structure that is comprised of four muscles: supraspinatus, infraspinatus, teres minor and subscapularis. The supraspinatus, infraspinatus, and teres minor insert on the greater tuberosity of the humerus; the subscapularis inserts on the lesser tuberosity. These musculotendinous structures serve as a fixed fulcrum for the arm and function to move and rotate the humerus. The rotator cuff sits under the coracoacromial arch; the components of the coracoacromial are the acromion, coracoacromial ligament, and the distal clavicle found at the acromioclavicular joint (AC) joint.

Differential Diagnosis

  • Rotator cuff tendonitis

  • Subacromial bursitis or impingement syndrome

  • Long head of biceps tenosynovitis or tear

  • Calcific tendonitis

  • AC joint arthritis

  • Suprascapular neuropathy

Management

The management of partial-thickness rotator cuff tears is quickly evolving due to new modalities that are emerging and bridging the gap in the surgeon’s armamentarium to deal with these tears. Historically, partial-thickness tears greater than 25-50% of the tendon diameter have been indicated for conversion (by the surgeon) to a full-thickness tear, followed by primary repair of the tendon similar to a repair of a full-thickness tear. Bursal-sided tears >25% and articular-sided tears >50% of the tendon diameter or depth have been considered indications for tear conversion to a complete tear and primary repair. The reason for this is because of the natural history of these tears; it is understood that most partial-thickness tears will progress to a full-thickness (complete) tear over a few years. However, newer innovations may prevent us from converting these partial thickness tears to complete tears, while preventing the natural history of progression of these tears.

Non-Operative Management Options:

  • Physical therapy

  • Stem cell injections (BMAC)

  • Platelet-rich plasma (PRP) injections

  • Corticosteroid injections

  • NSAIDs

  • Corticosteroid injections

Surgical Management Options:

  • Arthroscopic tear conversion and primary repair

  • Bio-inductive collagen patch (Link)

  • Subacromial decompression and debridement vs. repair

Studies:

Dr. Dold specializes in the management of all rotator cuff injuries and tear patterns. You may be a candidate for non-operative treatment. Book a consultation today by calling 469.850.0680 or schedule online here. Please bring all previous imaging (XRays, MRI, CT) and all arthroscopic pictures from previous surgeries.