If you’ve recently been diagnosed with a rotator cuff tear, you may be unsure of its severity and whether you’ll need surgery. The answer depends on whether the tear is partial or full-thickness. At Interventional Spine & Surgery Group, our team provides patients in central and northern New Jersey with fast, patient-centered care for orthopedic injuries and more. Here, we explore partial vs. full rotator cuff tears, their key differences, and when they may require surgery.
Key Takeaways
- The rotator cuff is made up of four main muscles that surround the shoulder joint. When one of the muscles gets frayed, damaged, or torn, it is called a rotator cuff tear.
- Rotator cuff tears can either be partial, where the tendon is still attached to the humerus, or full, where the tendon is completely detached from the bone.
- Partial and full rotator cuff tears vary by symptoms and treatment. Partial tears are typically milder and often resolve with conservative treatments, while full tears are more severe and may require surgery.
- Interventional Spine & Surgery Group provides non-surgical and surgical treatments for patients with rotator cuff tears in central and northern New Jersey.
The Four Rotator Cuff Muscles
The rotator cuff is a group of four muscles and tendons that surround the shoulder joint. They help keep the head of the upper arm bone (humerus) secured into the shoulder socket, stabilizing the joint and enabling movement. The four muscles, known as SITS, originate on the scapula and merge into a single tendon. They include:
- Supraspinatus: This muscle enables abduction, or lifting the arm out to the side.
- Infraspinatus: This muscle helps you rotate the arm outward (external rotation).
- Teres minor: This muscle helps with outward rotation and joint stabilization.
- Subscapularis: This is the largest and strongest muscle of the four, which rotates the arm inward (internal rotation).
These muscles work together to stabilize the shoulder, keeping the humeral head in the socket so it doesn’t shift or pop out during intense movements. When one or more of these muscles gets frayed, damaged, or split, it is known as a rotator cuff tear.
Partial vs. Full-Thickness Rotator Cuff Tears
A rotator cuff tear is when one of the rotator cuff tendons tears away from the humerus, typically due to an acute injury, repetitive strain, or degeneration. There are two main types of rotator cuff tears: partial and full thickness.
A partial tear is when the tendon is damaged or frayed but still connected to the humerus. They are classified by where they are located within the tendon and how deep they go (low-grade vs. high-grade). A partial tear often causes dull, aching shoulder pain, especially when lying on the affected side or with overhead movements. Most partial tears are treated with conservative, non-surgical treatments.
A full-thickness tear is when the tendon has completely detached from the humerus, disrupting the connection of the muscle. It is typically classified by the size of the tear, ranging from less than one centimeter (small) to more than five centimeters (massive). Full tears cause more severe symptoms, including intense pain, substantial functional limitations, and major weakness. These tears often require surgery to restore full mobility.
Partial vs. Full Rotator Cuff Comparison Table
| Partial Tear | Full-Thickness Tear | |
|---|---|---|
| Severity | Mild to moderate | Severe |
| Symptoms |
|
|
| Surgery Rate | Less than 20% | 35% to 45% |
Symptoms by Tear Type
Partial and full rotator cuff tears have different severities and, therefore, different symptoms. The symptoms of a partial-thickness tear are generally milder than full-thickness tears. For partial tears, patients often experience positional or activity-related pain, such as when lifting or reaching overhead, subtle weakness, and a maintained range of motion. Patients may also hear a clicking, catching, or crackling noise during certain movements.
For full-thickness tears, patients generally have severe pain, substantial arm weakness, and a severely limited range of motion. Pain may be especially worse when lying on the affected shoulder. Daily tasks, such as putting on a seatbelt or lifting items, can become extremely difficult or impossible.
How Are Rotator Cuff Tears Diagnosed?
To determine whether a rotator cuff tear is partial or full, doctors use various diagnostic tests and imaging scans. The process often includes:
- Physical exam and symptom evaluation: The doctor will review your medical history, examine your shoulder to look for swelling or bruising, and evaluate whether your symptoms are more consistent with a partial or full tear.
- Diagnostic tests: The doctor also often performs strength and range of motion tests. These can include the drop-arm test or resisted external rotation, which help determine which of the four tendons is damaged and gauge how the range of motion and strength are impacted.
- Imaging scans: Imaging scans are the main way to confirm whether a tear is partial or full. Magnetic resonance imaging (MRI) scans are the gold standard for visualizing soft tissues, which allows them to tell the severity of the tear. X-rays may also be used to rule out other causes of pain, like fractures or arthritis. Ultrasounds may also be used to view the tendon in real time while the shoulder is moved.
Through this information, doctors can differentiate between a partial and full-thickness rotator cuff tear and develop the best treatment plan.
How Do Treatments Differ for Partial and Full Rotator Cuff Tears?
The main difference in the treatments for partial and full rotator cuff tears is whether surgery is needed. Most partial tears are treated conservatively, while full tears often require surgery to reattach the tendon to the bone. Rotator cuff treatments include:
Conservative, Non-Surgical Options
For most partial tears and some full tears, non-surgical treatments will provide effective relief. Some common options include:
- Activity modification: Resting the shoulder joint and modifying activities that irritate the tear is often recommended to give the tendon time to heal. This may mean limiting overhead reaching and heavy lifting or temporarily stopping sports like swimming, tennis, and golf.
- Medications: Over-the-counter medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), can help reduce pain and swelling. They are often used to relieve pain so the patient can participate in physical therapy without too much discomfort.
- Physical therapy: Physical therapy is a key part of treating rotator cuff tears. Using targeted exercises led by a physical therapist, patients can build strength, improve stability, and restore flexibility and range of motion.
- Injections: Occasionally, corticosteroid injections may be used if other conservative methods don’t provide sufficient symptom relief. These involve injecting strong steroid medication into the shoulder joint to reduce pain and inflammation.
These treatments are often effective for treating partial rotator cuff tears. They may also be used for older, less active patients with full tears, as long as the shoulder is relatively painless and functional.
Surgery
When a rotator cuff is fully torn, surgery is the only way to reattach the tendon to the humerus. The surgery is known as a rotator cuff repair, and it is most commonly performed through a minimally invasive method called arthroscopic surgery. The process involves:
- Making two to three small incisions to insert a camera (arthroscope) and specialized instruments
- Injecting a saline solution into the shoulder to inflate it and provide a clearer view
- Removing any inflamed or damaged tissue
- Preparing the humerus for reattachment with debridement (removal of dead or damaged tissue)
- Drilling small holes into the humerus and attaching suture anchors with threads
- Using the threads to sew the tendon tightly against the bone
An arthroscopic method is the most common approach, but open surgery may also be used in certain cases.
Decision-Making: When Is Surgery Necessary for a Rotator Cuff Injury?
Not everyone with a rotator cuff tear needs surgery, even those with full-thickness tears. Patients who are surgical candidates include those who:
- Have a large or acute full-thickness tear from a sudden injury
- Are active, younger individuals who rely on their shoulder strength for work or sports
- Have significant weakness and functional limitations
- Have not gotten improvement from three to six months of conservative treatment
Surgery is typically not recommended when the tear is small or partial, the patient has little to no pain, or the patient’s shoulder strength and mobility are still functional. It is also avoided if non-surgical treatments provide significant symptom relief.
Find Treatment for Partial and Full Rotator Cuff Tears Near You in New Jersey
Whether your rotator cuff tear is partial or full, you can get fast, high-quality treatment at Interventional Spine & Surgery Group. Orthopedic procedures, including rotator cuff repairs, are performed by Dr. Deramo, a board-certified orthopedic surgeon. He utilizes the latest minimally invasive arthroscopic methods whenever possible to promote faster healing. At Interventional Spine & Surgery Group, we can see you now, we care, and we’ll help you get better. To learn more about partial vs. full rotator cuff tears or to schedule an appointment near you in central or northern New Jersey, contact us today.
Frequently Asked Questions About Rotator Cuff Tears
What is a rotator cuff tear?
A rotator cuff tear is an injury to one of the four muscles that make up the rotator cuff. It occurs when one of the muscles gets frayed, damaged, or completely torn.
What is the difference between a partial and full rotator cuff tear?
A partial rotator cuff tear is when the tendon is damaged or frayed but still connected to the humerus, and a full-thickness tear is when the tendon is completely detached from the humerus.
Do partial rotator cuff tears need surgery?
Not typically. Most partial tears can be treated non-surgically with conservative treatments like physical therapy, activity modification, medications, and injections. In severe cases, surgery may be used.
How do I know if my rotator cuff is fully torn?
To know if your rotator cuff is fully torn, you will need to get imaging scans. A magnetic resonance imaging (MRI) scan is most often used to determine whether the tendon is completely or partially torn.
What happens if a rotator cuff tear is left untreated?
If a rotator cuff tear is left untreated, it can worsen and result in permanent damage. People may experience chronic pain, severe muscle atrophy, frozen shoulder, and lasting weakness.
How long does rotator cuff surgery recovery take?
Recovery from rotator cuff surgery generally takes four to six months, although it can take six to 12 months for full strength and flexibility to return.
Can a rotator cuff tear heal without surgery?
Yes, a rotator cuff tear can heal without surgery. Surgery is typically reserved for patients who have acute, full tears or those who need full shoulder strength for their jobs or sports. It may also be recommended when physical therapy fails to relieve pain after six to 12 months.
What MRI findings indicate a full-thickness tear?
The main sign of a full-thickness tear on MRI imaging is a fluid-filled gap that extends completely through the tendon (from the joint to the bursa).