ROTATOR CUFF TEARS
Partial Thickness
Rotator Cuff Tears
A partial thickness rotator cuff tear means that part of the tendon is damaged, but the tendon is not completely torn through. Some partial tears improve without surgery, while others remain painful and may eventually require repair.
Tendon Not Fully Detached
Pain Can Vary Widely
Often Starts Without Surgery
When Symptoms Persist
What Is A Partial Thickness Rotator Cuff Tear?
A partial thickness tear is an incomplete tear of the rotator cuff tendon. I often explain this like a rope whose fibers have started to fail. The tendon is not completely detached, but a portion of the tendon has become damaged.
Partial tears may occur on the joint side of the tendon, the bursal side of the tendon, or within the tendon itself. The location, depth, tissue quality, symptoms, age, and activity level all matter when deciding how to treat it.
Dr. Streit's Clinical Perspective
I treat patients, not MRI reports. A partial tear on MRI does not automatically mean surgery is needed. Some small partial tears can be very painful, especially in younger active patients. Some older patients may have partial tearing that causes little or no symptoms. The full clinical picture matters.
Common Symptoms
Night Pain
Pain that interferes with sleep or makes it difficult to lie on the shoulder.
Pain With Lifting
Pain reaching overhead, away from the body, or lifting objects.
Weakness
Some patients feel weak because of pain, while others have true tendon-related weakness.
Exercise Pain
Pain with weight training, throwing, swimming, tennis, or overhead sports.
Clicking Or Catching
Some patients notice mechanical symptoms, especially when biceps or labral pathology is also present.
Persistent Soreness
Symptoms may persist despite rest, medication, therapy, or activity modification.
Do Partial Tears Heal Without Surgery?
It depends on the entire clinical scenario. Some partial tears remain stable and become less painful with therapy, activity modification, and time. Others remain symptomatic or gradually enlarge.
Age, tear location, activity level, tendon quality, symptoms, and physical examination findings all influence whether nonsurgical treatment is likely to succeed.
Often Treated Without Surgery
- Mild symptoms
- Good strength
- Improving pain
- Lower activity demands
- Older patients with degenerative partial tearing
- No major functional limitation
More Concerning Features
- Persistent night pain
- Failure of appropriate physical therapy
- Symptoms limiting work or sports
- Young active patient with focal symptoms
- Progressive weakness
- Clinical findings that match the MRI tear
What Does “Failed Conservative Treatment” Mean?
Failed conservative treatment does not mean simply waiting a few days. It usually means that an appropriate nonsurgical plan has not produced meaningful improvement.
Persistent Pain
Pain continues despite therapy, rest, activity changes, medication, or injection when appropriate.
Night Pain
Ongoing sleep disruption is often a sign that the shoulder problem remains active.
Loss Of Activity
The patient cannot return to desired work, exercise, sports, or daily function.
When Is Surgery Considered?
There is no single percentage of tendon involvement that automatically determines treatment. A commonly discussed threshold is whether the tear involves more or less than 50% of the tendon thickness, but I do not make the decision based on that number alone.
The decision depends on the patient’s symptoms, age, activity level, physical examination, tissue quality, imaging findings, and goals.
Why Age Matters
Younger active patients may become very symptomatic even from a smaller partial tear. Older patients may tolerate partial tearing better, and completing a partial tear in an older patient may create more healing risk. The treatment should match the patient, not just the MRI description.
How I Usually Repair Symptomatic Partial Tears
When a symptomatic partial thickness tear requires surgery, I generally prefer completing the tear and repairing it rather than performing a transtendinous or PASTA-style repair.
My reasoning is that completing the tear allows the tendon to be restored more anatomically, helps recreate the normal length-tension relationship of the tendon, and stimulates a healing response at the tendon-bone interface.
Repair Goals
- Remove damaged tendon tissue
- Restore tendon attachment to bone
- Improve tendon length-tension relationship
- Create a biologic healing surface
- Restore shoulder strength and function
Why Technique Matters
Partial tear surgery is not simply “stitching something down.” The repair must restore the tendon in a way that maximizes healing potential and long-term shoulder mechanics.
Recovery After Surgery
Recovery after surgery for a partial thickness tear generally follows rotator cuff repair principles because the tendon must heal back to bone. The timeline depends on tear size, tissue quality, repair strength, and individual healing biology.
Recovery Timeline
Understand the phases of healing after rotator cuff repair.
PT Protocol
Procedure-specific therapy guidance after rotator cuff repair.
Sleeping After Repair
Practical guidance for sleep during early recovery.
Related Resources
Concerned About A Partial Rotator Cuff Tear?
A focused shoulder evaluation can determine whether your partial tear is likely to improve without surgery or whether repair may offer the best chance of restoring long-term shoulder function.
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