Diagnosis and Management of Partial Thickness Rotator Cuff Tears

A Comprehensive Review

Kevin D. Plancher, MD, MPH; Jaya Shanmugam, MD; Karen Briggs, MPH; Stephanie C. Petterson, MPT, PhD


J Am Acad Orthop Surg. 2021;29(24):1031-1043. 

In This Article

Abstract and Introduction


Partial thickness rotator cuff tears (PRCTs) are a challenging disease entity. Optimal management of PRCTs continues to be controversial. Although advances in magnetic resonance imaging and ultrasonography have aided in early diagnosis, arthroscopic evaluation remains the benchmark for diagnosis. Conservative treatment is often the first line of management for most patients; however, evidence suggests that surgical intervention may limit tear progression and the long-term sequelae. Surgical decision making is driven by factors such as age, arm dominance, etiology, activity level, tear thickness, and tear location. Many surgical options have been described in the literature to treat PRCTs including arthroscopic débridement, transosseous, in situ repair techniques, and tear completion and repair. Biologic supplements have also become an attractive alternative to aid in healing; however, the long-term efficacy of these modalities is largely unknown. This article will provide a detailed review of the etiology and natural history of PRCTs, as well as diagnosis, and current management to guide clinical decision-making and formulate an algorithm for management of PRCTs for the orthopaedic surgeon.


Rotator cuff (RC) pathology is a leading cause of shoulder-related disability with a continuum of disease from tendinosis to partial-thickness (PRCT), full-thickness (FTT), and massive tears. Although strong evidence supports treatment of small to medium FTT, the literature is limited for PRCTs. Conservative treatment and arthroscopic repair of high-grade PRCTs[1] yield good functional results in carefully selected patients. However, tear progression and long-term consequences are still a concern.[2,3] This article will provide a comprehensive review of the etiology, natural history, diagnostic methods, and current trends in nonsurgical and surgical treatment of PRCTs.