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

Disclosures

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

In This Article

Arthroscopic Diagnosis

Arthroscopy remains the best method for diagnosing and surgically treating PRCTs (Figures 6 and 7). Field and Lindeman[29] suggest a 30 to 30 position (ie, 30° forward flexion, 30° abduction, and gentle downward traction) in a beach chair position to increase the space below the superior capsule and enhance visualization of the supraspinatus and infraspinatus footprint. Intratendinous tears are often missed on arthroscopic investigation because the outer surface of the tendon is not visualized. Bellows sign, a ballooning of capsular tissue attached to the RC, is indicative of an intrasubstance tear (Figure 8, A and B).[29] A dimple sign is a small clue that near the rotator cable and articular surface there may be an interstitial tear (Figure 9).[29] Palpation is our preferred way of detecting the fall off or hollow feeling between the bursal and articular surfaces. Finally, the most common way to detect this type of PRCT is to push the arthroscopic probe into the defect and watch it fall right in.

Figure 6.

Arthroscopic image showing an articular-sided partial thickness rotator cuff tear in a 47-year-old woman. Copyright K. Plancher, MD, MPH. H = humeral head, SS = supraspinatus

Figure 7.

Arthroscopic image showing an bursal-sided partial thickness rotator cuff tear in a 55-year-old man. Copyright K. Plancher, MD, MPH. D = deltoid, SS = supraspinatus

Figure 8.

Image showing a Bellows sign in a left shoulder. A, A Spinal needle is inserted into the RC at the site of a suspected interstitial RC tear. B, As normal saline is injected, the interstitial defect fills and creates a visible bubble (dashed black lines), confirming an interstitial tear of the RC. RC, rotator cuff. (Reproduced from Burkhart SS, Lo IK, Brady PC, Denard PJ. The Cowboy's Companion: A Trail Guide for the Arthroscopic Shoulder Surgeon. (Wolters Kluwer/Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2012): Figure 5.43.

Figure 9.

Image showing a dimple sign in a left shoulder. A medial bulge (black arrow) of the rotator cuff is seen from the posterior glenohumeral viewing portal indicative of an interstitial rotator cuff tear. (Reproduced from Burkhart SS, Lo IK, Brady PC, Denard PJ. The Cowboy's Companion: A Trail Guide for the Arthroscopic Shoulder Surgeon. (Wolters Kluwer/Lippincott Williams & Wilkins: Philadelphia, PA, USA, 2012): Figure 5.41.

Débridement and a subacromial decompression can improve visualization and diagnostic accuracy of bursal-sided tears.[29] Identifying the location of the bursal side of an articular-sided tear can be aided with the placement of a spinal needle inserted from outside (bursal side) through the tear (articular side). A suture may be passed through the needle and retrieved through the anterior portal. The suture is left in place as a marker to aid in definitive treatment of an articular-sided tear.

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