The rotator cuff is a group of four muscles and tendons that stabilize the shoulder joint and allow you to lift and rotate your arm. Unlike a full-thickness tear, which goes all the way through the tendon, a partial thickness tear means the tendon is frayed or damaged but not completely severed.
Symptoms and Presentation
Patients with a partial thickness tear often describe a “nagging” pain rather than an acute, debilitating injury. Common presentations include:
- Pain with overhead activity: Reaching into a cupboard, playing tennis, or lifting weights.
- Night pain: Difficulty sleeping on the affected side.
- Weakness: A subtle loss of strength when lifting the arm out to the side.
- Catching or popping: A mechanical sensation during certain shoulder movements.
When to See a Doctor
While minor aches can sometimes be managed at home, you should consult an orthopaedic specialist if:
- Pain persists for more than 2–4 weeks despite rest.
- The pain prevents you from sleeping.
- You experience a sudden loss of strength after a specific trauma (like a fall).
- The pain limits your ability to perform your job or enjoy sports.
How We Diagnose the Injury
Diagnosis begins with a clinical examination to check for “impingement signs”—pain triggered when the arm is moved in specific ways that compress the tendon.
- X-rays: Used to look for bone spurs (acromial spurs) that might be “pinching” the tendon.
- MRI: The gold standard for visualizing the cuff. It allows us to see if the tear is on the bursal side (top), articular side (bottom), or within the tendon itself (interstitial).
Treatment Options: Conservative vs. Surgical
Most partial tears are initially treated conservatively:
- Activity Modification: Avoiding heavy overhead lifting.
- Physiotherapy: Strengthening the surrounding scapular stabilizers to take the pressure off the rotator cuff.
- Medications/Injections: Anti-inflammatories or corticosteroid injections can reduce swelling and provide a “window” of pain relief to allow for effective rehab.
When is surgery needed?
Surgery is generally considered if:
- Symptoms do not improve after 3–6 months of dedicated physiotherapy.
- The tear is “high-grade” (involving more than 50% of the tendon thickness).
- The patient is young, active, and requires high shoulder function.
Case Study
History
Our patient is a 48-year-old male, an avid gym-goer who remains very active in sports. He had a long-standing history of left shoulder pain with overhead movements, which had been successfully managed a few years prior with a steroid injection.
The New Injury
In January 2026, he suffered a fall while skiing. By February, his pain had intensified significantly. Clinical examination revealed positive impingement signs, and he found it increasingly difficult to maintain his gym routine.
Findings
An MRI was performed, which revealed two significant issues:
- Type 2 Acromial Spur: A curved bone growth that narrows the space for the rotator cuff.
- High-Grade Bursal Sided Supraspinatus Tear: A significant fraying on the top surface of the main lifting tendon.
Treatment Journey
Despite a course of medications and targeted physiotherapy, his symptoms persisted. Given his high activity level and the “high-grade” nature of the tear, he elected for surgery.
He underwent Arthroscopic Subacromial Decompression (removing the bone spur to create space) and a Supraspinatus Tendon Repair. By using minimally invasive “keyhole” surgery, we were able to reattach the frayed edges and smooth out the bone, allowing him a clear path back to the gym after a structured rehabilitation program.
Torn supraspinatus tendon seen on arthroscopy
The torn tendon is probed.
The tendon is high grade and involves more than 50% of the supraspinatus tendon insertion footprint.
The acromial spur is shown. This crushes against the supraspinatus tendon below when the shoulder is lifted overhead.
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The acromial bony spur is removed using an arthroscopic burr.
This is after the spur has been removed.
The torn supraspinatus tendon has been successfully repaired back to bone.
