Partial rotator cuff tear

Anatomy and function of the rotator cuff

The rotator cuff consists of four muscles and their tendons: supraspinatus, infraspinatus, teres minor and subscapularis. Together they grip the head of the humerus like a cuff and center it in the flat joint socket. They enable precise, pain-free lifting, turning and guiding of the arm - especially during overhead movements.

• Supraspinatus: Beginning of arm elevation, stabilization in the painful arch
• Infraspinatus and Teres minor: external rotation, posterior capsular pull
• Subscapularis: internal rotation and anterior stability
• Subacromial bursa: sliding layer between tendons and acromion
• Long biceps tendon (LBS): neighboring structure, often affected

Tendon fibers are most vulnerable at the bone attachment. Age-related changes, repeated overhead strain or cramped conditions under the acromion (impingement) can reduce tissue strength.

What is a partial rupture? Demarcation and levels of severity

A partial rotator cuff tear occurs when part of the tendon fibers are torn without the tendon being completely severed. This distinguishes a partial tear from a complete tear, in which the tendon and function are often significantly impaired.

• Location: joint side (articular), bursa side (towards the bursa side) or intratendinous (inside the tendon).
• Extent: low grade (<25% tendon thickness), moderate (25–50%), high grade (>50%).
• Tendon involved: often supraspinatus, rarely infraspinatus, subscapularis or teres minor.

Not every partial tear causes severe symptoms. The decisive factors are symptoms, loss of function, everyday limitations and the individual activity level.

Causes and risk factors

Partial ruptures usually occur due to wear and tear and recurring overload. A recent trauma (e.g. falling onto an outstretched arm) can trigger a partial tear, especially in younger or physically active people.

• Repetitive overhead strain (painting, tennis, volleyball, CrossFit)
• Subacromial impingement due to tightness, spurs or bursitis
• Age and degenerative tendon changes
• Smoking, diabetes, lipid metabolism disorders: impaired tissue healing
• Previous shoulder problems (e.g. tendinopathies)
• Acute trauma or sudden overload
• Multiple cortisone injections in the past (tissue risk)

Typical symptoms

• Lateral shoulder pain, radiating to the upper arm
• Pain when raising the arm above 60-120 degrees (painful arc)
• Night pain, especially when lying on the affected side
• reduction in strength, v. a. with external or internal rotation depending on the affected tendon
• Stress-dependent grinding or snapping
• Occasional discomfort at rest with an accompanying inflammatory reaction

Evidence of the affected tendon: Pain and weakness when abducting to the side are more likely to suggest supraspinatus; External rotation weakness for infraspinatus/teres minor; Pain and weakness with internal rotation (e.g., buttoning jacket, reaching behind back) for subscapularis.

When should you seek medical advice quickly?

• Acute pain and significant loss of strength after trauma
• Sensation of sudden rupture followed by weakness
• Fever, significant redness/overheating (suspected infection)
• Numbness or persistent symptoms of paralysis
• Persistent pain at rest despite rest and basic therapy

Diagnostics: anamnesis, examination, imaging

We start with a targeted anamnesis: pain character, triggers, stress profile, nighttime complaints, previous illnesses. This is followed by a structured functional test of the shoulder.

• Clinical tests: e.g. B. Jobe/Empty-Can (supraspinatus), external rotation lag (infraspinatus), lift-off/belly press (subscapularis), Hawkins/Neer (impingement sign).
• Assessment of posture, shoulder blade guidance (scapula control) and muscle chains.
• Palpation of tendon attachments and bursa.

Imaging is used individually: it supports the diagnosis but does not replace clinical assessment. Not every partial tear requires an MRI immediately.

• Ultrasound: dynamic, radiation-free, good for partial superficial tears and bursitis.
• MRI: high soft tissue contrast, assessment of tear location/extent, accompanying pathologies; if necessary with contrast (MRA) in special questions.
• X-ray: Assessment of bones, calcium deposits and space under the acromion (e.g. spurs).

Conservative therapy: the first and most important step

The goal is to reduce pain, calm inflammation, restore shoulder function and prevent progression. A structured program over several weeks is crucial. We transparently explain the benefits and limitations of the measures.

Timeline: First improvements often after 4-6 weeks, stable results after 8-12 weeks. Patience and continuity pay off. We monitor progress and adapt the program.

Injections and regenerative procedures – conservative and targeted

Injections can reduce pain and enable active training. Regenerative approaches are discussed individually. We provide information about evidence, benefits and possible risks.

• Subacromial cortisone injection: may reduce pain in the short term; Use rarely and specifically to minimize tissue risks.
• PRP (platelet-rich plasma): partly promising but heterogeneous evidence for partial ruptures; can be considered if a conservative program is not effective enough.
• Hyaluronic acid subacromial: inconsistent data; Decision on a case-by-case basis.
• Shockwave: not standard for crack healing; may be indicated for calcifying tendinopathy.

Important: Injections do not replace training. They can enable a training phase, but cannot alone restore function.

When does an operation make sense?

Surgery is considered if, despite consistent conservative therapy for several weeks to a few months, relevant complaints and functional deficits persist or if there are severe partial ruptures (>50% tendon thickness) or acute traumatic tears - especially in cases of high overhead demands in sports/occupation.

• Arthroscopic partial suture (transtendinous) or completion with subsequent reconstruction - depending on the location and extent of the tear.
• Debridement (smoothing) for small, stable partial tears in combination with functional rehabilitation.
• Accompanying measures if necessary: ​​treatment of the long biceps tendon (tenotomy/tenodesis), reduction of tightness under the acromion, treatment of the bursa - always according to the indication.

What is crucial is the individual assessment of findings, complaints, level of demands and healing process. In our practice, the focus is on conservative options. If an operation appears to make sense, we provide independent advice and, if desired, coordinate a referral to an experienced shoulder surgeon.

Follow-up treatment and rehabilitation

Whether conservative or surgical: a structured rehabilitation plan is the key to success. The phases build on each other and are adapted to pain, swelling, mobility and strength development.

After the operation, specific protection times apply (sling/abduction cushion depending on the suture technique), initially passive, later active guidance. Full return to overhead exercise can take 4-6 months (or longer). The surgeon determines the exact protocol; we manage conservative aftercare.

Prognosis and course

Many patients with partial ruptures achieve significant relief of symptoms and usability for everyday use with conservative therapy. Anatomical “growth” is not absolutely necessary if the function compensates. Symptom-based stabilization is crucial.

• Risk of progression: increases with age, crack size, sustained overhead strain and smoking habits.
• Regular follow-up checks help to detect deterioration early.
• Consistent exercise programs and load management protect the tendon.

Prevention: Keep your shoulders strong and flexible

• Balanced training of the rotator cuff and scapula stabilizers
• Warm-up and technique training before overhead exercise
• Breaks and micro-deloads during repetitive tasks
• Ergonomics in the workplace (mouse/keyboard setup, monitor orientation)
• Stop nicotine, optimize metabolic health (diabetes, lipids).

Gentle self-help exercises (if the diagnosis is confirmed)

Please only carry out exercises in the pain-free area and ideally discuss them once with the physiotherapist. Pain is a stop signal.

Differential diagnoses that we think about

• Inflammation of the bursa (subacromial bursitis)
• Impingement syndrome without a tear
• Calcified shoulder (tendinosis calcarea)
• Biceps tendon problems (LBS tendinitis or dislocation)
• AC joint irritation
• Cervical nerve root irritation with shoulder pain