Rotator cuff tears: Partial, Complete, Retracted..Huh? 

I was diagnosed with full thickness tears on supraspinatus and subscapularis back in 2010. I didn't want to have surgery, so I treated it conservatively for 13 years. Last year my symptoms returned after some gardening work. I had a new MRI and it revealed the tears were now classified as massive. I had successful surgical repair straight away as I was concerned that doing nothing would lead to my condition becoming irreparable. I'm now one year post opp. Doing ok. My lesson is to first educate yourself on how to prevent rotator cuff tears, then put that information into practice. The whole experience has been a 14 year long nightmare. In the end, I felt like surgery was really my only option left on the table. Prevention is better than cure. Tread your own path. Thanks for another great video doc. All the way from Tasmania, Australia. 🇦🇺

My shoulder pain started 10 months ago, just suddenly and progressively got worse. Went thru physical therapy for 2 months. Had an MRI at 6 months and I had 2 large full tears. I had surgery after 10 months, and it was very involved due to muscle deterioration. I'm 3 weeks out and still in a lot of pain, but I guess we'll see.

I played volleyball for 30 years and last year I suffered from a full shoulder dislocation. Months later. an MRI showed that I had full tears of my rotator cuff, infra, subscap, and teres minor. The surgeon said when he went in, they were all torn with retraction. I'm 5 months into rehab. I'm turning 46 in September. I hope to play ball again in 2-3 more months. Great video. Good info.

great job in explaining rotator cuff injury stages...well spoken...

Very good clear explanation. Thank you very much.

A Thalamic stroke in '21, following a ACDF Surgery. It tore all four of my shoulder tendons plus rib, hip, knee and ankle and foot

Thanks for sharing, very helpful to hear your experience and knowledge. A+ : ) BSc PT.

Awesome video!! Thanks for sharing!

I’ve had dominant shoulder pain for 4 years, only ever had X-rays. Joint injections multiple times and some rehab. It just never got better and has become a constant toothache pain. I have lost range of motion and it’s painful to work over my head, pick up anything more than 20 pounds etc. Went to ortho and one mri later was told I had a partial tear and bicep tendonitis. It makes doing many things painful, it’s a very frustrating injury so I have opted to have it repaired.

Very informative! Thank you so much!

Thank you for the explanation.

Very good video. Per Dr. I have "complete tear" of supraspinatus & complete infraspinatus and dislocated bicep tendon. It has been almost a month and I am in sharp, stabbing pain with most movement (oddly, not all). I bought a book on how to heal without surgery (hang from a bar) but I'm starting to think maybe I'm going to need surgery. Is waiting this long harming my recovery?

Hi, Dr. Orcutt, I've got a complete right supraspinatus tendon tear at the foot plate with 4.6 cm retraction (visualized by MRI) and am very conflicted about surgery versus no surgery due to risks of repair failures and risks that surgery represents in my situation. The complete tear occurred 5 weeks ago (after a symptomatic partial tear 10 weeks before that, for which I received a cortisone shot in my bursa guided by ultrasound). 1.5 years prior to this, I was hit by Parsonage Turners, which transformed into an ongoing autoimmune attack on my brachial plexus - which led to atrophy of my deltoids, biceps, and supraspinatus - likely contributing to the tears. A 3-month daily dose of prednisone, which I'm slowly tapering off for an additional 3.5 months, suppressed the autoimmune activity and my nerves are remapping and muscles regrowing. While I was on prednisone, I was strength training to optimize the regrowth process when the first, partial tear was felt. 1. In addition to the retraction, the supraspinatus tear is close to the muscle interface, leaving very little tendon attached. 2. My supraspinatus muscle already is significantly atrophied from the Parsonage Turners, creating a visible space between the muscle and the fosa. The atrophy that has been ongoing for 21 monthsj. 3. If I pursue surgery, there is a risk that a cytokine storm or infection during surgery could restart the autoimmune attacks on my nerves. 4 If I pursue surgery, I will need general anesthesia because a nerve block presents a risk to my brachial plexus due to the Parsonage Turners / recently suppressed autoimmune attacks. I have surgery scheduled, but am very concerned that the repair will fail due to the first two issues above. Surgery also presents other risks due to the last two issues above. I have good range of motion: Forward Flexion: 180 degrees (L); 180 degrees (R) Extension: 45 degrees (L); 45 degrees (R) External Rotation: 90 degrees (L); 80 degrees (R) Internal Rotation: T4 (R) I experience no pain at night and little pain while going about life, although I do sometimes get pangs moving my arm anteriorly and am in some mild discomfort a lot of the time. Between now and my surgery date 8 weeks from now, I am continuing a systematic physiotherapy / strength training program using bands and light dumbbells to maintain my range of motion and increase my infraspinatus and deltoid strength, particularly my anterior deltoid. If I continue to be ~pain free and with good range of motion leading up to my surgery, I may cancel this and then sustain the physiotherapy and strength training program perpetually to stave off increased pain or loss of motion for as long as possible. When this fails to keep me pain free, I would fall back to superior capsular reconstruction to address this, while acknowledging that I will not have the same strength - and that I will no longer have a supraspinatus. What are your views of the no-surgery-now approach versus having surgery now before my supraspinatus is no longer salvageable? Thanks.

Hi, I've been having neck, shoulder and back pain for the past year and a half mostly on the right side of my body. sometimes I have pain shooting through my hand, and when I lie on my side, the pain becomes unbearable. The muscles surrounding my right shoulder blade hurt pretty bad. Also, I feel like all of my other body parts are getting a lot more sore quicker like my hip, and my left foot, is this common for back injuries? Any ideas on what it might be? Im scheduling an appointment with a an orthopedic doctor very soon but I just wanted some info to prepare for what I might be in for. Thank you so much for the video

I just got my results back from an MRI and I have complet tears of the suprespinatus and the infraspinatus with retraction of both at 3.0 cm. I also have several tears in the bicep groove and the tendon has small tears as well. I had an accident on an ATV and also tore my hamstring on my right leg. Not a good time but I see my surgeon tomorrow to plan out the surgery

I have full thicknesses irreparable tears in ny supraspinatus and infraspinatus. I had an operation back in 2018 to insert a patch graft to help stabilise the joint, but this operation left me with very limited shoulder movement, i have zero external rotation. My shoulder function was a lot better before the operation.

Hey Doc, can you also talk about fatty infiltration along with full thickness tears that are retracted?

Hi, I just need your opinion on the results on my right shoulder mri results. rotator cuff tendinopathy including a low grade partial thickness interstitial tear of infraspinatus at its myotendinous junction extending 2cm medially. Would I possibly need to have surgery to prevent the tear from getting bigger or to keep it to where it can’t be repaired later on? also would a sling be advisable. This is freshly new happened on Sept 5 from being tboned. I would love your opinion on this and look forward to hearing back from you

I have a

Very interesting..I detached my supraspinatus completely with a 2.5cm retraction when I was bench pressing,taken to ER by Ambulance as the paramedics thought it may be broken,I was seen by a consultant who did no tests for a rotator cuff tear,and even tho I could hardly lift my arm sideways and was in extreme pain,I had 20mg morphine By the paramedics. I was told,swollen tendon,catching on the bursa given paracetamol and sent home,they did a x-ray which revealed proximal migration of the humerus..but still discharged me. After going to ER again 3 days later,no sleep and trying to work as a engineer..I was again told,you have seen the x-ray and its fine!!!! After 5 visits and 2 requests for a MRI,2months later I got the diagnosis...total detachment of the supraspinatus with 2.5 retraction. I was put on a list for surgery,after 9 months,working everyday,getting hooked on oral morphine and valium to help me sleep..I had the first operation to reattach the tendon..lol. This was obviously unsuccessful and a subacromial balloon was inserted,3 days in hospital as I caught aspiration pneumonia under the anesthetic. This ballon burst and I had another op to replace it..this moved jammed my arm,when I tried to move it my bicep tendon ruptured..then my shoulder dislocated in the night. 3rd op to remove balloon and referred to a specialist surgeon. He told me my infraspinatus was also badly torn and gave me a subscapular nerve block to stop the pain. I saw the surgeon again yesterday where he referred me to another specialist to see if I'm a candidate for a partial capsular reconstruction if my infraspinatus is repairable. Humeral head is constantly grinding on my acromion causing severe pain even with a nerve block. I have a full tear in my right supraspinatus,this has been left for two years and is now causing severe neck pain. Been off work for 6 months,company sick pay stopped,now claiming government benefits. Outstanding service from the UK NHS. Hope nobody else goes through this🤯😫😫

I have a low to intermediate grade partial tear of the articular surface of my supraspinatus, I also have an inferior labral tear same shoulder… am an overhead athlete and am unsure how to proceed. Have completed one month of PT and have seen a little bit of progress but still not great, also have done an injection a month ago that has also somewhat eased the pain.

Hi, I just had an AC joint decompression and a 1cm supraspinatus tear repair with swivelocks and fibrewire. The surgeon wrote 5cm deltoid split on the the post op notes. Do you know what that means? And do you think the prognosis for a 1cm tear is good? Not sure if he meant a partial or through tear though. Thank you in advance. M

I have a full retracted tear,and my surgeon said at some stage I will need a new ball and socket at some stage, He operated and tidied it up so I could use it without pain,how long would you say that it is before I need a new shoulder joint. It’s pain free and I can use my arm reasonably normally,it’s been 3 years now since that op. I use my arm as I’m a builder and hope I can carry on using before I need the op,what sort timescale would you say it would last.

Hi Doc, Thank you for all your videos, I love what you do After a fall during surfing 8 months ago, my shoulder started burning and clicking hard in some position, after injections and a lot of PT, I felt better but I still feel constant weakness in my left arm and strong pain after some exercices Scan with injection showed I have a small tear of the distal part of the supraspinatus tendon with irregularities on the deep surface of the tendon, can it explain my symptoms since the pain and the weakness is so strong and the tear seems small ? The tear wasn’t on a previous exam I had 3 years ago for another pain that was way less important. I’m seeing an orthopedic surgeon in 6 weeks Thank You!

Hi. I'm a fairly active 38 year old with an autoimmune disorder. After an injury a recent MRI shows a diffuse high-grade partial tear of the supraspinatus with a superimposed 4-5 mm full-thickness tear mid fibers at the insertion retracted 3mm. There are also moderate grade tears in the infraspinatus. Exercising on my own has allowed me to get most of my ROM back. Abduction is still a problem. Do you think this would progress to cause a loss of the ROM I have recovered? What are my options? I'm trying to avoid surgery as much as possible because I use my shoulder frequently at work and also would like to avoid autoimmune flare ups and extended downtime. Thanks!

i had my fall in oct 2020 after four hours of operation i was in pain when i woke up now its june 2021 my arm and shoulder is still very sore in physio once a week does not seem to help surgeon said my bone looked old ostiporosis will it ever heel

Hi. Can you define what "tendonosis involving supraspinatus and infraspinatus tendons."??? Ortho didnt seem to look at mri. Because he said its "frozen shoulder. Nothing torn".

I had 4 total tears in Rotator Cuff per MRI in December. Retracted biceps attempted reattach, but ripped out during 1st surgery. February, Second biceps surgery was successful x4 days, then it ripped out...now waiting for surgeon to decide what he plans to do. The waiting is horrible!

I fell. Xrays showed that I separated my shoulder. MRI showed that I have a severe rotator cuff tear. It also showed that I have and old injury that I was not aware of. That is, (this is how it was explained to me) that 3 of the 5 muscles have torn completely away from the other 2 muscles and they have "dried up." How serious is this and do you think I will need surgery soon?

enjoyed your video but its been a month since my last surgery and im still in a lot of pain it does not seem to want to heal. surgeon says no physio and an xray in about a week. signs of ostioporosis

I am 56 years old. I injured my left shoulder bench pressing about 15 weeks ago. I felt a pull on the side of my arm followed by pain. I completed my workout with pain but I knew that was it for a while. The pain has remained constant. I have good rotation but pain with some movements. Mostly external rotation. Sleeping can be troublesome at times. I can do all shoulder movements and activities with pain. Bringing the bed covers over from left to right when in bed is my goto check for pain improvement. The pain has not improved one bit for this movement. Dr. recommended rest followed by physical therapy. Rest and PT did not improve my level of pain. I do my prescribed PT exercises regularly and ice daily with no noticeable improvement. They tell you in PT to only do the movement if you feel no pain. If I followed that advice I would do no external rotation movements. I try not to take meds because I want to feel for improvement but I do on bad days. I was finally referred to the orthopedist who believes I have a partial tear because I have some strength. An MRI is scheduled later this week. I want to get back to weight lifting as I see my gains diminishing. Anyhoot, I hope this helps inform fellow sufferers. I will post the MRI outcome when I get the results.

Sir I have SLAP3 tear 11 to 1 clock....can I get my actual strength after the surgery?

I hurted my shoulder in the weight room and I didn't know I did until I went to a chiropractor he sent me to get an mri and it said partial thicknss tear and he stick me 3 times with a cortisone shot and it made my shoulder feel much better but I still need to strengthen the muscles around my should so can I go back into the weight room and start LIFTING weights again but slowly until it's strong again

Re your comments on the retracted tear, iMO it's impossible to get a valid sample on the matter. You guys naturally see everyone with pain and other issues; such is your sample. But I believe there're many out there (like myself) who constantly exercise the area, have virtually no daily issues, and never see a surgeon at all (I opted for an MRi only because, as an MRI tech, I get them free). Not to say I won't have issues down the line, but something to consider...

Thank you for the info! I came across this video. I fell directly on my right shoulder 10 days ago. It’s been very painful and I’m unable to lift my arm or lift anything. I have little to no strength in my arm. I can’t rotate it at all. It’s quite painful. I went to the ER and the doctor said I probably tore my rotator cuff. I have an appointment with an orthopedic doctor next week. X-rays only showed moderate arthritis. It’s so weird not having much strength in my arm.

What does complete disruption of the Supra and Infra tendons mean?

Delaminated supraspinatus tendon?

I discovered I have a full tear with retraction (2 cm). One doctor says he'd use a skin allograft and not try to reattach tendon, a different doctor says he thinks he can repair the retracted tendon as it is a moderate 2 cm distance. I asked him if we could do both the repair and the graft. I am an active senior. Also have you heard of bone vents to leak bone marrow stem cells to assist healing?

I’ve a retracted tear , it’s 6 weeks , still waiting for surgery , what’s the upper limit for waiting , I’m an active 61 year old , I can still go to the gym and work around the injury , dead lifting with out pain up to 130 kg x 5 just to try to get a ripple effect of growth to prevent atrophy . Is this correct ?

Does a No retracted full thickness tear mean there is no tear?

How long can I wait to have surgery on a small full thickness tear? I started having pain in November 2020 and got diagnosed feb 2021.

What is a near complete supraspinatus tear?

Can I send u MRI to look at ?

Sorry for the long comment but I had an mri in December and can’t see a consultant till June, could you explain the following to me please. Indications: Query rotator cuff tear. Procedure: Standard MRI shoulder. Findings: Rotator cuff: Mild heterogeneity of the anterior supraspinatus in keeping with mild tendinosis. Mild anterior infraspinatus tendinosis. Mild superior subscapularis tendinosis. The rest of the rotator cuff tendons are normal. Biceps tendon: Small amount of fluid in the biceps tendon sheath suggesting mild tenosynovitis. Labrum: A type 2 SLAP tear is seen in the base of the superior labrum. This extends into a suspected tear in the base of the posterior labrum. Capsule: Normal. Bone and cartilage: Normal. AC ioint: Type 1 acromion. Moderate degenerative changes seen in the acromioclavicular joint with oedema on both sides of the joint. Capsular thickening and oedema is noted. This could be related to previous trauma. Fluid: Normal. Impressions: Near full-thickness type 2 SLAP tear of the superior labrum with likely extension into a full-thickness tear in the base of the posterior labrum. This could be further assessed with MR arthrography, if clinically indicated. Moderate AC joint degenerative change with oedema on both sides of the joint with capsular thickening and oedema. This could be related to previous trauma.

Mine is snapped in half...

Thank you, but You didn't show any Image to buttress ur explanation

Don't say that can't happen because it can. Internal decapitation can happen. You need account for EDS and other connective tissue disorders .🦓 * I've 3 torn ligaments in my right shoulder. Two of them are full thickness tears. One is damn close. My bicep is intact. I've Lupus, EDS and degenerative disc disease. 🎉 Having a party!!! Surgery next month 🎉🎉🎉

I'm 63 and very active. I slipped on water and landed on my elbow. Had an MRI and waiting on a doctor to read MRI. I got a copy and here is what I did. Partial tear involving the supraspinatus tendon at the musculotendinous junction. Complete thickness tear of the supraspinatus tendon at the insertion with an 8.2mm tendinous gap. Complete thickness tear of the infraspinatus tendon at the insertion with no appreciable retraction. Complete thickness tear of the subscapularis tendon. Mixed intrasubstance signal and thickening of the supraspinatus, infraspinatus, and subcapularis tendons. Tear involving the trees minor tendon also noted A SLAP type tear of the superior glenoid lebrum. Ac joint impingement. There is more. But I am wondering if I need surgery.

Does 30 - 40% supraspinatus tear require surgery? Can it regenerate itself if left without a surgery? Are there any patients of a young age who had it grow back on its own? Or it never grows back because it’s impossible from the anatomy and biology standpoint and with special exercises we only make what is still attached to the bone stronger and the torn part remains torn forever?

Thanks for explaining that a full thickness tear does not mean it's detached because the width of the tear also matters. That part is often left out in explanations.

Ok, but why don't you talk about the CAUSE of the tear and not just the current type of tear?? I had a partial exterior supraspinatus tear diagnosed with mri that was caused by a significant hooked bone spur on the acromion. I by-the book did pt for six months and all it did was progress to a full thickness nearly full width massive tear! WHY not better diagnose these causes and avoid a patient suffer through a lot of unnecesary pain, and end up with surgery on a massive tear that was GOING to happen because the underlying cause?

🤡😆😂🤣

Good video but injections are never an option in my book.