This website is under development - The information contained on this site is for guidance only and is not intended for self diagnosis or self treatment. This will not replace professional medical advice or consultation. Always seek the professional advice of a qualified health care provider like your doctor or specialist before embarking on any treatment. If you have a problem please consult your doctor or specialist.
What is it?
A partial tear is when the damage to the tendon has started but not yet completed. If left unchecked, this is likely to complete into a full thickness tear.
Various investigations can pick up partial tear but none of them can reliably give information about the full extent of the damage. There are subtle signs on the ultrasound scan which can suggest partial tear and sometimes it is possible to state the degree of the ‘partial damage to the tendon. In my opinion, MRI scan has a tendency to over diagnose the level of the tear. Even at the time of surgery, it is quite difficult to make an exact measure of the extent of the tendon damage. This is true if the damage is within the substance of the tendon and the true extent of the damage is neither seen in the joint or bursal side. Therefore, it becomes quite difficult to plan the correct treatment.
Decision making for repair of Partial tear
The aim of the operation is to assess the extent of the tear and then decide if it is worthwhile to reattach the tendon back to the area in the humeral head either by completing the tear and converting it into a full thickness tear or to re-attach it in-situ. Sometimes, a decision is made not to repair the tendon. The literature is divided in its opinion when and how to treat these difficult problems.
In my opinion, if the damage is judged to be less than 50% and the main pathology of impingement is addressed, then on balance the tendon heals. If it is more than 50% and one has lot of weakness before operation, then it makes sense to repair the damage. Sometimes, it becomes difficult to make the judgement regarding the extent of damage. Sometimes, even after a successful decompression, the internal damage continues and the partial tear then presents later as a full
thickness tear. This is very much like the presence of latent heat in the milk which results in boiling and spilling over even when the heat is switched off. .
Operation - Arthroscopic evaluation and repair
The Steps that are undertaken are same as that for an arthroscopic cuff repair. The quality of the tendon and the status of the long head of biceps are checked from inside the joint. An extensive partial bursectomy is done to expose the tendon and the muscle unit. The site and the extent of the damage is then judged using various techniques including level of ‘peeling’ of the tendon at foot print, loss of tension at the site of insertion of the tendon, assessing the thickness of tear by using probes, needles etc.
Decompression is an essential step in the process. If a decision is made to repair the tendon, then it is done either by completing the tear (if the damage is greater than 50%) or rarely, an in-situ repair is done. The steps are similar to those followed in the arthroscopic cuff repair and the intention is to attach the tendon to the foot print area. The wound is closed with sutures and water resistant dressing is applied. This is covered with a further layer of pressure dressing. The arm is then placed in a sling. You will be given information regarding wound care and information regarding various exercises you need to do.
Rotator cuff repair surgery can be very painful during the post-operative phase and the painkillers will only subdue the pain and not fully abolish it. It can take a week or two for the pain to come under full control. The level of pain is usually proportional to the size of the tear and the amount of mobilisation that is needed to get the repair done. Physiotherapy will be arranged if required.