Bursal-sided rotator cuff tear

Last revised by Dr Joachim Feger on 15 Sep 2021

Bursal-sided rotator cuff tears are referred to as partial-thickness rotator cuff tears extending from the bursal side into the rotator cuff.

Bursal-sided rotator cuff tears are less common than articular-sided rotator cuff tears or intra-substance tears in cadaver studies an increase with age 5.

Bursal-sided rotator cuff tears are associated with subacromial impingement. Intrinsic factors include the relative hypovascularity of the distal parts of the tendon and the footprint and age-related microscopic changes are probably further intrinsic factors 4,5.

  • a bursal-sided rim rent tear of the footprint, most commonly found at the tendon insertion of the supraspinatus tendon is called reverse-PASTA lesion
  • a bursal-sided partial-thickness tear with intratendinous extension should be described as such since delamination hamper the healing potential of the tendon 1
  • focal hypoechoic or anechoic defect of the rotator cuff, extending from the bursal side into the tendon substance

Unless the contrast medium is injected into the subacromial-subdeltoid bursa, which will fill the tear with contrast ref, MR and CT arthrography is not of much additional use to MRI in isolated bursal-sided rotator cuff tear 1,6.

Partial-bursal sided tears can be initially treated conservatively. Surgery is indicated for patients, who failed conservative treatment and younger patients with a single acute injury and include debridement and repair the latter, especially in larger tears 4,5. Subacromial decompression might be an option if there are extrinsic risk factors for subacromial impingement 5.

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