Bursal-sided rotator cuff tear
Citation, DOI and article data
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.
- subacromial impingement
- spurs on the acromion undersurface 6
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
- focal non-transmural bursal-sided defect of fluid signal intensity of the rotator cuff on fat-saturated T2 weighted or intermediate weighted images with intact residual fibers
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.
Treatment and prognosis
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.
- 1. Palmer W, Bancroft L, Bonar F et al. Glossary of Terms for Musculoskeletal Radiology. Skeletal Radiol. 2020;49(S1):1-33. doi:10.1007/s00256-020-03465-1
- 2. Nazarian L, Jacobson J, Benson C et al. Imaging Algorithms for Evaluating Suspected Rotator Cuff Disease: Society of Radiologists in Ultrasound Consensus Conference Statement. Radiology. 2013;267(2):589-595. doi:10.1148/radiol.13121947
- 3. Schaeffeler C, Mueller D, Kirchhoff C, Wolf P, Rummeny E, Woertler K. Tears at the Rotator Cuff Footprint: Prevalence and Imaging Characteristics in 305 MR Arthrograms of the Shoulder. Eur Radiol. 2011;21(7):1477-1484. doi:10.1007/s00330-011-2066-x
- 4. Liu J, Garcia G, Gowd A et al. Treatment of Partial Thickness Rotator Cuff Tears in Overhead Athletes. Curr Rev Musculoskelet Med. 2018;11(1):55-62. doi:10.1007/s12178-018-9459-2
- 5. Matthewson G, Beach C, Nelson A et al. Partial Thickness Rotator Cuff Tears: Current Concepts. Adv Orthop. 2015;2015:1-11. doi:10.1155/2015/458786
- 6. Huang T, Liu J, Ma Y, Zhou D, Chen L, Liu F. Diagnostic Accuracy of MRA and MRI for the Bursal-Sided Partial-Thickness Rotator Cuff Tears: A Meta-Analysis. J Orthop Surg Res. 2019;14(1):1-11. doi:10.1186/s13018-019-1460-y