Intrasubstance rotator cuff tear

Last revised by Dr Joachim Feger on 15 Sep 2021

Intrasubstance rotator cuff tears also known as concealed interstitial delaminations (CID) are concealed partial-thickness rotator cuff tears neither extending to the articular nor the bursal side of the rotator cuff.

According to cadaver studies they are the most common form of partial-thickness rotator cuff tear.

Intrasubstance tears are confined to the tendon substance and the bursal, as well as the articular side, appear normal at arthroscopy 1.

Intrasubstance tears are most commonly found in the posterior supraspinatus tendon 3.

Intrasubstance rotator cuff tears are difficult to detect.

On ultrasound, a focal hypoechoic or anechoic slit of the rotator cuff within the tendon substance might be seen.

A typical finding is a linear non-transmural intrasubstance slit of fluid signal intensity of the rotator cuff on fat-saturated T2 weighted or intermediate weighted images with intact articular-sided and bursal-sided fibers. 

CT arthrography will not depict an intrasubstance rotator cuff tear 1 since per definition it is concealed. MR arthrography should not have any additional advantage over MRI unless to prove the suspected tear is not a partial articular tear with intratendinous extension or PAINT lesion.

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