Massive rotator cuff tear

Last revised by Dr Joachim Feger on 15 Sep 2021

Massive rotator cuff tears are large full-thickness tears usually leading to glenohumeral joint destabilization. Different definitions of a massive rotator cuff tear exist in regard to tear size or the involvement of tendons.

They constitute up to 40% of all rotator cuff tears 1,2.

Clinical symptoms may vary and can be categorized e.g. with the modified UCLA scoring system. In a massive tear, there will be, however, probably some functional deficit 3.

Massive tears are larger full-thickness tears 3 which involve more than one tendon 4 and can be classified as follows 5,6:

  • supraspinatus and superior subscapularis tears
  • supraspinatus and entire subscapularis tears
  • supraspinatus, superior subscapularis, and infraspinatus tears
  • supraspinatus and infraspinatus tears
  • supraspinatus, infraspinatus and teres minor tears

Large hypoechoic or anechoic defect in the area of the torn tendons.

Larger full-thickness tear with the presence of fluid signal intensity in the location of the rotator cuff on fat-saturated T2 weighted or intermediate weighted images of a defined size extension into one of the other tendons e.g. posterosuperior cuff tear and/or rotator interval.

The report of rotator cuff tears, particularly if massive should include the following 1,3:

Treatment options include interval slides, margin convergence, partial repair or tendon transfer e.g. from latissimus dorsi or pectoralis major tendons, superior capsular reconstruction in young people and several treatment strategies from conservative management over arthroscopic debridement up to reverse prosthesis of the glenohumeral joint in the older patients 2,3,7,8.

There are many and more options but no consensus on the ideal treatment for massive or irreparable rotator cuff tears 7.

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Cases and figures

  • Case 1: US with biceps tendon dislocation
    Drag here to reorder.
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