Rotator Cuff Tear on MRI

What You'll See on Your MRI

Before understanding what a rotator cuff tear looks like on an MRI, let's review some important context about this common shoulder problem.

Think of your rotator cuff as four tendons (supraspinatus, infraspinatus, teres minor, subscapularis) that work together to stabilize and move your shoulder joint. When one or more of these tendons tears, the shoulder loses both stability and strength. The supraspinatus tendon is by far the most commonly torn.

Here are the key statistics about MRI accuracy for rotator cuff tears:

Understanding Rotator Cuff Tears

The rotator cuff is a group of four muscles and their tendons that form a "cuff" around the shoulder joint:

• Supraspinatus - Initiates arm elevation (most commonly torn)
• Infraspinatus - Externally rotates the arm
• Teres minor - Assists external rotation
• Subscapularis - Internally rotates the arm

Types of Tears:

Full-Thickness Tear:

• Complete disruption of the tendon from attachment to bone
• Fluid signal intensity passes entirely through the tendon
• Can be partial or complete detachment
• Often requires surgical repair in active patients

Partial-Thickness Tear:

• Articular surface (joint side) - more common
• Bursal surface (outside)
• Intratendinous (within the tendon)
• May or may not need surgery depending on depth and symptoms

Tendinosis vs Tear:

• Tendinosis: Degeneration without complete disruption
• Tear: Actual disruption of tendon fibers with fluid signal

Symptoms of a Rotator Cuff Tear:

• Pain at night, especially when lying on the affected shoulder
• Weakness when lifting or rotating the arm
• Crepitus (crackling sensation) when moving the shoulder
• Limited range of motion
• Pain that worsens with overhead activities
• Inability to reach above head or behind back

How It Appears on Imaging

Let's compare what a normal rotator cuff looks like versus what a tear looks like on an MRI:

Key Findings Pattern

When interpreting an MRI for rotator cuff tear, radiologists assess specific features that guide treatment:

When Your Doctor Orders This Test

Here's a typical clinical scenario where an MRI is ordered for suspected rotator cuff tear:

Your doctor might order an MRI for suspected rotator cuff tear if you have:

| Symptom | Why It Matters | |---------|----------------| | Night pain | Classic rotator cuff tear symptom; pain worse when lying on affected shoulder | | Weakness with elevation | Suggests significant tendon disruption; supraspinatus initiates arm elevation | | Positive drop-arm test | Inability to hold arm elevated suggests large tear | | Failed conservative therapy | Persistent symptoms after PT indicate possible structural damage needing surgery | | Pseudoparalysis | Inability to elevate arm beyond 90° suggests massive tear |

What Else Could It Be?

Not every shoulder problem is a rotator cuff tear. Here's what else could be causing your symptoms:

How Accurate Is This Test?

The evidence for MRI in rotator cuff tear diagnosis shows excellent performance:

What Happens Next?

If your MRI confirms a rotator cuff tear, here's what to expect:

Prognosis and Treatment Outcomes

Tear Size and Prognosis:

• Small tears (＜ 1cm): Excellent outcomes with repair or PT
• Medium tears (1-3cm): Good outcomes with repair
• Large tears (3-5cm): Fair outcomes; higher re-tear rate
• Massive tears (＞ 5cm): Poor outcomes with repair alone; may need reverse TSA

Muscle Quality Impact:

• Goutallier Grade 0-1: Good healing potential after repair
• Goutallier Grade 2: Fair healing potential
• Goutallier Grade 3-4: Poor healing; may recommend reverse shoulder replacement

Treatment Outcomes:

• Surgical repair: 80-90% patient satisfaction, 70-80% tendon healing
• Non-surgical: Many patients improve, but persistent weakness common
• Recovery time: 4-6 months for return to light duties, 6+ months for overhead sports

Frequently Asked Questions

Will my rotator cuff tear heal without surgery?

Partial tears and some small full-thickness tears may improve with physical therapy, but complete tears typically do not heal spontaneously. The tendon retracts and the muscle atrophies over time, making repair more difficult.

How soon should I have surgery?

Timing depends on the tear. Acute traumatic tears (after injury) should be repaired within weeks. Chronic degenerative tears can be managed conservatively first, with surgery if symptoms persist. Delaying too long leads to muscle atrophy and poorer outcomes.

Can I still tear my rotator cuff after repair?

Yes, re-tear rates range from 10-30% depending on tear size and patient factors. Large tears, older patients, and smokers have higher re-tear rates. However, many patients with re-tears still have symptom improvement.

Will I regain full strength after surgery?

Most patients regain good functional strength, but not necessarily "normal" strength. Overhead athletes may not return to their pre-injury level of performance. The focus is on pain-free function rather than perfection.

Is shoulder replacement an option?

For massive, irreparable tears with arthritis, reverse total shoulder replacement is an excellent option. This surgery reverses the normal ball-and-socket anatomy, allowing the deltoid muscle to compensate for the torn rotator cuff.

References

Medical Disclaimer: This information is for educational purposes. Always discuss your imaging results with your orthopedic surgeon or healthcare provider for personalized medical advice.