Bursal-sided rotator cuff tear

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 .




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

  • 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 healing potential of the tendon

Radiographic features

  • 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
MR/CT arthrography

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

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 . Subacromial decompression might be an option if there are extrinsic risk factors for subacromial impingement .

See also