Partial thickness rotator cuff tears

Partial-thickness rotator cuff tears are partial disruptions of tendon fibers. These may be located on the articular surface (PASTA lesions) on the bursal surface (Monk's Hood lesions) or be strictly intra-tendinous (PAINT lesions). In each case there is no communication between the glenohumeral joint and subacromial bursa. Clinically the patients describe chronic pain and diminished shoulder function. If after a non-operative program the patient continues to be symptomatic, surgery should be considered. Surgical options depend in part on the location of the lesion. Bursal-sided Monk's Hood tears tend to do worse with simple debridement and require repair to the greater tuberosity with decompression of any impinging bone. PASTA lesions can be treated using a transtendon approach for those tears with 50% or more involvement. However, as the thickness of the tendon tear approaches 80% or more a "complete and repair" is preferred. PAINT tears are usually identified on MRI and confirmed arthroscopically when the probe breaks through the tendon layer into the interior delaminating space. At that point the repair can be approached based upon the side of the breakthrough.