Full-thickness tears mostly represent the end result of degenerative changes and chronic partial-thickness tears. Traumatic tears involving otherwise healthy tendons are far less common. The prevalence increases with age, though many are asymptomatic or cause minimal functional disability. The primary sonographic finding of full-thickness tears is volume loss and focal tendon nonvisualization. In recent tears, the space left by the missing tendon is filled in by fluid. Most full-thickness tears occur in the distal enthesis of the supraspinatus, but some may arise more proximally and leave a distal tendon stump attached to the greater tuberosity. In long-standing tears, fluid is usually absent and the gap filled in by fibrous tissue and proliferating synovium. Graded compression must be liberally used to depict full-thickness tears because complex fluid, fibrous tissue, and proliferating synovium may all mimic a heterogeneous but intact tendon on static images; dynamic compression induce shift of these material from the tear and allows for accurate diagnosis. The sonographic appearance of larger chronic tears is more intuitive, since retracted tendon permits abnormal close apposition of the deltoid muscle over the greater tuberosity. Full-thickness tears may also affect the subscapularis, infraspinatus, and teres minor tendons, in these two latter usually secondary to posterior extension of a supraspinatus tear. Dynamic ultrasound evaluation during internal and external rotation of the shoulder is useful to make full-thickness tears of the infraspinatus tendon more conspicuous.

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