Common shoulder condition, especially in older and active people. Tears can be symptomatic or asymptomatic.
Cause of tear can be traumatic or attritional.
Treatment typically based on degree of dysfunction, pain, and quality of tendons and muscles of the rotator cuff, as well as patient goals and activity level.
In patients with lower functional demands, rehabilitation therapy, including ROM and strengthening exercises, is critical to return patients to better function. A subacromial injection can alleviate pain.
If higher activity level is desired or the tear is acute, surgical intervention has a better functional result than non-operative treatment.
The spectrum of rotator cuff pathology is one of the most common groups of conditions affecting the adult shoulder. Tears can occur with trauma (such as with shoulder dislocation in patients >40 years of age) or be attritional (such as with repetitive overhead activity or chronic degeneration). Shoulder impingement, subacromial bursitis, rotator cuff syndrome, and rotator cuff tendonitis all overlap and can be a continuum of terminology representing similar pathology.
History and exam
Key diagnostic factors
- presence of risk factors
- shoulder pain
- shoulder weakness
- loss of active ROM
- pain and weakness on external rotation test
- pain and weakness on empty-can test
Other diagnostic factors
- deltoid pain
- night pain
- pain and weakness on lift-off test
- pain and weakness on belly-press test
- pain on Neer impingement test
- pain on Hawkins impingement test
- adhesive capsulitis
- age >60 years
- hx of repetitive overhead movement
- hx of superior labral tears
- shoulder injury
1st investigations to order
Investigations to consider
- diagnostic injection
- magnetic resonance arthrography
- CT arthrography
- CT scan
acute small tear
acute medium/large/massive reparable tear
acute irreparable tear
chronic symptomatic tear
- Rotator cuff impingement
- Rotator cuff tendonitis
- Subacromial bursitis
- Optimizing the management of rotator cuff problems
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Rotator cuff injury
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