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
Robert J. Gionfriddo, DO
Department of Medicine
RJG declares that he has no competing interests.
Jason Jacob, MD
Department of Medicine
JJ declares that he has no competing interests.
Dr Robert J. Gionfriddo and Dr Jason Jacob would like to gratefully acknowledge Dr Daniel J. Solomon and Dr Michael G. Clarke, previous contributors to this monograph. DJS serves as a speaker/course instructor for Arthrex Inc. and Pacific Medical Inc. and has received honoraria from both companies. MGC declares that he has no competing interests.
Matthew T. Provencher, MD
Orthopaedic Shoulder and Sports Surgery
Naval Medical Center San Diego
MTP declares that he has no competing interests.
Radhakant Pandey, FRCS, McH(orth)
Consultant in Trauma and Orthopaedics
Department of Trauma and Orthopaedics
Leicester Royal Infirmary
RP declares that he has no competing interests.
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