Rotator cuff tendinopathy (or rotator cuff tear) is an injury or rupture of the rotator cuff tendons, usually involving more than one shoulder muscle. Rotator cuff tendinopathy is common during aging. Rotator cuff tendinopathy is, by far, the most common reason people seek care for shoulder pain. Pain related to rotator cuff tendinopathy is typically on the front side of the shoulder, down to the elbow, and worse reaching up or back. Diagnosis is based on symptoms and examination. Medical imaging is used mostly to plan surgery and is not needed for diagnosis. Treatment may include pain medication, such as NSAIDs and specific exercises. It is recommended that people who are unable to raise their arm above 90 degrees after two weeks should be further assessed. Surgery may be offered for acute ruptures and large attritional defects with good quality muscle. The benefits of surgery for smaller defects are unclear as of 2019. A 2025 study concluded that arthroscopic subacromial decompression offered no benefit after ten years of follow-up over placebo surgery (diagnostic arthroscopy) or exercise in people with symptoms consistent with subacromial pain syndrome for more than three months.
Signs and symptoms
Rotator cuff tendinopathy is often asymptomatic even when there is thinning or a full-thickness defect. Rotator cuff defects are common on post mortem and MRI studies in those without any history of shoulder pain or symptoms. Rotator cuff tendinopathy is associated with pain over the front and side (anterolateral) of the shoulder that radiates towards the elbow. The pain may occur with shoulder movement above the horizontal position, shoulder flexion and abduction. Pain is often described as weakness. Actual muscle weakness does not correlate with symptoms of weakness. Symptom severity does not correlate with rotator cuff defect size and associated muscle quality.
Risk factors
Epidemiological studies strongly support a relationship between age and cuff tear prevalence, with the most common cause being age-related degeneration and, less frequently, sports injuries or trauma. Those most prone to failed rotator cuff syndrome are people 65 years of age or older and those with large, sustained tears. Smokers, people with diabetes, individuals with muscle atrophy or fatty infiltration, and those who do not follow postoperative-care recommendations are also at greater risk. In a 2008 study the frequency of such tears increased from 13% in the youngest group (aged 50–59 y) to 20% (aged 60–69 y), 31% (aged 70–79 y), and 51% in the oldest group (aged 80–89 y). Some risk factors, such as age and height, cannot be changed. Increased body mass index is also associated with tearing. Recurrent lifting and overhead motions are at risk for rotator cuff injury as well. This includes jobs that involve repetitive overhead work, such as carpenters, painters, custodians, and servers. People who play sports that involve overhead motions, such as swimming, water polo, volleyball, baseball, and tennis, and American football quarterbacks are at a greater risk of experiencing a rotator cuff tear. Striking-based combat sports, such as boxing, also account for severe rotator cuff injuries in competitors, typically, when their punches miss the target, or overuse the shoulder by throwing an excessively large number of punches. Certain track-and-field activities, such as shot put and javelin throw are also of considerable risk, especially when athletes perform outdoors under cold weather conditions or neglect warming-up procedures; proper warm-up of the throwing and/or swinging arm can help reduce the stress on the musculature of the shoulder girdle. Corticosteroid injections around the tendons increase the risk of tendon tear and delay tendon healing.
Mechanisms of injury
The shoulder is a complex mechanism involving bones, ligaments, joints, muscles, and tendons. The two main causes are acute injury or chronic and cumulative degeneration of the shoulder joint. Mechanisms can be extrinsic, intrinsic, or a combination of both. The cuff is responsible for stabilizing the glenohumeral joint to allow abduction and rotation of the humerus. When trauma occurs, these functions can be compromised. Because individuals are dependent on the shoulder for many activities, overuse can lead to tears, with the vast majority being in the supraspinatus tendon. The role of the supraspinatus is to resist downward motion, both while the shoulder is relaxed and while carrying weight. Supraspinatus tears usually occurs at its insertion on the humeral head at the greater tubercle. Though the supraspinatus is the most commonly injured tendon in the rotator cuff, the other three can also be injured at the same time.
Acute tears The amount of stress needed to acutely tear a rotator cuff tendon will depend on the underlying condition of the tendon. If healthy, the stress needed will be high, such as with a fall on the outstretched arm. This stress may occur coincidentally with other injuries such as a dislocation of the shoulder or separation of the acromioclavicular joint. In the case of a tendon with pre-existing degeneration, the force may be more modest, such as with a sudden lift, particularly with the arm above the horizontal position. The type of loading involved with injury is usually eccentric, such as when two people are carrying a load and one lets go, forcing the other to maintain force while the muscle elongates.
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