Practice Essentials

Rotator cuff injuries are a common cause of shoulder pain in people of all age groups. They represent a spectrum of disease, ranging from acute reversible tendinitis to massive tears involving the supraspinatus, infraspinatus, and subscapularis. Diagnosis is usually made through detailed history, physical examination, and often, imaging studies.^{[1, 2, 3, 4, 5]}

A normal rotator cuff and rotator cuff tear are shown below.

Rotator cuff, normal anatomy.

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Rotator cuff tear, anterior view.

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Often, younger individuals with rotator cuff injuries relate a history of repetitive overhead activities involving the rotator cuff or, less commonly, a history of trauma preceding clinical onset of symptoms. In contrast, older individuals usually present with a gradual onset of shoulder pain and, ultimately, after radiographic testing are shown to have significant partial or full rotator cuff tears without a clear history of predisposing trauma. Nonoperative or conservative treatment is usually sufficient to heal the problem in the vast majority of individuals, with a few exceptions that are discussed.^{[1, 2, 3, 4, 5]}

Next: Epidemiology

Epidemiology

United States statistics

It is difficult to determine the exact prevalence of rotator cuff tears, as many patients are asymptomatic and do not have any pain or weakness that would lead them to seek medical care. Certain population screening studies have identified the prevalence of rotator cuff tear using shoulder ultrasonography techniques, including a cross-sectional study of women in the UK that showed 22.2% of a study population of 1000 in the UK had a full-thickness rotator cuff tear. Observational studies in Asian populations demonstrated higher prevalence in individuals aged ≥57 years and in men compared with women.

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Media Gallery

Rotator cuff, normal anatomy.
Rotator cuff tear, anterior view.
The acromioclavicular arch and the subacromial bursa.
Neer impingement test. The patient's arm is maximally elevated through forward flexion by the examiner, causing a jamming of the greater tuberosity against the anteroinferior acromion. Pain elicited with this maneuver indicates a positive test result for impingement.
Hawkins test. The examiner forward flexes the arms to 90° and then forcibly internally rotates the shoulder. This movement pushes the supraspinatus tendon against the anterior surface of the coracoacromial ligament and coracoid process. Pain indicates a positive test result for supraspinatus tendonitis.
Rotator cuff injury.

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Author

Christopher J Visco, MD, FAAPMR, RMSK Ursula Corning Associate Professor of Rehabilitation, Vice Chair of Education, Columbia University Medical Center; Adjunct Associate Professor of Rehabilitation, Weill Cornell Medical Center; Associate Attending Physiatrist, NewYork-Presbyterian Hospital

Christopher J Visco, MD, FAAPMR, RMSK is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, American Medical Society for Sports Medicine, American Registry for Diagnostic Medical Sonography, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Coauthor(s)

Madhavan Elangovan, MD Resident Physician, Department of Rehabilitation and Regenerative Medicine, NewYork-Presbyterian Hospital

Madhavan Elangovan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Medical Society for Sports Medicine, Association of Academic Physiatrists

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Clinical Professor of Orthopaedic Surgery and Sports Medicine, Michigan State University College of Human Medicine; Academic Chief of Orthopaedic Sports Medicine, Regional Director of Ambulatory Clinic Site, Sports Medicine Institute, Detroit Medical Center

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, Arthroscopy Association of North America, Detroit Academy of Orthopaedic Surgeons, International Association for Dance Medicine and Science, International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine, Michigan Orthopaedic Society, Michigan State Medical Society, Mid-America Orthopaedic Association

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Additional Contributors

Andrew L Sherman, MD, MS Professor, Interim Department Chair and Vice Chair of Education, Department of Physical Medicine and Rehabilitation, University of Miami, Leonard A Miller School of Medicine; Interim Chief Medical Officer, Christine E Lynn Rehabilitation Center for the Miami Project to Cure Paralysis and Jackson Health System

Andrew L Sherman, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, Florida Society of Physical Medicine and Rehabilitation

Disclosure: Nothing to disclose.

Gerard A Malanga, MD † Founder and Partner, New Jersey Sports Medicine, LLC and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine

Gerard A Malanga, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Institute of Ultrasound in Medicine, International Spine Intervention Society, North American Spine Society

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Lipogems.

Jay E Bowen, DO Assistant Professor, Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School; Medical Director, New Jersey Regenerative Institute, LLC

Jay E Bowen, DO is a member of the following medical societies: American Academy of Osteopathy, American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Osteopathic Association, American Osteopathic College of Physical Medicine and Rehabilitation, North American Spine Society, Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Lipogems<br/>Have a 5% or greater equity interest in: DataBiologics.

Acknowledgements

Stephen G Andrus, MD Sports Medicine Fellow, Department of Physical Medicine and Rehabilitation, Kessler Institute for Rehabilitation, University of Medicine and Dentistry of New Jersey

Stephen G Andrus, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American College of Sports Medicine, American Medical Association, and Physiatric Association of Spine, Sports and Occupational Rehabilitation

Disclosure: Nothing to disclose.

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