Rotator cuff tear

Rotator cuff tendinopathy is a process of senescence. The pathophysiology is mucoid degeneration. Most people develop rotator cuff tendinopathy within their lifetime. As part of rotator cuff tendinopathy, the tendon can thin and develop a defect. This defect is often referred to as a rotator cuff tear. Acute, traumatic rupture of the rotator cuff tendons can also occur, but is less common. Traumatic rupture of the rotator cuff usually involves the tendons of more than one muscle. 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. Many rotator cuff tears have no symptoms. Both partial and full thickness tears have been found on post mortem and MRI studies in those without any history of shoulder pain or symptoms. However, the most common presentation is shoulder pain or discomfort. This may occur with activity, particularly shoulder activity above the horizontal position, but may also be present at rest in bed. Pain-restricted movement above the horizontal position may be present, as well as weakness with shoulder flexion and abduction. However, symptoms of pain do not correlate with rotator cuff tear severity. Abnormal mobility or function of the scapula (scapular dyskinesia) may be present and is related to lower functional scores; it unclear whether scapular dyskinesia is a cause, effect, or compensation for rotator cuff pathology.