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Rotator cuff disease

Rotator cuff disease refers to a spectrum of disorders affecting the tendons of the rotator cuff, ranging from tendinopathy and subacromial pain to partial- and full-thickness tears. It commonly presents with shoulder pain, painful overhead activity, night pain, and weakness. Management depends on the severity of tendon damage, patient age, functional demands, and response to conservative treatment.

Rotator cuff disease is a broad term describing pathological conditions involving the rotator cuff tendons, particularly the supraspinatus, infraspinatus, subscapularis, and teres minor. The spectrum includes tendinopathy, bursitis, partial-thickness tears, full-thickness tears, and chronic massive rotator cuff tears. Degenerative changes are common with increasing age, although acute traumatic tears may occur in younger or active individuals. Patients commonly present with anterolateral shoulder pain, pain during overhead activities, night pain, weakness, and difficulty with activities such as lifting or reaching behind the back. Clinical examination includes assessment of range of motion, strength, and specific provocative tests for individual rotator cuff tendons and subacromial pain. Diagnosis is based on clinical assessment and imaging. Plain radiographs help identify associated bony abnormalities and degenerative changes, while ultrasound and MRI are useful for evaluating tendon integrity, tear size, retraction, muscle atrophy, and fatty degeneration. Initial treatment in many patients consists of activity modification, analgesia, physiotherapy, and rotator cuff and scapular strengthening exercises. Selected patients may benefit from subacromial corticosteroid injection for short-term symptom control. Surgical treatment, most commonly arthroscopic rotator cuff repair, may be considered for traumatic tears, significant weakness, persistent symptoms despite appropriate conservative treatment, or repairable full-thickness tears in active patients. The goals of treatment are to relieve pain, restore shoulder strength and function, preserve tendon integrity where possible, and prevent progression to chronic cuff insufficiency and cuff tear arthropathy.

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