Rotator cuff disease – basics of diagnosis and treatment

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Robert E. Boykin
Hinrich J.D. Heuer
Suketu Vaishnav
Peter J. Millett *
(*) Corresponding Author:
Peter J. Millett | drmillett@steadman-hawkins.com

Abstract

Rotator cuff (RTC) disease is a particularly prevalent cause of shoulder pain and weakness presenting to primary care physicians, internists, rheumatologists, and orthopedists. An understanding of the anatomy of the RTC tendons and the underlying pathogenesis aids in the diagnosis, which is based largely on history and specific physical examination tests. Imaging may further define the pathology and aid in the evaluation of other sources of shoulder pain. Injuries to the RTC range from tendonitis to partial thickness tears to full thickness tears. The majority of patients with impingement and some cases of partial thickness tears may be managed effectively with non-operative measures including non-steroidal anti-inflammatory drugs, local injections, and physical therapy. Predictors of a good outcome with non-operative treatment include pre-injury strength, ability to raise the arm to the level of the shoulder, and a more acute presentation. Persistent symptoms may require operative intervention including debridement, subacromial decompression, and/or RTC repair. Acute full thickness tears in younger patients in addition to failed non-operative management of full thickness tears in older patients are the most likely to require surgery, which may be done open or arthroscopically. The majority of tears are amenable to the less invasive arthroscopic method, which yields good success rates and high patient satisfaction.

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Author Biographies

Robert E. Boykin, Massachusetts General Hospital, Boston, MA

Department of Orthopaedic Surgery

Hinrich J.D. Heuer, Steadman Hawkins Clinic, Vail, CO

Department of Orthopaedic Surgery

 

Suketu Vaishnav, Steadman Hawkins Clinic, Vail, CO

Department of Orthopaedic Surgery

 

Peter J. Millett, Steadman Hawkins Clinic, Vail, CO

Director of Shoulder Surgery

Shoulder, Knee, Sports Medicine