» Articles » PMID: 26716086

Rotator Cuff Tears: An Evidence Based Approach

Overview
Journal World J Orthop
Specialty Orthopedics
Date 2015 Dec 31
PMID 26716086
Citations 63
Authors
Affiliations
Soon will be listed here.
Abstract

Lesions of the rotator cuff (RC) are a common occurrence affecting millions of people across all parts of the globe. RC tears are also rampantly prevalent with an age-dependent increase in numbers. Other associated factors include a history of trauma, limb dominance, contralateral shoulder, smoking-status, hypercholesterolemia, posture and occupational dispositions. The challenge lies in early diagnosis since a high proportion of patients are asymptomatic. Pain and decreasing shoulder power and function should alert the heedful practitioner in recognizing promptly the onset or aggravation of existing RC tears. Partial-thickness tears (PTT) can be bursal-sided or articular-sided tears. Over the course of time, PTT enlarge and propagate into full-thickness tears (FTT) and develop distinct chronic pathological changes due to muscle retraction, fatty infiltration and muscle atrophy. These lead to a reduction in tendon elasticity and viability. Eventually, the glenohumeral joint experiences a series of degenerative alterations - cuff tear arthropathy. To avert this, a vigilant clinician must utilize and corroborate clinical skill and radiological findings to identify tear progression. Modern radio-diagnostic means of ultrasonography and magnetic resonance imaging provide excellent visualization of structural details and are crucial in determining further course of action for these patients. Physical therapy along with activity modifications, anti-inflammatory and analgesic medications form the pillars of nonoperative treatment. Elderly patients with minimal functional demands can be managed conservatively and reassessed at frequent intervals. Regular monitoring helps in isolating patients who require surgical interventions. Early surgery should be considered in younger, active and symptomatic, healthy patients. In addition to being cost-effective, this helps in providing a functional shoulder with a stable cuff. An easily reproducible technique of maximal strength and sturdiness should by chosen among the armamentarium of the shoulder surgeon. Grade 1 PTTs do well with debridement while more severe lesions mandate repair either by trans-tendon technique or repair following conversion into FTT. Early repair of repairable FTT can avoid appearance and progression of disability and weakness. The choice of surgery varies from surgeon-to-surgeon with arthroscopy taking the lead in the current scenario. The double-row repairs have an edge over the single-row technique in some patients especially those with massive tears. Stronger, cost-effective and improved functional scores can be obtained by the former. Both early and delayed postoperative rehabilitation programmes have led to comparable outcomes. Guarded results may be anticipated in patients in extremes of age, presence of comorbidities and severe tear patters. Overall, satisfactory results are obtained with timely diagnosis and execution of the appropriate treatment modality.

Citing Articles

Risk factors for rotator cuff tear in Syrian adults: a cross-sectional study.

Khadour F, Khadour Y, Alharbi N, Alhatem W, Albarroush D, Dao X Sci Rep. 2025; 15(1):5837.

PMID: 39966503 PMC: 11836180. DOI: 10.1038/s41598-025-89878-1.


Real-world clinical and economic impacts of delayed rotator cuff repair surgery in Japan: analysis of a large claims database.

Sugaya H, Otaka Y, Shiotsuki Y, Seno A JSES Rev Rep Tech. 2025; 5(1):30-39.

PMID: 39872333 PMC: 11764658. DOI: 10.1016/j.xrrt.2024.09.004.


The Clinical Application of Gel-Based Composite Scaffolds in Rotator Cuff Repair.

Tharakan S, Hadjiargyrou M, Ilyas A Gels. 2025; 11(1).

PMID: 39851973 PMC: 11764754. DOI: 10.3390/gels11010002.


Causal Relationships Between 4 Exposure Factors and Rotator Cuff Syndrome Using Mendelian Randomization Analysis.

Zhang Z, Han S, Sun X, Guo Z, Wang Z, Sha P Orthop J Sports Med. 2025; 13(1):23259671241285860.

PMID: 39811155 PMC: 11729446. DOI: 10.1177/23259671241285860.


Factors contributing to persistent shoulder pain after arthroscopic rotator cuff repair: Protocol for a scoping review.

Prabhu B A, Maiya G, Pandey V, Acharya K, Raja G P, Elliott M J F1000Res. 2025; 13:1236.

PMID: 39790171 PMC: 11715645. DOI: 10.12688/f1000research.156193.2.


References
1.
Moosmayer S, Tariq R, Stiris M, Smith H . The natural history of asymptomatic rotator cuff tears: a three-year follow-up of fifty cases. J Bone Joint Surg Am. 2013; 95(14):1249-55. DOI: 10.2106/JBJS.L.00185. View

2.
Aydin N, Kocaoglu B, Guven O . Single-row versus double-row arthroscopic rotator cuff repair in small- to medium-sized tears. J Shoulder Elbow Surg. 2010; 19(5):722-5. DOI: 10.1016/j.jse.2009.11.053. View

3.
Lenza M, Buchbinder R, Takwoingi Y, Johnston R, Hanchard N, Faloppa F . Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev. 2013; (9):CD009020. PMC: 6464715. DOI: 10.1002/14651858.CD009020.pub2. View

4.
Bigliani L, Ticker J, Flatow E, Soslowsky L, Mow V . The relationship of acromial architecture to rotator cuff disease. Clin Sports Med. 1991; 10(4):823-38. View

5.
Robinson P, Doll H, Roy B . Treating the torn rotator cuff: current practice in the UK. Ann R Coll Surg Engl. 2011; 93(7):532-6. PMC: 3604923. DOI: 10.1308/147870811X13137608454858. View