Rotator Cuff Syndrome
Pain and loss of function from the rotator cuff tendons, spanning tendinopathy, partial tear and full-thickness tear. Preferred term: <strong>rotator cuff related shoulder pain (RCRSP)</strong>.
Anatomy: SITS
| Muscle | Action | Nerve |
|---|---|---|
| Supraspinatus (most affected) | Initiates abduction | Suprascapular |
| Infraspinatus | External rotation | Suprascapular |
| Teres minor | External rotation | Axillary |
| Subscapularis | Internal rotation | Subscapular |
The cuff compresses the humeral head into the glenoid, providing dynamic stability.
Mechanism and risk
- Overhead activity (swimming, throwing, tennis, volleyball, weightlifting) is the dominant mechanism. Acute overload (fall on outstretched hand) also occurs.
- Most tears in older patients are degenerative.
- Intrinsic tendon degeneration plus extrinsic factors such as scapular dyskinesis. Overlaps heavily with shoulder impingement.
- Risk factors: age over 50 (strongest), diabetes and metabolic syndrome, smoking, overhead work above 90°, cuff and scapular weakness.
Presentation
- Lateral or anterior shoulder pain, may reach the deltoid insertion
- Night pain, lying on the affected side
- Painful arc 60 to 120° abduction
- Weakness in abduction or external rotation. Global stiffness suggests adhesive capsulitis instead.
| Test | Muscle |
|---|---|
| Jobe (empty can) | Supraspinatus |
| External rotation lag | Infraspinatus |
| Hornblower | Teres minor |
| Lift-off, belly-press | Subscapularis |
Drop arm test suggests a significant tear. Impingement tests (Neer, Hawkins-Kennedy) have low specificity.
Imaging caution
about 40% of asymptomatic people over 60 have cuff tears. Correlate with the clinical picture.
Management
- Progressive cuff and scapular exercise: first-line. Trials in degenerative tears show outcomes comparable with surgery.
- Load management: essential.
- Adjuncts: manual therapy (small benefit), NSAIDs (short-term). Shockwave helps calcific tendinopathy.
- Corticosteroid injection: short-term pain relief only, no long-term advantage over exercise.
- Avoid: PRP (no consistent benefit) and subacromial decompression (no better than placebo surgery).
- Cuff repair: acute traumatic full-thickness tears in younger patients, or failed 3 to 6 months of conservative care with a repairable tear.
Most improve over 12 to 24 weeks. Review non-responders for progression.
References
- Lewis, Man Ther 2016, doi:10.1016/j.math.2016.03.009
- Lewis, Br J Sports Med 2009, doi:10.1136/bjsm.2008.052183
- J Orthop Sports Phys Ther 2015, doi:10.2519/jospt.2015.5455
Related
Medical disclaimer: this article is general information, not personal medical advice. Always consult a qualified doctor about your own situation.