Presentation and diagnosis of rotator cuff tears
- Stephen M Simons, MD, FACSM
Stephen M Simons, MD, FACSM
- South Bend-Notre Dame Sports Medicine Fellowship
- J Bryan Dixon, MD
J Bryan Dixon, MD
- Clinical Assistant Professor of Family Medicine
- Michigan State University College of Human Medicine
- Medical Director
- United States Olympic Education Center
- David Kruse, MD
David Kruse, MD
- Primary Care Sports Medicine
- Orthopaedic Specialty Institute
- Section Editor
- Karl B Fields, MD
Karl B Fields, MD
- Editor-in-Chief — Primary Care Sports Medicine (Adolescents and Adults)
- Section Editor — Biomechanics, Rehabilitation, and Recovery; Sports-Related Injuries; Symptom Assessment and Physical Examination
- Professor of Family Medicine and Sports Medicine
- University of North Carolina at Chapel Hill
- Deputy Editors
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Emergency Medicine (Adult and Pediatric)
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
- Susanna I Lee, MD, PhD
Susanna I Lee, MD, PhD
- Deputy Editor — Radiology
- Associate Professor of Radiology
- Harvard Medical School
- Massachusetts General Hospital
Shoulder pain is a common presenting complaint to primary care offices and sports medicine clinics. Estimates of the prevalence of shoulder pain range from 16 to 34 percent in the general population [1,2]. Rotator cuff pathology is the most common condition of the shoulder for which patients seek treatment . Estimates published in 2004 by the United States Agency for Health Care Research and Quality and United States Department of Health and Human Services show rotator cuff problems accounted for more than 4.5 million clinician visits and approximately 40,000 surgeries .
Despite this burden on patients and health care resources, there remains significant controversy regarding the etiology of rotator cuff injuries, the role of rotator cuff tears in generating shoulder pain, and the ability of commonly accepted clinical tests to diagnose rotor cuff tears.
The etiology, presentation, and diagnosis of rotator cuff tears will be reviewed here. The treatment of rotator cuff tears, rotator cuff tendinopathy, the shoulder examination, and the general management of patients with shoulder pain are discussed separately. (See "Management of rotator cuff tears" and "Rotator cuff tendinopathy" and "Physical examination of the shoulder" and "Evaluation of the patient with shoulder complaints".)
ANATOMY AND BIOMECHANICS
The anatomy and biomechanics of the shoulder generally are discussed separately (figure 1A-C). (See "Evaluation of the patient with shoulder complaints", section on 'Anatomy and biomechanics'.) The biomechanics of the rotator cuff specifically are discussed elsewhere. (See "Rotator cuff tendinopathy", section on 'Clinical anatomy' and "Rotator cuff tendinopathy", section on 'Basic biomechanics'.)
MECHANISM OF INJURY
The development of underlying rotator cuff tendinopathy is discussed elsewhere. (See "Rotator cuff tendinopathy".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Urwin M, Symmons D, Allison T, et al. Estimating the burden of musculoskeletal disorders in the community: the comparative prevalence of symptoms at different anatomical sites, and the relation to social deprivation. Ann Rheum Dis 1998; 57:649.
- Silverstein BA, Viikari-Juntura E, Fan ZJ, et al. Natural course of nontraumatic rotator cuff tendinitis and shoulder symptoms in a working population. Scand J Work Environ Health 2006; 32:99.
- McFarland EG. Examination of the shoulder. In: The Complete Guide, Kim TK, Park HB, Rassi GE, et al (Eds), Thieme Medical Publishers, New York 2006. p.142.
- Oh LS, Wolf BR, Hall MP, et al. Indications for rotator cuff repair: a systematic review. Clin Orthop Relat Res 2007; 455:52.
- Andrews, JR, Angelo, RL. Shoulder arthroscopy for the throwing athlete. Tech Orthop 1988; 3:75.
- Abrams JS. Special shoulder problems in the throwing athlete: pathology, diagnosis, and nonoperative management. Clin Sports Med 1991; 10:839.
- Gerber C, Galantay RV, Hersche O. The pattern of pain produced by irritation of the acromioclavicular joint and the subacromial space. J Shoulder Elbow Surg 1998; 7:352.
- Reilly P, Macleod I, Macfarlane R, et al. Dead men and radiologists don't lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl 2006; 88:116.
- Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br 1995; 77:296.
- Yamaguchi K, Ditsios K, Middleton WD, et al. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am 2006; 88:1699.
- Murrell GA, Walton JR. Diagnosis of rotator cuff tears. Lancet 2001; 357:769.
- Sørensen AK, Bak K, Krarup AL, et al. Acute rotator cuff tear: do we miss the early diagnosis? A prospective study showing a high incidence of rotator cuff tears after shoulder trauma. J Shoulder Elbow Surg 2007; 16:174.
- Wolff AB, Sethi P, Sutton KM, et al. Partial-thickness rotator cuff tears. J Am Acad Orthop Surg 2006; 14:715.
- Rowan KR, Andrews G, Spielmann A, et al. MR shoulder arthrography in patients younger than 40 years of age: frequency of rotator cuff tear versus labroligamentous pathology. Australas Radiol 2007; 51:257.
- Kane SM, Dave A, Haque A, Langston K. The incidence of rotator cuff disease in smoking and non-smoking patients: a cadaveric study. Orthopedics 2006; 29:363.
- Wendelboe AM, Hegmann KT, Gren LH, et al. Associations between body-mass index and surgery for rotator cuff tendinitis. J Bone Joint Surg Am 2004; 86-A:743.
- Neer CS 2nd. Impingement lesions. Clin Orthop Relat Res 1983; :70.
- Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med 1980; 8:151.
- Itoi E, Minagawa H, Yamamoto N, et al. Are pain location and physical examinations useful in locating a tear site of the rotator cuff? Am J Sports Med 2006; 34:256.
- Sher JS, Uribe JW, Posada A, et al. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am 1995; 77:10.
- Dunn WR, Kuhn JE, Sanders R, et al. Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear. J Bone Joint Surg Am 2014; 96:793.
- Fukuda H. Partial-thickness rotator cuff tears: a modern view on Codman's classic. J Shoulder Elbow Surg 2000; 9:163.
- Gotoh M, Hamada K, Yamakawa H, et al. Interleukin-1-induced subacromial synovitis and shoulder pain in rotator cuff diseases. Rheumatology (Oxford) 2001; 40:995.
- Moosmayer S, Smith HJ, Tariq R, Larmo A. Prevalence and characteristics of asymptomatic tears of the rotator cuff: an ultrasonographic and clinical study. J Bone Joint Surg Br 2009; 91:196.
- Schibany N, Zehetgruber H, Kainberger F, et al. Rotator cuff tears in asymptomatic individuals: a clinical and ultrasonographic screening study. Eur J Radiol 2004; 51:263.
- Kim HM, Teefey SA, Zelig A, et al. Shoulder strength in asymptomatic individuals with intact compared with torn rotator cuffs. J Bone Joint Surg Am 2009; 91:289.
- Park HB, Yokota A, Gill HS, et al. Diagnostic accuracy of clinical tests for the different degrees of subacromial impingement syndrome. J Bone Joint Surg Am 2005; 87:1446.
- Luime JJ, Verhagen AP, Miedema HS, et al. Does this patient have an instability of the shoulder or a labrum lesion? JAMA 2004; 292:1989.
- Jain NB, Luz J, Higgins LD, et al. The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear: The ROW Cohort Study. Am J Phys Med Rehabil 2017; 96:176.
- Hegedus EJ, Goode A, Campbell S, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. Br J Sports Med 2008; 42:80.
- Hermans J, Luime JJ, Meuffels DE, et al. Does this patient with shoulder pain have rotator cuff disease?: The Rational Clinical Examination systematic review. JAMA 2013; 310:837.
- Keener JD, Wei AS, Kim HM, et al. Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears. J Bone Joint Surg Am 2009; 91:1405.
- de Jesus JO, Parker L, Frangos AJ, Nazarian LN. Accuracy of MRI, MR arthrography, and ultrasound in the diagnosis of rotator cuff tears: a meta-analysis. AJR Am J Roentgenol 2009; 192:1701.
- Lenza M, Buchbinder R, Takwoingi Y, et al. 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; :CD009020.
- Smith TO, Daniell H, Geere JA, et al. The diagnostic accuracy of MRI for the detection of partial- and full-thickness rotator cuff tears in adults. Magn Reson Imaging 2012; 30:336.
- Gazzola S, Bleakney RR. Current imaging of the rotator cuff. Sports Med Arthrosc 2011; 19:300.
- Sershon RA, Mather RC, Sherman SL, et al. Low accuracy of interpretation of rotator cuff MRI in patients with osteoarthritis. Acta Orthop 2013; 84:479.
- Iannotti JP, Zlatkin MB, Esterhai JL, et al. Magnetic resonance imaging of the shoulder. Sensitivity, specificity, and predictive value. J Bone Joint Surg Am 1991; 73:17.
- Chun KA, Kim MS, Kim YJ. Comparisons of the various partial-thickness rotator cuff tears on MR arthrography and arthroscopic correlation. Korean J Radiol 2010; 11:528.
- Omoumi P, Bafort AC, Dubuc JE, et al. Evaluation of rotator cuff tendon tears: comparison of multidetector CT arthrography and 1.5-T MR arthrography. Radiology 2012; 264:812.
- Edmonds EW, Eisner EA, Kruk PG, et al. Diagnostic shortcomings of magnetic resonance arthrography to evaluate partial rotator cuff tears in adolescents. J Pediatr Orthop 2015; 35:407.
- Waldt S, Bruegel M, Mueller D, et al. Rotator cuff tears: assessment with MR arthrography in 275 patients with arthroscopic correlation. Eur Radiol 2007; 17:491.