II. Epidemiology

  1. Rotator cuff is responsible for most Shoulder Pain
  2. Age of onset typically over 40 years old

III. Anatomy

  1. See Shoulder Anatomy
  2. Rotator cuff fuses near humeral tuberosity
  3. Image
    1. ShoulderAnteriorRotatorCuff.jpg

IV. Risk Factors: Predisposition for injury increases with advancing age

  1. Trauma at tendons (especially supraspinatus)
  2. Secondary inflammation
  3. Thickening at subacromial bursa

VI. Symptoms

  1. Characteristics
    1. Lateral arm without radiation beyond elbow
    2. Associated with arm weakness
  2. Timing
    1. Night pain interferes with sleep
  3. Provocative
    1. Exacerbated by throwing motion
    2. Overhead work

VII. Signs

  1. Painful arc
  2. Positive Shoulder Impingement Signs

VIII. Differential Diagnosis

IX. Imaging

  1. Shoulder XRay (first-line)
    1. Calcific Tendonitis
    2. Hook Acromion (See Acromion XRay Findings)
    3. Bone cysts or sclerosis within humeral head
  2. Shoulder Ultrasound
    1. Evaluates Rotator Cuff Tears (esp. full thickness) well
    2. Best in patients older than age 40 years old (tend to have full thickness tears)
    3. Rotator cuff is nearly identical appearance as T2w MRI (with an inverse/negative of brightness/echogenicity)
  3. Shoulder MRI
    1. Best at evaluating differential diagnosis (e.g Labral Tear)
    2. Best in patients younger than age 40 years (tend to have partial tears and other pathology)

X. Management: Sample Protocol

  1. See specific rotator cuff conditions
    1. Rotator Cuff Tendonitis
    2. Rotator Cuff Rupture
    3. Rotator Cuff Calcification
  2. Initial Visit
    1. Evaluate for serious Traumatic Injury
      1. Careful Shoulder Exam
      2. Shoulder XRay
    2. Start Conservative Therapy
      1. Modify activity (e.g. Avoid overhead work, avoid heavy lifting)
      2. Start physical therapy and encourage early Shoulder mobilization
      3. NSAIDs
  3. Next Visit (at 3 weeks from onset)
    1. Consider Subacromial Corticosteroid Injection for severe or refractory symptoms
    2. Adjust activity restrictions
    3. Consider MRI and Orthopedic Consultation if suspect large Rotator Cuff Tear
      1. Traumatic Injury
      2. Severe pain and weakness
      3. Positive Drop Arm Test
      4. Weakness on Empty Cans Testing (esp. if persists despite injection)
  4. Next Visit (at 6 to 12 weeks from onset)
    1. Adjust activity restrictions
    2. Consider MRI and Orthopedic Consultation
      1. Suspected partial Rotator Cuff Tear and persistent symptoms
  5. Next visit (at 6 months from onset)
    1. Reevaluate Shoulder function and pain
    2. Consider permanent change in job duties if recurrent reinjury
    3. Consider repeat Subacromial Corticosteroid Injection
    4. Consider MRI and referral for persistent symptoms (esp. if Hook Acromion)
    5. Consider advanced measures (typically by sports medicine)
      1. Extracorporeal shock wave therapy
      2. Dextrose prolotherapy
      3. Platelet-rich plasma injection
        1. No benefit compared with saline injection Placebo
        2. Hurley (2019) Arthroscopy 35(5): 1584-91 [PubMed]
  6. Avoid Unhelpful Measures
    1. Kinesiology taping is no better than sham therapy in rotator cuff disease
      1. No benefit in overall pain, function, range of motion or quality of life
      2. Gianola (2021) Cochrane Database Syst Rev (8): CD012720 [PubMed]

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Related Studies

Ontology: Rotator cuff syndrome (C0263912)

Concepts Disease or Syndrome (T047)
ICD10 M75.1
SnomedCT 267991003, 156658000, 202839004, 268087008, 202845007, 267992005, 4106009
English Rotator cuff syndrome, Rotator cuff syndrome unspecif, Rotator cuff syndrome, unspecified, Rupt rotat cuff shoulder, ROTATOR CUFF SYNDROME, cuff rotator syndrome, cuff rotator tears, impingement syndrome, cuff rotator tear, rotator cuff tear, syndrome rotator cuff, rotator cuff rupture, tear rotator cuff, Rotator cuff syndrome, unspecified (disorder), Rotator cuff syndrome NOS (disorder), Rotator cuff tear, Rotator cuff rupture, Rupture of rotator cuff of shoulder, Impingement syndrome, Rotator cuff syndrome (disorder), rotator cuff syndrome, impingement; syndrome, rotator cuff; rupture, rotator cuff; syndrome, rotator cuff; tear, rupture; rotator cuff, syndrome; impingement, syndrome; rotator cuff, tear; rotator cuff, Rotator cuff syndrome, NOS, Rotator cuff syndrome NOS
Italian Sindrome della cuffia dei rotatori, Lacerazione della cuffia dei rotatori, Sindrome da impingement
Dutch rotator cuff scheur, impingement syndroom, impingement; syndroom, rotator cuff; ruptuur, rotator cuff; scheur, rotator cuff; syndroom, ruptuur; rotator cuff, scheur; rotator cuff, syndroom; impingement, syndroom; rotator cuff, Rotator cuff syndrome, rotator cuff syndroom
French Déchirure de la coiffe des rotateurs, Syndrome d'empiètement, Syndrome de la coiffe des rotateurs
German Rotatorenmanschettenabriss, Impingement-Syndrom, Laesionen der Rotatorenmanschette, Rotatorensyndrom der Schulter
Portuguese Laceração da coifa dos rotadores, Síndrome de choque, Síndrome da touca dos rotadores
Spanish Desgarro del manguito de los rotadores, Síndrome de pinzamiento articular, síndrome del manguito rotador, SAI, síndrome del manguito rotador, SAI (trastorno), síndrome del manguito rotador, no especificado (trastorno), síndrome del manguito rotador, no especificado, síndrome del manguito de los rotadores (trastorno), síndrome del manguito de los rotadores, Síndrome del manguito rotatorio
Japanese 肩回旋筋腱板症候群, 肩回旋筋腱板断裂, カタカイセンキンケンバンショウコウグン, カタカイセンキンケンバンダンレツ, インピンジメントショウコウグン, インピンジメント症候群, ケンカイセンキンケンバンショウコウグン
Czech Syndrom rotátorové manžety, Natržení rotátorové manžety, Koronární syndrom
Korean 근육둘레띠 증후군
Hungarian Rotatorköpeny syndroma, Impingement syndroma, Rotatorköpeny szakadás