Rotator cuff disease – basics of diagnosis and treatment

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 nonsteroidal 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 nonoperative 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.

Rehabilitation after Rotator Cuff Repair

“…Symptomatic disease affects between 4% and 32% of the patients’ population with rotator cuff tears [1]. Although patient’s age, activity level, size of the tear and smoking status influence the decision of management, frequently the preferred method of initial treatment is non-surgical.…”

Physical Therapy and Rehabilitation after Rotator Cuff Repai: A Review of Current Concepts

“…The teres minor originates on the posterior surface of the axillary border of the scapula, and inserts below the supraspinatus insertion on the greater tuberosity and immediately inferior to the greater tuberosity. The supraspinatus, infraspinatus, and teres minor make up the posterosuperior rotator cuff, which is responsible for abduction, forward flexion, and external rotation moments [1,19,23,24]. The subscapularis muscle is the only rotator cuff muscle that originates anterior to the scapula.…”

Biocompatible chitosan–collagen–hydroxyapatite nanofibers coated with platelet-rich plasma for regenerative engineering of the rotator cuff of the shoulder

“…2 In view of 2010 studies, around 5 million individuals in the USA have some dimension of discomfort in the shoulder, requiring doctor's visits for more assessment. 3 Of the 5 million appointments, roughly 4 lakh patients underwent surgeries to treat rotator cuff injuries. 4 The problems of high expensive surgeries and United follow up nonoperative medicines, high disappointment rates running between 20 and 70% have been accounted for aer RCF surgical repair.…”