Science & nature · Evidence-backed
Rotator Cuff Injuries
The rotator cuff is a group of four muscles and their tendons that stabilise the shoulder joint. Injuries range from inflammation and partial tears to full-thickness ruptures, often related to age, overhead activity, or trauma. Understanding the anatomy, risk factors, and evidence-based options is key to informed decision‑making.
A concise overview of rotator cuff injuries, their causes, symptoms, diagnosis, and management, grounded in the supplied orthopaedic evidence.
Anatomy of the rotator cuff
The rotator cuff comprises four muscles – supraspinatus, infraspinatus, teres minor, and subscapularis – and their tendons, which form a cuff over the head of the humerus and enable shoulder rotation and elevation.
Prevalence increases with age
Rotator cuff tears are most common in individuals over 60 years, with prevalence rising significantly after age 70, often due to degenerative changes rather than acute injury.
Common causes in younger adults
In younger populations, acute trauma, repetitive overhead motions, and sports such as baseball, swimming, or tennis are frequent causes of rotator cuff damage.
Symptoms of a rotator cuff tear
Typical symptoms include shoulder pain, weakness, limited range of motion, and difficulty performing overhead tasks or sleeping on the affected side.
Physical examination findings
Clinicians may detect weakness on abduction, positive drop‑arm sign, and reduced external rotation strength during a targeted orthopaedic examination.
Imaging for diagnosis
Ultrasound and magnetic resonance imaging (MRI) are the primary modalities used to confirm the presence, size, and retraction of a rotator cuff tear.
Non‑operative treatment options
Initial management often includes physiotherapy, non‑steroidal anti‑inflammatory drugs, activity modification, and corticosteroid injections for pain relief.
Physiotherapy effectiveness
Structured physiotherapy can improve pain and function in many patients with partial‑thickness tears or chronic impingement, potentially avoiding surgery.
Surgical repair indications
Surgery is typically considered for full‑thickness tears, significant functional loss, failure of conservative treatment, or in younger, active patients with acute injuries.
Surgical techniques
Common approaches include arthroscopic repair, open repair, and mini‑open repair, with arthroscopy increasingly favoured for less morbidity and faster recovery.
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