A study of individuals 50 years and older demonstrates more than two-thirds of the U.S. population has at least one rotator cuff tendon abnormality. The highest numbers of tendon tears are for the subscapularis tendon (38.9%) and biceps tendon (26.8%).
The outcomes of rotator cuff repair vary widely, with the most common failure being re-rupture of repair. Although most re-ruptures can be managed with repeat procedures, a significant proportion must be managed with index procedures, of which cuff repair yields good results the vast majority of the time. A small proportion fails with non-specific management (i.e. watchful waiting), which is difficult to define with the available data. The most successful outcome after re-rupture is when the cuff is treated by repair, which usually will prevent further re-rupture.
The surgical treatment most frequently used by orthopaedic surgeons is an arthrotomy, followed by repair of a cuff tear. The arthrotomy has a low recurrence rate for full healing of the cuff tear and is recommended in all cases with intact biceps tendon. The arthrotomy is recommended as the treatment of choice for partial-thickness or full-thickness tears in all cases, regardless of patient age or severity of the rotator cuff tear. The arthrotomy can be carried out laproscopically or from an endoscopic approach.
Rotator cuff injuries are common in athletic young female athletes. Imaging studies are an essential part of a comprehensive assessment of this disease state. The diagnosis of rotator cuff tears is difficult to make on clinical criteria alone. Clinical examination combined with MRI may provide more information that allows the establishment of a definite diagnosis.
A sudden onset of shoulder pain is the key to recognizing an acute rotator cuff tear in a young, healthy person. The patient should be asked to look at the other hand and rotate the shoulder to search for a tear. A patient with pain that worsens within a few days should be advised to undergo a magnetic resonance imaging, preferably on a multi-slice or a multi-detector row system, which allows for faster and more precise imaging. The presence of any fluid or fatty degeneration within the tear should be noted along with the thickness of the full-thickness tears.
The rotator cuff is the most common site of rotator cuff tears in subjects with shoulder symptomatology, including subacromial impingement syndrome. An exhaustive assessment of shoulder symptomatology should be part of the workup for diagnosing subacromial impingement.
Familial shoulder diseases of an undetermined etiology are not uncommon. In our cohort, the inheritance of these diseases exhibited an X-linked recessive pattern. When they affect two male members of a family, this underscores the need for early recognition and management.
The most common underlying causes of rotator cuff tears were tear of the supraspinatus tendon and degenerative changes. A minority of patients, however, had an acute traumatic tendon tear, and a smaller group had bursitis of the rotator cuff as only contributing factor. The primary cause of the majority of rotator cuff tears is idiopathic.
A recent Cochrane review showed that there is not enough high-quality evidence to conclude on the treatment of adhesive capsulitis. Two studies showed reduced shoulder pain and other symptoms. Another study reported fewer symptoms when injecting the shoulder with corticosteroids. One trial found that the injections reduced pain more than the placebo. A third trial showed that steroid injections may be just as good or a better option than arthroscopic surgery. A fifth trial found patients treated with injections received one treatment less of pain and stiffness than the placebo. Another study reported pain scores improved. A sixth trial found patients with symptoms of adhesive capsulitis who underwent arthroscopic treatment had fewer symptoms than those who received injection or did not undergo treatment.
There is a risk of worsening symptoms and, in some patients, complete shoulder deterioration. A full-thickness tear can often give rise to shoulder pain and stiffness that are resistant to treatments.
No clinical trials have included an experimental group(bursa implantation)/control group(surgery, surgery, or no intervention). A follow-up period of less than one year in most of the studies may be too short a duration to have significant clinical implications.
The most common common side effects of experimental group(bursa implantation) were transient pain during surgery (1.4%); postoperative edema with subclinical effusion(1.3% vs. 0.2%); and effusion(0.1% vs. 0.0%); but these are not serious side effects. The side effects were not associated with gender.