Evidence-based practice is limited by the low quality of research found in the literature and the poor evidence level of the reviewed studies. More high-quality research is needed.
At least some patients with small rotator cuff tears have the ability to recover normal shoulder function, and for these patients, long-term results in the shoulder range of motion are satisfactory after a single treatment in most cases.
Tear characteristics such as location, size, and severity are important. A tear will often result in increased shoulder pain, decreased shoulder motion, and pain with lifting/carrying. Decreased shoulder function results in the inability to meet work or sporting requirements. Subjective data are paramount as it is the only measure that can distinguish between a traumatic rotator cuff tear and a degenerative tear. Magnetic resonance imaging (MRI) is the gold standard method for diagnosis and follow-up of rotator cuff tears.
Approximately one-third of patients with rotator cuff tears undergo surgery. Most rotator cuff repairs are performed using sutures; other techniques include arthroscopy and anchor repair. Complications of rotator cuff repair include deltoid muscle injury and revision procedures.
Symptoms were common. Symptoms included shoulder pain, fatigue, weakness, or stiffness and were worse when the shoulder was in abduction. Pain was seen in more than half of patients. The shoulder mobility, arm function and shoulder strength were unaffected. The patient was able to return to daily activities, work and sport. There was no correlation between the symptoms and the range of motion, muscle strength, activity level, or the ability to participate in sports activities. In the study, only a minority had physical examination findings suggestive of a tear. Results from a recent clinical trial of an MRI of the shoulder indicate that the labrum most often remains intact. [BMI (body mass index)] has been found to be an independent risk factor for tearing the rotator cuff [M.
In a recent study, findings shows significant over- and under-reporting of rotator cuff tear rates. When we correct for these under- and over-reporting rates there appears to be no significant trend in rotator cuff tear severity rates or rates of surgical repair.
Traumatic tearing of the rotator cuff is a major risk factor for subsequent tears in individuals without a family history of the disorder, as well as in people with a family history of the disorder. A history of shoulder dysfunction in the first degree relative may be an independent risk factor. This data may provide insight into the prevention of rotator cuff tears or tear progression.
Since this is the first study to analyze the association of self-reported symptoms of rotator cuff tears and radiographic findings, we conclude that in middle-aged patients without prior rotator cuff tears, the presence of rotator cuff tears has little effect on functional outcomes.
A non-statistic analysis of a large dataset was used to assess the efficacy of therapeutic exercise for treatment of painful rotator cuff tendinopathy / subacromial pain syndrome. Although data were not significant and data from previous studies were omitted from this analysis, there are strong indications that exercise may assist in the healing process and reduce pain. It will be interesting to see results of an ongoing randomised design. Data from a recent study are not statistically significance enough to be a reason enough to recommend therapeutic exercise. The evidence level used here is low. This is not a recommendation for treatment, but rather a suggestion of things to do more high quality research on.
To date, some of the existing treatment modalities for rotator cuff tendinosis seem to prove useful in minimizing the healing time and reducing the risk of rotator cuff tears. A meta-analysis conducted on randomized studies showed no significant difference between suture-reinforced and nonreinforced arthroscopic treatment for rotator cuff tendinosis, other than the suture-reinforced technique significantly reducing pain in the short-term compared to the nonreinforced technique. However, in the long-term randomized studies showed no difference in either pain, pain resolution or reoperation. Additional randomized clinical studies with longer follow-up is needed to make a conclusion.
Recent findings of this study suggest that exercise can significantly improve health-related quality of life for those with rotator cuff tendinopathy/subacromial pain syndrome regardless of severity of disease.
About half of rotator cuff tears are due to a previous episode of blunt force trauma. For older patients, it is most likely that a shoulder subluxation or dislocation is the cause of the tear. More commonly, rotator cuff tears are due to strenuous labour-related movements of the arm with a repetitive tear. For patients older than 65 years, pain typically begins in the upper back or shoulder area. The disorder responds well to conservative medical treatment.