Rotator cuff disorders - Recognition and management among patients with shoulder pain

Rotator cuff disease is a frequent cause of shoulder pain and encompasses a spectrum of pathologic changes, ranging from tendinosis to subacromial impingement to partial- and full-thickness tears. Most rotator cuff injuries can be adequately diagnosed on the basis of a careful history review and physical examination, and respond well to conservative measures. The subset of individuals who experience acute onset of weakness, especially in the setting of trauma in younger patients, requires early diagnostic investigation to exclude the possibility of a significant rotator cuff tear. These patients should be referred to a shoulder specialist early on for potential surgical intervention. Overall, studies have found satisfactory results of nonoperative treatment in more than 50% of patients with full-thickness tears and in more than 70% of patients with impingement syndrome (40). Failures in the treatment of full-thickness tears were generally due to persistent weakness even in the face of substantial improvements in pain and motion (65,66). Prognostic factors for poor outcome are a tear size >3 cm, and duration of symptoms for longer than 6-12 months. Among those patients undergoing surgical repair, ∼85% can expect substantial pain relief and at least partial restoration of strength (65).