Rotator Cuff Tear

Rotator cuff tear occurs because of direct trauma or degeneration and can involve partial- or full-thickness. Degenerative rotator cuff tear tends to occur in adults over 40 years of age and its pathological changes include increased fibroblast cellularity, neovascularity, thinning or loss of collagen matrix, and fatty infiltration. The biceps tendon can be affected in lieu of a rotator cuff tear. Superior migration of humeral head can be seen in massive rotator cuff tear and rotator cuff tear arthropathy may ensue as result of repetitive cartilage wear. Patients with rotator cuff tear complain of shoulder pain, loss of range of motion, weakness, and limitations in self-care and overhead activities. Magnetic resonance imaging (MRI) is the most commonly used imaging modality to diagnose rotator cuff tear and it can provide information on tear thickness, size, fatty infiltration, muscle atrophy, and tendon retraction. Ultrasound visualizes cuff tear as an area of hypoechogenicity and can achieve diagnostic sensitivity and specificity comparable to MRI; however, it is operator dependent. Magnetic resonance angiography is an invasive imaging modality and indicated when labrum tear is suspected. Both conservative and operative treatments can be used for rotator cuff tear but strong evidence for decision-making is still lacking. Surgery is preferred for acute traumatic tear and chronic symptomatic full-thickness tear, non-responsive to conservative treatment. Nonoperative treatment entails pharmacological treatment, physical therapy, and procedures. Pain control can be achieved by nonsteroidal anti-inflammatory drugs, selective cyclooxygenase 2 inhibitor, acetaminophen, and cryotherapy. Ultrasound guided corticosteroid/lidocaine injection can be performed for symptom relief.