Rotator cuff syndrome
Rotator cuff syndrome spans subacromial impingement, tendinopathy, and full-thickness tear of the supraspinatus and its neighboring tendons, presenting with lateral shoulder pain worse with overhead activity and at night. Impingement is managed with activity modification, NSAIDs, physical therapy, and corticosteroid injection, while a confirmed full-thickness tear with weakness or failed conservative therapy is referred for surgical repair.
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What this article covers
- Overview
A spectrum, not a single lesion: rotator cuff syndrome spans subacromial impingement, tendinopathy (tendinosis), and partial- or full-thickness tear of the rotator cuff tendons, with impingement or tendinopathy often preceding a full tear.
- Epidemiology
The leading cause of shoulder pain in older adults, typically related to impingement, glenohumeral osteoarthritis, or a superimposed acute traumatic event.
- Risk factors
Age over 40 years. Repetitive overhead activity: occupations or sports requiring sustained arm elevation (throwing, swimming, overhead lifting) accelerate tendon degeneration and impingement.
- Pathophysiology
Impingement from mechanical compression: the rotator cuff tendons, most often the supraspinatus, are compressed between the humeral head and the acromion process, producing pain that is classically worse with abduction.
- Clinical features
Anterolateral or lateral deltoid shoulder pain, worse with abduction and external rotation, and classically worse at night, which is the feature that separates rotator cuff pathology from the…
- Differential diagnosis
Adhesive capsulitis: global loss of both active and passive range of motion in multiple planes, unlike the motion loss confined to abduction and external rotation with preserved passive motion in…
- Diagnosis
Rotator cuff syndrome is a clinical diagnosis confirmed by the history and provocative exam findings (painful arc, Neer and Hawkins signs, drop-arm and empty-can tests), with imaging used to grade…
- Management
First, for impingement or tendinopathy without a confirmed tear, start conservative therapy: rest and activity modification (avoiding repetitive overhead motion), combined with an NSAID and…
- Complications
Progression to full-thickness tear if impingement or tendinopathy is not addressed, particularly with continued overhead activity.
- Prognosis
Impingement and tendinopathy generally respond well to conservative management, with most patients improving with rest, NSAIDs, and physical therapy alone.
- Prevention
Activity modification and load management in overhead athletes and workers (avoiding sustained repetitive overhead motion, building in rest intervals) reduces cumulative impingement and tendon degeneration.
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