A thorough examination is important to help rule out other causes of shoulder pain. Some of the symptoms a patient will present with are pain, which is often worse when the arm is raised overhead, instability, weakness and limited range of motion. Other complaints are swelling, numbness and propping of the shoulder. The pain could start acutely or worsening in a course of a known repetitive activity. In older people, the symptoms are often deceptive with no precise injury [6].

• Inflammation

  These symptoms lead to a continuing cascade of dysfunction, including continued spreading inflammation to the other structures of the shoulder such as the bursa. Traditionally, cortisone injections are used to decrease inflammation. [stoneclinic.com]

  Hot packs After about two or three days, when the pain and inflammation have improved, hot packs (used for 20 minutes at a time) may help relax tightened and sore muscles. Take pain relieving medications. [phongtran.com.au]

  It’s caused by inflammation of the bursa. These are fluid-filled sacs that sit between the rotator cuff tendons and the underlying bone. Rotator cuff strains or tears are caused by overuse or acute injury. [healthline.com]

  In some cases, steroid injections such as cortisone may be used to relieve pain and inflammation. [medicinenet.com]

• Severe Pain

  If rotator cuff tears left untreated to accelerated wear and tear of the joint causing severe pain and further restriction of movements, the condition is called as “Rotator cuff arthropathy”. [ortho-one.in]

  Rotator cuff tears, whether acute or chronic can cause severe pain. [howardluksmd.com]

  When left untreated, this injury can cause severe pain and a decrease in the ability to use the arm. Rotator cuff tears are called either “full-thickness” or partial-thickness” depending on how severe they are. [riverdalept.com]

  Rotator cuff tears cause severe pain (even at rest), weakness and a crackling sensation on moving your shoulder in certain positions. There may be stiffness, swelling, loss of movement and tenderness in front of the shoulder. [carrellclinic.com]

• Arm Pain

  Pain may also be felt when moving the arm in certain ways. The pain stops before the elbow. If the injury is acute (sudden) pain will be intense and immediate. If the injury is degenerative (damage occurs over time) the pain may be mild at first. [medicinenet.com]

  If you sustain a rotator cuff tear you are likely to experience shoulder and arm pain, restricted shoulder movement and pain at night. Sometimes rotator cuff tears can occur slowly without any pain or discomfort. [psmgroup.com.au]

  Pain If you have a torn rotator cuff, you will experience pain over the outside of the shoulder and upper arm. Pain most commonly occurs while performing overhead activities. [scoi.com]

  These symptoms may include: pain or swelling in the front of the shoulder pain or swelling in the side of the arm pain when raising or lowering the arm clicking or popping sound when the arm is moved pain that disrupts sleep loss of mobility or strength [hss.edu]

• Turkish

  [All arthroscopic treatment of rotator cuff tears][in Turkish]. Acta Orthop Traumatol Turc. 2003;37(suppl 1):93–104. PubMed Google Scholar 5. Faucett J, Gordon N, Levine J. Differences in postoperative pain severity among four ethnic groups. [doi.org]

• Shoulder Pain

  Many patients with severe shoulder pain have very small full thickness rotator cuff tears, partial thickness rotator cuff tears, or no tear at all. Yet some patients with mild shoulder pain have massive rotator cuff tears. [howardluksmd.com]

  It is a common cause of shoulder pain and disability in people of all age groups. A rotator cuff tear weakens the shoulder making normal daily activities like combing the hair painful and difficult to do. [symptoma.com]

  The main symptoms are pain in and around the shoulder joint and painful movement of the shoulder. If there has been an injury, the pain may come on suddenly. Pain is worst when you use your arm for activities above your shoulder level. [patient.info]

  Symptoms of rotator cuff injuries are due to inflammation and swelling in the rotator cuff and include: Pain in the shoulder and arm. Pain is felt often at night when lying on the affected shoulder. [medicinenet.com]

• Arthritis

  For example, shoulder arthritis, AC joint arthritis Spurs Calcium deposits Ultrasound Scan. An ultrasound scan can diagnose rotator cuff tears. It is painless and easy to obtain. However, it can sometimes be inaccurate. MRI Scan. [phongtran.com.au]

  CONCLUSION: ARCR can lead to reversal of preoperative pseudoparalysis in patients with minimal preoperative glenohumeral arthritis. [ncbi.nlm.nih.gov]

  Hand and Wrist Arthritis Carpal Tunnel Syndrome Trigger Finger Thumb Arthritis (Basal Joint, CMC, Gamer’s Thumb, Texting Thumb) Other conditions that cause pain Learn More Elbow Most injuries of the elbow’s tendons and ligaments, as well as arthritis, [regenexx.com]

  They are specifically useful in ruling out calcific tendonitis and predisposing factors such as type III acromions or acromioclavicular joint arthritis. [aafp.org]

• Frozen Shoulder

  Major factors that contribute to frozen shoulder include: Age and gender – People between the ages of 40 – 60 years, particularly women over 40, are more likely to suffer from frozen shoulder. [orthoatlanta.com]

  A popping or clicking noise when moving the shoulder. Frozen Shoulder The signs and symptoms of a frozen shoulder include: Stiffness in the joint. Tightness. Unable to lift the arm. Fracture The signs and symptoms of a fracture include: Severe pain. [niams.nih.gov]

  However, just because an MRI scan shows a tear doesn’t mean it is the cause of your shoulder pain. The most common condition that mimics a rotator cuff tear is shoulder stiffness or a frozen shoulder. [hopkinsmedicine.org]

• Fracture

  After the initiation of physical therapy, he was diagnosed with an isolated greater tuberosity fracture. Little is known regarding the optimal management and overall prognosis of this type of fracture. [ncbi.nlm.nih.gov]

  Fracture Treatment for a fracture may include: A doctor putting the bones into a position to promote healing. A sling or other device to keep the bones in place. After the bone heals, exercise to strengthen the shoulder and restore movement. [niams.nih.gov]

• Stiffness of the Shoulder

  Frozen Shoulder Frozen shoulder is also known as adhesive capsulitis. It is characterized by pain and stiffness in the shoulder and sometimes in the upper arm. Symptoms will get progressively worse but with proper treatment can eventually recover. [orthoatlanta.com]

  The treatment is focused on maintaining the range of motion and preventing the shoulder from becoming stiff. It may include: Stretching for five minutes every day to prevent stiffness. [hopkinsmedicine.org]

  Pain that may be constant or come and go (such as only when you lie on the injured shoulder) Pain or stiffness in your shoulder that travels down your arm Trouble lifting your arm or placing it behind your back Trouble moving or using your shoulder A [drugs.com]

  You usually have normal shoulder strength. Shoulder arthritis: This type of arthritis causes limited shoulder motion and pain. Frozen shoulder: This is marked by stiffness in your shoulder, but your shoulder is typically strong. [orthobethesda.com]

• Neglect

  Focusing solely on the static stabilizers in treatment neglects the dynamic structures that probably initiate and perpetuate the cycle. [emedicine.com]

  […] overusing the shoulder by throwing excessively large amounts of punches.[17] Certain track-and-field activities, such as shot put, javelin throw are also of considerable risk,[18] especially when performing outdoors under cold weather conditions or neglecting [en.wikipedia.org]

Imaging tests are the gold standard in rotator cuff tears. A plain radiograph of the shoulder is useful and the typical views are AP view to determine acromiohumeral distance which may be reduced. It will also show reactive changes at the rotator cuff insertion site like sclerosing and cyst formation. An outlet view will show the acromion shape and slope while the axillary view identifies the position of the humeral head in relation to the glenoid [7]. Magnetic resonance imaging is highly sensitive and specific and it shows the site, size and characteristics of rotator cuff injuries.

Ultrasonography is also useful and highly sensitive in detecting full thickness tears but it is extremely dependent on the skill of the observer. Electrodiagnostic testing can also be done to rule out nerve involvement and nerve conduction as a source of pain.

This could either be non-operative or operative. Non-operatative treatment is reserved for those who have relatively normal function in the affected limb. The modality includes the use of oral and topical analgesics to relieve pain, a shoulder sling to reduce movement of the joint, physical therapy to avoid joint stiffness due to immobility. As pain decreases, a strengthening program is instated to return the joint to its normal strength [8].

When operative treatment is indicated, the surgeries of choice are arthroscopy, mini-open and open repair. Arthroscopy was initially reserved for very small tears but with the advancement in technology, have been as successful as open surgery in the repair of large tears.

Most athletes respond well to nonsurgical treatment in primary outlet impingement without full thickness rotator cuff tears. When surgery is done, response is determined by a number of factors including age, size and pattern of the injury, degree of retraction, quality of the tissue and quality of the repair.

Rotator cuff tear could either be an acute episode or from a chronic degenerative insult. An acute episode results from a great force on the muscle such as a fall on the outstretched arm. A lesser force could also cause a tear if the muscle has already started undergoing some degeneration. It could also result from sudden heavy lifting.

Chronic causes include reduced perfusion, degeneration related to old age, repeated heavy lifting especially overhead and bone spurs, which are extra pieces of bone that may grow and irritate the muscle [2].

People at risk for this injury are older people, certain athletes like basket-ballers, and construction workers.

Rotator cuff injury occurs in as much as 40% of the population with the incidence increasing with age. Rotator cuff tears are commoner in males, affect the dominant arm more, and people that are involved in physical activity and those with a history of trauma [3].

The two main mechanisms of rotator cuff tears are injury and degeneration and they could either be due to intrinsic, when it occurs from within the rotator cuff itself, and extrinsic, when the source is from surrounding structures like the acromion, factors. A rotator cuff tear could also either be a partial thickness or a full thickness tear.

The amount of stress needed to acutely tear a rotator cuff depends on the condition before application of the force. In a healthy tendon, the force required is greater than that required in a tendon with preexisting degeneration [4].

Chronic tears are a result of wear that occurs over time, due to extended use, poor biomechanics or muscular imbalance and aging. They usually occur more in the dominant arm and the stressor is mainly from repeating the same shoulder motions frequently. Another factor in chronic tear is diminished blood supply. This occurs mainly in older people and it impairs the ability if the tendons to repair themselves leading to tears.

A third mechanism is what is referred to as impingement syndrome. The tendons of the rotator cuff pass through the subacromial space below the acromion, when they become inflamed, the space becomes smaller and there is pain on motion. Repeated impingement can lead to inflammation of the tendons and bursa and result in the syndrome [5].

Some preventive measures include, resting shoulder when experiencing pain, regular shoulder exercises, using proper form when lifting weight, and adequate rest periods in occupations that involve heavy lifting [9].

The shoulder joint has a wide range of motion, and it gives up stability for this wide range of motion making it a relatively unstable joint. Its stability is ensured by bony and muscular components. Part of this muscular component is the rotator cuff muscles. It is made up by 4 muscles; the supraspinatus, infraspinatus, subscapularis and teres minor [1]. These muscles come together via their tendons to stabilize the joint while it is in motion.

Definition

Rotator cuff tear is a tear in the muscles that help to stabilize the shoulder joint. These tears could be partial or full. They could also occur suddenly or build up over time.

Cause

It can result suddenly from trauma. It can also result from long term degeneration of the tendon associated with aging. Repeated motions of the joint in occupation that require lifting and reaching can also cause it as well as reduced blood supply to the tendon from any cause.

Symptoms

Symptoms include pain which could be worsened by raising the hand above the head. There could also be swelling and redness of the shoulder. The shoulder may also be numb and the range of motion may be lost. 

Diagnosis

Diagnosis is usually done by a plain X-ray of the joint. An MRI which is a more expensive procedure is also a very reliable diagnostic tool. An ultrasound in the hands of a skilled observer can also diagnose the condition.

Treatment

This involves the use of pain medications to reduce pain, shoulder slinging and physical therapy. For those who do not respond to conservative management or in whom rapid recovery is required, surgery may be performed [10]. 

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3. Janda DH, Loubert P. Basic science and clinical application in the athlete's shoulder. A preventative program focusing on the glenohumeral joint. Clin Sports Med. Oct 1991;10(4):955-71.
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7. Teefey SA, Hasan SA, Middleton WD, Patel M, Wright RW, Yamaguchi K. Ultrasonography of the rotator cuff. A comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am. Apr 2000;82(4):498-504. 
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9. Arroyo JS, Hershon SJ, Bigliani LU. Special considerations in the athletic throwing shoulder. Orthop Clin North Am. Jan 1997;28(1):69-78.
10. Cohen RB, Williams GR Jr. Impingement syndrome and rotator cuff disease as repetitive motion disorders.Clin Orthop Relat Res. Jun 1998;351:95-101.