English

Abstract

Introduction Rotator cuff tears are a common cause for shoulder pain in the older population. The aetiology and pathophysiology are not fully understood. Theories for tear evolvement are divided into intrinsic (e.g. recurrent microtrauma) and extrinsic (e.g. subacromial impingement). The subacromial bursa is probably the source of pain in symptomatic patients with rotator cuff tears. It is uncertain whether the tear itself can produce pain because of the high prevalence of asymptomatic tears. Typically, there is a gradual increase in shoulder pain and weakness; however, it can present acutely due to an injury. Difficulties in overhead activities and night pain are common. Imaging such as ultrasound and magnetic resonance are required for accurate evaluation of RCTs in patients with ongoing pain and limitations. Primary treatment includes activity modifications, pain relief and physical therapy. Surgery is advised for acute tears in active patients or chronic symptomatic tears in patients that fail to improve. This article discusses the evaluation and treatment of rotator cuff tears. Conclusion Symptoms of pain and weakness about the shoulder imply on rotator cuff tear. There are typical impingement signs in physical evaluation together with limited range of motion and weakness. Plain radiography is required to rule out other pathologies and observe acromion morphology, while ultrasound and magnetic resonance imaging are used to define the tear and tendon quality before surgical intervention. Most repairs are currently performed in an all-arthroscopic minimally invasive technique with easier rehabilitation and less pain compared to the traditional open surgery. Introduction Shoulder pain is a very common complaint. Studies report on about one-third of the population that suffer from shoulder symptoms during their lifetime. One of the main causes for shoulder pain in the older population is rotator cuff tears (RCTs). The prevalence of RCTs in the general population is 20%1. Without appropriate evaluation and treatment, the pain may persist for a long period of time. Since the early 1990s, there was a significant progress in arthroscopic surgery techniques for symptomatic tears of the rotator cuff. Currently, selected patients are treated with these techniques with high success and low morbidity rates. The aim of this review was to discuss the methods for evaluation and the treatment techniques for RCTs. Anatomy There are two synovial spaces in the shoulder—the glenohumeral and subacromial spaces. Between those spaces is the rotator cuff complex of four tendons together with the underlined joint capsule2. These are the supraspinatus, infraspinatus and teres minor, which originate from the posterior scapula and insert into the greater tuberosity of the proximal humerus, and the subscapularis that originate from the anterior scapula and insert into the lesser tuberosity. The RC moves and stabilises the humeral head in the centre of the glenoid by the principle of coupling forces. The subacromial bursa is localised in between the RC below and the acromion with thecoracoacromial ligament (CAL) above. The normal separation between the glenohumeral and subacromial spaces is violated when there is a full-thickness tear of the RC. The most common tear of the RC involves the supraspinatus tendon. This tendon has a unique structure of several parallel independent fibre units that allows for wide-ranging mobility3. During movement, some units are elongated, while others are shortened. The sheering forces that are produced can cause pathology. Tear types Accurate description of RCTs is essential for clinical and academic purposes. Measurements can be done by imaging or at surgery. It is usually defined by the tendon involved, its thickness (partial or complete) and size (anterior to posterior). Crescent shape tear is the most common full-thickness configuration. Pathophysiology Codman4 described a hypovascularised zone adjacent to the supraspinatus insertion site. Although the pathological process is not fully understood, it is degenerative and deteriorates with age. Imaging studies have shown that the prevalence of asymptomatic RCTs is 30% and 65% * Corresponding author Email: barak_haviv69@hotmail.com 1 Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel 2 Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University P.O. Box 39040, Tel Aviv 6997801, Israel