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Rotator cuff tears

Nature Reviews Disease Primers volume 10, Article number: 8 (2024) Cite this article

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Abstract

Rotator cuff tears are the most common upper extremity condition seen by primary care and orthopaedic surgeons, with a spectrum ranging from tendinopathy to full-thickness tears with arthritic change. Some tears are traumatic, but most rotator cuff problems are degenerative. Not all tears are symptomatic and not all progress, and many patients in whom tears become more extensive do not experience symptom worsening. Hence, a standard algorithm for managing patients is challenging. The pathophysiology of rotator cuff tears is complex and encompasses an interplay between the tendon, bone and muscle. Rotator cuff tears begin as degenerative changes within the tendon, with matrix disorganization and inflammatory changes. Subsequently, tears progress to partial-thickness and then full-thickness tears. Muscle quality, as evidenced by the overall size of the muscle and intramuscular fatty infiltration, also influences symptoms, tear progression and the outcomes of surgery. Treatment depends primarily on symptoms, with non-operative management sufficient for most patients with rotator cuff problems. Modern arthroscopic repair techniques have improved recovery, but outcomes are still limited by a lack of understanding of how to improve tendon to bone healing in many patients.

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Fig. 1: Structural anatomy of the rotator cuff when viewed from the anterior and posterior aspects.
Fig. 2: Representative pathology and functional differences in rotator cuff pathology.
Fig. 3: Muscle and tendon biology of the rotator cuff.
Fig. 4: Surgical anatomy of rotator cuff tears.
Fig. 5: Algorithm for rotator cuff tear treatment.

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Acknowledgements

The authors acknowledge S. E. Feeley for her initial artwork for the Primer.

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA

    Asheesh Bedi

  2. NorthShore Health System, Chicago, IL, USA

    Asheesh Bedi

  3. Department of Orthopedic Surgery, The Ohio State Wexner Medical Center, Columbus, OH, USA

    Julie Bishop

  4. Department of Orthopedic Surgery, Washington University, St. Louis, MO, USA

    Jay Keener

  5. Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA, USA

    Drew A. Lansdown & Brian T. Feeley

  6. Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK

    Ofer Levy

  7. Department of Surgery, Max Rady College of Medicine, Winnipeg, Manitoba, Canada

    Peter MacDonald

  8. Department of Trauma and Orthopaedic Surgery, Faculty of Medicine and Psychology, University of Rome Sapienza, Rome, Italy

    Nicola Maffulli

  9. Department of Orthopedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul, Korea

    Joo Han Oh

  10. HCA Florida JFK Orthopaedic Surgery Residency Program, Atlantis Orthopedics, Atlantis, FL, USA

    Vani J. Sabesan

  11. Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA

    Joaquin Sanchez-Sotelo

  12. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Riley J. Williams III

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Contributions

Introduction (B.T.F. and A.B.); Epidemiology (J.K. and P.M.); Mechanisms/pathophysiology (A.B. and B.T.F.), Diagnosis, screening and prevention (R.J.W.III, J.B. and D.A.L.), Management (O.L., J.H.O. and V.J.S.), Quality of Life, (J.S.-S.) Outlook (N.M.); Overview of Primer (B.T.F.).

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Correspondence to Brian T. Feeley.

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Nature Reviews Disease Primers thanks A. Carr; N. Jain, who co-reviewed with R. Prakash; and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Bedi, A., Bishop, J., Keener, J. et al. Rotator cuff tears. Nat Rev Dis Primers 10, 8 (2024). https://doi.org/10.1038/s41572-024-00492-3

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