Rotator Cuff Injury

Resistance bands used in shoulder physical therapy
Resistance bands used in shoulder physical therapy

Table of Contents

  1. What Is the Rotator Cuff?
  2. Types of Rotator Cuff Injuries
  3. Causes and Risk Factors
  4. Symptoms and Presentation
  5. Diagnosis
  6. Conservative Treatment
  7. Physical Therapy Programs and Exercises
  8. Natural and Supportive Approaches
  9. Surgical Options
  10. Complications and Prognosis
  11. Return to Activity and Prevention
  12. Key Research Papers
  13. Connections
  14. Featured Videos

What Is the Rotator Cuff?

The rotator cuff is a group of four muscles and their associated tendons that surround the glenohumeral joint — the ball-and-socket joint of the shoulder. Together these muscles hold the head of the humerus (the upper arm bone) within the shallow socket of the shoulder blade (glenoid fossa), while allowing the arm a wide range of motion in multiple planes.

The four muscles of the rotator cuff are:

Working together, the rotator cuff muscles act less like isolated prime movers and more like a force-couple system — compressing the humeral head into the glenoid socket and adjusting its position throughout the arc of motion. When the cuff is torn beyond repair, the humeral head can ride upward: in a case series of irreparable tears, the distance between the humeral head and the acromion averaged 4.6 mm before superior capsule reconstruction and 8.7 mm after it (Mihata 2013).

Rotator cuff tears are common, and many cause no symptoms. In an ultrasound survey of 683 residents of a Japanese mountain village (1,366 shoulders), 20.7% of shoulders had a full-thickness tear; 36% of people with current shoulder symptoms had a tear, and so did 16.9% of people without symptoms (Yamamoto 2010). A second village screening of 664 residents found full-thickness tears in 22.1%, rising from 0% in people in their 20s to 40s to 10.7% in their 50s, 15.2% in their 60s, 26.5% in their 70s and 36.6% in their 80s; about two-thirds of the tears caused no symptoms (Minagawa 2013). These findings mean that a tear seen on imaging is not necessarily the source of a person's pain.

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Types of Rotator Cuff Injuries

Rotator cuff injuries range from irritated but intact tendons to complete tears. The main categories are:

Rotator Cuff Tendinitis

Tendinitis (also spelled tendonitis) is irritation of one or more rotator cuff tendons without structural tearing. It is commonly attributed to repetitive overhead loading, and the tendon becomes painful with activity.

Subacromial Bursitis

The subacromial bursa is a fluid-filled sac that cushions the rotator cuff tendons from the overlying acromion. When it is inflamed, the pain is often diffuse and may be worse at night. Bursitis and tendinitis frequently occur together and can be difficult to tell apart on examination.

Subacromial Impingement Syndrome

Impingement describes pinching of the supraspinatus tendon and subacromial bursa between the humeral head below and the acromion (and coracoacromial ligament) above during arm elevation. A hooked (Type III) acromion is one proposed structural cause; a 2019 meta-analysis found almost three times greater odds of a rotator cuff tear in people with a Type III acromion than in those with Type I or II (odds ratio 2.82) (Morelli 2019). Whether removing bone under the acromion helps is discussed under Surgical Options: two placebo-controlled trials found that it did not outperform a diagnostic arthroscopy alone.

Partial-Thickness Rotator Cuff Tears

Partial tears involve damage to only part of the tendon's thickness. They can occur on the articular surface (the underside of the tendon, facing the joint) or on the bursal surface (the upper side, facing the subacromial bursa). Ellman's 1990 paper proposed a grading system for partial-thickness tears based on their location, depth and area, so that results from different investigators could be compared; it noted that the precise extent of a partial tear is difficult to define on imaging and is documented at arthroscopy, and described combining arthroscopic and open techniques when a partial tear in an active person involves more than half the cuff thickness (Ellman 1990).

Partial tears can grow. In a prospective study of people with a painless degenerative tear in one shoulder, followed for a median of 5.1 years, 44% of partial-thickness tears and 61% of full-thickness tears enlarged (Keener 2015).

Full-Thickness Rotator Cuff Tears

A full-thickness tear extends completely through the tendon, creating a hole that connects the glenohumeral joint with the subacromial space. These tears are described by their size and by the number of tendons involved. Trials often group them by size: the Norwegian repair-versus-physiotherapy trial enrolled tears not exceeding 3 cm (Moosmayer 2014), and a study of large and massive tears used a cut-off of more than 2 cm (Galatz 2004).

Fatty degeneration and wasting of the cuff muscles, seen on CT or MRI, did not reverse after repair in two cohort studies and were linked to poorer function (Goutallier 1994; Gladstone 2007). Over about six years in the Finnish trial, shoulder arthritis progressed across the trial population, and surgery did not protect against it or against cuff tear arthropathy (Kukkonen 2021).

Acute Traumatic Tears

Some full-thickness tears occur from a single event, such as a fall onto an outstretched arm or a forceful pulling injury, and present with sudden pain and weakness. In the Japanese village study, a history of trauma was one of three independent risk factors for a tear (Yamamoto 2010). The 2019 Cochrane review noted that the trials comparing surgery with non-operative treatment mostly enrolled small degenerative supraspinatus tears, so their conclusions may not apply to traumatic tears, large tears involving the subscapularis, or young people (Karjalainen 2019). Goutallier and colleagues, who found that infraspinatus fatty degeneration worsened with time, wrote that it seems preferable to operate on wide tears before irreversible muscle damage takes place (Goutallier 1994).

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Causes and Risk Factors

Rotator cuff injuries arise from a combination of tendon ageing, the loads placed on the shoulder, and individual factors. The studies below identified the following associations.

Age and Degenerative Change

Age is the factor most consistently linked to tears. In the two Japanese village screenings, age was an independent risk factor (Yamamoto 2010), and the prevalence of full-thickness tears rose from 0% before age 50 to 36.6% in people in their 80s (Minagawa 2013).

Repetitive Overhead Activity and Heavy Labor

In the Yamamoto village study, tears were more common in people engaged in heavy labor, although in the final statistical model the independent risk factors were a history of trauma, the dominant arm and age (Yamamoto 2010). Repetitive overhead loading in athletes and manual workers is a commonly proposed cause of tendinitis and tears; the village study did not measure overhead work specifically.

Anatomical Variation

Bigliani's classification of acromion shape describes three types: Type I (flat), Type II (curved), and Type III (hooked). A 2019 meta-analysis of 17 studies found almost three times greater odds of a non-traumatic rotator cuff tear with a Type III acromion than with Type I or II, and a link between a larger acromial index and tears (Morelli 2019).

Smoking

In 586 consecutive patients who had ultrasound for one-sided, non-traumatic shoulder pain, a history of smoking was more common in those with a tear (61.9%) than in those without one (48.3%), and the authors observed a dose-dependent and time-dependent relationship between smoking and tears (Baumgarten 2010). After repair, a 2022 meta-analysis of 14 studies found smoking associated with about twice the risk of re-tear (risk ratio 2.06) and a higher risk of reoperation (Fan 2022).

Dominant Arm and Genetics

The dominant arm was an independent risk factor in the Japanese village study (Yamamoto 2010). Family history also matters: in a study of 205 patients with full-thickness tears, their siblings had 2.42 times the risk of a full-thickness tear compared with spouses used as controls, and 4.65 times the risk of a symptomatic one (Harvie 2004).

Previous Shoulder Injury

A history of trauma to the shoulder was an independent risk factor for a tear in the Japanese village study (Yamamoto 2010).

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Symptoms and Presentation

Rotator cuff injury ranges from no symptoms at all to marked disability. In the second Japanese village screening, about two-thirds of full-thickness tears caused no symptoms (Minagawa 2013). How much a tear hurts is also only loosely tied to its size: in 169 patients with full-thickness tears, a mental-health score correlated more strongly with shoulder pain and function scores than tear size, retraction or the number of tendons involved did (Wylie 2016).

Pain

Pain is a common complaint. It is usually felt at the front and side of the shoulder and may spread into the upper arm. It is typically brought on by reaching overhead, reaching behind the back, or lifting the arm across the body. Many people report night pain that disturbs sleep, particularly when lying on the affected shoulder.

Weakness

Which movement is weak depends on which tendon is torn. A supraspinatus tear reduces abduction strength. Infraspinatus and teres minor tears impair external rotation. Subscapularis tears weaken internal rotation. In the Japanese village study, people with tears had less active forward elevation and weaker abduction and external rotation strength than people without them (Yamamoto 2010). Pain itself can limit strength testing and look like weakness even when no tendon is torn.

Stiffness and Limited Range of Motion

A rotator cuff injury may limit some movements, such as reaching behind the back, while others are kept. A general loss of motion in all directions is more typical of adhesive capsulitis (frozen shoulder), which can also follow a cuff injury or surgery.

Clicking, Catching, or Grinding

Some people describe clicking or catching inside the shoulder during movement. These sensations are not always significant, but combined with pain they raise the question of a structural problem.

Acute Traumatic Presentation

A traumatic tear usually follows a specific moment of injury — a fall, a heavy lift, a forceful jerk on the arm — with immediate pain and weakness. The trials comparing surgery with physiotherapy mostly enrolled degenerative tears, and two of them excluded tears with a traumatic onset, so their results may not apply to this group (Karjalainen 2019).

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Diagnosis

Diagnosis combines the history, physical examination and imaging. A 2012 systematic review with meta-analysis of shoulder examination tests concluded that no single test can make the diagnosis on its own, and that combinations of tests improve accuracy only marginally (Hegedus 2012).

Physical Examination Tests

A structured physical examination evaluates range of motion, strength, and special provocative tests. The major special tests include:

Imaging

Plain Radiographs

Standard shoulder X-rays cannot show tendons directly but can show secondary signs: an upward-shifted humeral head, the shape of the acromion, spurs at the acromioclavicular joint, calcium deposits in the tendon (calcific tendinitis), and arthritis of the joint.

MRI, MR Arthrography and Ultrasound

A 2013 Cochrane review of 20 studies (1,147 shoulders) in people being considered for surgery found summary sensitivity and specificity for full-thickness tears of 94% and 93% for MRI, 94% and 92% for MR arthrography (contrast injected into the joint first), and 92% and 93% for ultrasound, with no statistically significant difference between them; the authors judged that any of the three could be used to detect full-thickness tears. For any tear (partial or full thickness), summary sensitivity and specificity were 98% and 79% for MRI and 91% and 85% for ultrasound. Both MRI and ultrasound may have poor sensitivity for partial-thickness tears, and the sensitivity of ultrasound may be much lower than that of MRI. Most of the included studies were small and methodologically flawed (Lenza 2013). MRI also shows muscle wasting and fatty infiltration, which were linked to poorer function after repair (Gladstone 2007).

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Conservative Treatment

Several randomised trials have compared physiotherapy with surgical repair for degenerative tears:

Relative Rest and Activity Modification

"Relative rest" means reducing the activities that provoke pain — such as sustained overhead work, heavy lifting and sport-specific movements — without immobilising the arm. None of the trials on this page tested it on its own.

Ice and Heat

Ice and heat are used for symptom relief. None of the trials or reviews cited on this page tested them for rotator cuff injury.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)

Oral NSAIDs such as ibuprofen or naproxen, and topical NSAID gels, are used for pain relief. None of the trials or reviews cited on this page tested them for rotator cuff injury, and these sources do not address their effect on tendon healing.

Corticosteroid Injections

A 2010 Lancet systematic review of 41 randomised trials of injections for tendinopathy found that corticosteroid injections consistently reduced pain in the short term compared with other treatments, but that this effect reversed at intermediate and long term in the pooled analysis for tennis elbow; for rotator cuff tendinopathy, the authors reported that the short-term efficacy of corticosteroid injections was not clear. Of 991 participants given corticosteroid injections in studies that reported adverse events, one (0.1%) had a serious adverse event, a tendon rupture (Coombes 2010). Ultrasound guidance did not clearly improve results: a 2021 Cochrane review of 19 trials (1,035 participants) found that ultrasound-guided shoulder injection probably provides little or no clinically important benefit over injection without imaging for pain or function, and its authors concluded that the evidence does not support the use of image guidance (Zadro 2021).

Platelet-Rich Plasma (PRP)

PRP injections — in which a patient's own blood is processed to concentrate platelets and growth factors, then injected — have been studied as an alternative to surgery. A 2019 systematic review of 5 randomised trials (214 patients) concluded that the limited evidence suggests PRP injections may not be beneficial in the short term for chronic rotator cuff disease, and that PRP did not give better function, pain or range of motion when compared directly with exercise therapy (Hurley 2019). A 2021 meta-analysis of 8 randomised trials reached a different conclusion, that PRP injection was safe and effective for long-term pain and shoulder function, while noting that PRP preparation and control treatments varied between studies (A Hamid 2021).

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Physical Therapy Programs and Exercises

Physiotherapy was the non-operative treatment in the Finnish and Norwegian trials described above (Kukkonen 2014; Moosmayer 2014). In the Dutch trial of 56 patients, the Constant score of the conservatively treated group did not differ significantly from the surgical group at 12 months, although pain and disability scores favoured surgery (Lambers Heerspink 2015). Programs usually progress in phases, from pain control and range of motion to strengthening and then to activity-specific training. The exercises below are examples of what such programs commonly include; the trials on this page did not compare specific exercises with one another.

Early Phase: Pain Control and Range of Motion

The early phase aims to settle pain and regain passive range of motion without loading the injured tendon. Examples include:

Middle Phase: Rotator Cuff Strengthening

Once pain allows, programs move on to resisted strengthening, usually starting with light resistance and arm positions below shoulder height:

Later Phase: Functional Integration and Return to Activity

Later, exercises increase in load and become specific to the person's activities — sport-specific training and graded throwing for overhead athletes, or simulated work tasks for workers — along with balance and reaction (proprioceptive) training.

Scapular Stabilization

Programs also commonly include strengthening of the muscles that control the shoulder blade — the serratus anterior (for example wall push-up plus and scapular punches) and the lower and middle trapezius — because the shoulder blade's position affects the space under the acromion.

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Natural and Supportive Approaches

Research on nutrition and lifestyle in people with rotator cuff injury is limited. None of the approaches below has been tested in a trial of rotator cuff injury among the sources cited on this page; they are described with what has, and has not, been studied.

Collagen and Vitamin C

Tendons are composed mostly of type I collagen, and vitamin C is a cofactor for the enzymes that stabilise the collagen triple helix. In a small crossover study, 8 healthy men took 5 g or 15 g of vitamin C-enriched gelatin or a placebo before 6 minutes of rope-skipping; those who took 15 g one hour before exercise showed double the blood level of a marker of collagen synthesis (amino-terminal propeptide of collagen I) (Shaw 2017). The study did not include anyone with a shoulder injury and did not measure tendon healing.

Omega-3 Fatty Acids

The EPA and DHA in oily fish (sardines, mackerel, salmon) are studied for their effects on inflammation. No trial of omega-3 fats in rotator cuff injury is among the sources cited on this page.

Magnesium

Magnesium takes part in muscle contraction and relaxation and in nerve conduction. Food sources include dark leafy greens, pumpkin seeds, almonds and dark chocolate. No trial of magnesium in rotator cuff injury is among the sources cited on this page.

Turmeric and Curcumin

Curcumin, a compound in turmeric, is studied for anti-inflammatory effects. No trial of curcumin in rotator cuff injury is among the sources cited on this page.

Sleep, Stress and Mental Health

Mental health is linked to how much a rotator cuff tear hurts. In 169 patients with full-thickness tears, a mental-health score (SF-36 MCS) had the strongest association with shoulder pain and function scores in every model, while tear size, retraction and the number of tendons involved correlated only weakly, and only with self-rated function. The authors noted that further studies are needed to know whether this affects the outcome of treatment (Wylie 2016).

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Surgical Options

Surgery is considered when symptoms persist despite non-operative treatment, after an acute traumatic tear, or for large tears causing major loss of function. The 2019 Cochrane review concluded that it is uncertain whether repair provides clinically meaningful benefits over non-operative treatment for the mostly small, degenerative tears studied so far (Karjalainen 2019), while the Norwegian trial found an advantage for primary repair that had grown by ten years (Moosmayer 2019). Which tears are repaired, and when, is decided case by case.

Arthroscopic Rotator Cuff Repair

In arthroscopic repair, small incisions are made to insert the arthroscope (camera) and instruments, and the torn tendon is reattached to bone with suture anchors — small metal or bioabsorbable implants placed in the humerus at the tendon's footprint. Other problems can be treated at the same time, such as the long head of the biceps tendon. The UK UKUFF trial randomised 273 patients with degenerative tears to arthroscopic or open repair and found no difference in the Oxford Shoulder Score at two years (41.7 vs 41.5); re-tear rates at one year were high in both groups (46.4% arthroscopic, 38.6% open) for all tear sizes and ages, and healed repairs had the greatest improvement (Carr 2017).

Subacromial Decompression

Subacromial decompression — removal of bone spur and soft tissue under the acromion — is often performed for shoulder pain, sometimes together with repair. Two placebo-controlled trials tested it in people with subacromial pain. In the UK CSAW trial, which excluded full-thickness tears, decompression gave no extra benefit over diagnostic arthroscopy alone at 6 months, and both surgical groups' small advantage over no treatment was not clinically important (Beard 2018). In the Finnish FIMPACT trial, decompression provided no benefit over diagnostic arthroscopy at 24 months (Paavola 2018). In the Finnish repair trial, acromioplasty plus physiotherapy did no better than physiotherapy alone (Kukkonen 2021).

Mini-Open Repair

In a mini-open technique, the arthroscope is used first, and then a small incision is made to repair the tendon under direct vision.

Open Rotator Cuff Repair

Open surgery uses a larger incision through or around the deltoid muscle. It is used for some complex and revision cases. In the UKUFF trial, open repair gave the same two-year Oxford Shoulder Score as arthroscopic repair (Carr 2017).

Superior Capsule Reconstruction

For tears that cannot be repaired, superior capsule reconstruction (SCR) fixes a graft between the top of the socket and the humerus to restore stability. In the original case series of 24 shoulders treated with a fascia lata graft and followed for 24 to 51 months, active elevation rose from 84° to 148°, the ASES score from 23.5 to 92.9, and 83.3% had no graft tear or tendon re-tear; the series had no comparison group (Mihata 2013).

Reverse Total Shoulder Arthroplasty

A reverse total shoulder arthroplasty (RTSA) reverses the normal ball-and-socket geometry — a ball is attached to the glenoid and a socket to the humerus — so that the deltoid, rather than the cuff, powers elevation of the arm. A 2021 systematic review of 11 studies of RTSA for massive irreparable tears without arthritis found improved outcomes in all of them and described it as a reliable option for older patients with persistent pain and loss of function; it also reported relatively high complication rates, caution in patients who still had active forward elevation before surgery, and that joint-preserving options deserve careful consideration in younger patients (Viswanath 2021).

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Complications and Prognosis

Untreated tears can enlarge. In people with a painless degenerative tear followed for a median of 5.1 years, tears enlarged in 49% of shoulders (61% of full-thickness tears), and enlargement was associated with the onset of new pain and with progressive degeneration of the supraspinatus muscle (Keener 2015). In the Norwegian trial, 37% of tears treated with physiotherapy alone grew by more than 5 mm over five years, which was associated with a worse outcome (Moosmayer 2014). Goutallier's CT study graded fatty degeneration of the cuff muscles in five stages; infraspinatus degeneration never regressed after repair and had a highly negative influence on the outcome of supraspinatus repair (Goutallier 1994). In a prospective MRI study of 38 repairs, atrophy and fatty infiltration of the infraspinatus were the only independent predictors of shoulder scores one year after surgery, and neither improved after a successful repair (Gladstone 2007).

Re-tear After Surgical Repair

The most studied complication after repair is re-tear. In 65 arthroscopic repairs of isolated full-thickness supraspinatus tears, the cuff was completely healed in 71%, but in only 43% of patients over 65; shoulders that healed were stronger (Boileau 2005). A 2015 meta-analysis of 108 articles (over 8,011 shoulders) found a weighted mean re-tear rate of 26.6% at a mean of 23.7 months; re-tears were associated with more fatty infiltration, larger tear size, older age and, in that dataset, double-row repair, and patient-reported outcomes generally improved whether or not the repair healed (McElvany 2015). In large and massive tears the rate was higher: ultrasound showed recurrent tears in 17 of 18 patients after arthroscopic repair, yet 16 had less pain and better function at 12 months, before results deteriorated by two years (Galatz 2004). Smoking was associated with about twice the risk of re-tear (Fan 2022).

Stiffness After Surgery

A 2023 systematic review of 25 studies (9,373 patients) found postoperative shoulder stiffness in 6.4% of patients after arthroscopic repair — 5.2% after repair of full-thickness tears and 10.3% after repair of partial-thickness tears (Baumann 2023).

Other Complications

The 2019 Cochrane review could not estimate the risk of adverse events in the repair-versus-non-operative trials, because only one event was reported across the trials (Karjalainen 2019). In the CSAW decompression trial, the six study-related complications were all frozen shoulders (Beard 2018). Reverse arthroplasty carries a relatively high complication rate (Viswanath 2021).

Prognosis Overview

In the Finnish trial of small degenerative supraspinatus tears in people over 55, Constant scores improved by about 18 to 20 points in all three groups over six years, with no significant difference between physiotherapy and surgery (Kukkonen 2021). In the Norwegian trial of tears up to 3 cm, primary repair led by ten years (Moosmayer 2019). After repair, factors linked to worse structural or functional results in the studies above include older age, larger tears, fatty infiltration of the muscles, and smoking.

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Return to Activity and Prevention

Return to full activity after a rotator cuff injury — whether treated with or without surgery — is generally guided by functional milestones, such as pain-free range of motion and recovered strength, rather than fixed dates. Timelines vary with the type and severity of injury, the treatment, and the demands of the activity being resumed.

Conservative Treatment Timeline

How long recovery takes without surgery varies widely, and the trials on this page reported outcomes at fixed follow-up points (one, two, five, six and ten years) rather than return-to-activity times.

Post-Surgical Timeline

After repair, recovery follows a phased protocol: a period of sling protection, then passive motion, active motion and finally strengthening. Rehabilitation protocols and timelines differ between surgeons and by tear size, and the sources cited on this page do not compare them.

Prevention: What Is Known

There is little direct evidence on preventing rotator cuff injury. The studies on this page link tears to the following factors:

Of these, smoking and workload can change. These observational studies did not test whether changing them lowers the risk of a tear. Shoulder-strengthening programs and technique coaching are used with overhead athletes and workers; none of the sources on this page tested them for prevention.

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Key Research Papers

  1. Yamamoto A, Takagishi K, Osawa T, et al. (2010). Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 19(1):116-20 — PubMed PMID: 19540777
  2. Minagawa H, Yamamoto N, Abe H, et al. (2013). Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop 10(1):8-12 — PubMed PMID: 24403741
  3. Keener JD, Galatz LM, Teefey SA, et al. (2015). A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. J Bone Joint Surg Am 97(2):89-98 — PubMed PMID: 25609434
  4. Morelli KM, Martin BR, Charakla FH, et al. (2019). Acromion morphology and prevalence of rotator cuff tear: A systematic review and meta-analysis. Clin Anat 32(1):122-130 — PubMed PMID: 30362636
  5. Baumgarten KM, Gerlach D, Galatz LM, et al. (2010). Cigarette smoking increases the risk for rotator cuff tears. Clin Orthop Relat Res 468(6):1534-41 — PubMed PMID: 19283436
  6. Harvie P, Ostlere SJ, Teh J, et al. (2004). Genetic influences in the aetiology of tears of the rotator cuff. Sibling risk of a full-thickness tear. J Bone Joint Surg Br 86(5):696-700 — PubMed PMID: 15274266
  7. Wylie JD, Suter T, Potter MQ, et al. (2016). Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears. J Bone Joint Surg Am 98(4):251-6 — PubMed PMID: 26888672
  8. Hegedus EJ, Goode AP, Cook CE, et al. (2012). Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests. Br J Sports Med 46(14):964-78 — PubMed PMID: 22773322
  9. Lenza M, Buchbinder R, Takwoingi Y, et al. (2013). Magnetic resonance imaging, magnetic resonance arthrography and ultrasonography for assessing rotator cuff tears in people with shoulder pain for whom surgery is being considered. Cochrane Database Syst Rev 2013(9):CD009020 — PubMed PMID: 24065456
  10. Ellman H (1990). Diagnosis and treatment of incomplete rotator cuff tears. Clin Orthop Relat Res (254):64-74 — PubMed PMID: 2182260
  11. Goutallier D, Postel JM, Bernageau J, et al. (1994). Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res (304):78-83 — PubMed PMID: 8020238
  12. Gladstone JN, Bishop JY, Lo IK, et al. (2007). Fatty infiltration and atrophy of the rotator cuff do not improve after rotator cuff repair and correlate with poor functional outcome. Am J Sports Med 35(5):719-28 — PubMed PMID: 17337727
  13. Kukkonen J, Joukainen A, Lehtinen J, et al. (2014). Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. Bone Joint J 96-B(1):75-81 — PubMed PMID: 24395315
  14. Kukkonen J, Joukainen A, Lehtinen J, et al. (2015). Treatment of Nontraumatic Rotator Cuff Tears: A Randomized Controlled Trial with Two Years of Clinical and Imaging Follow-up. J Bone Joint Surg Am 97(21):1729-37 — PubMed PMID: 26537160
  15. Kukkonen J, Ryösä A, Joukainen A, et al. (2021). Operative versus conservative treatment of small, nontraumatic supraspinatus tears in patients older than 55 years: over 5-year follow-up of a randomized controlled trial. J Shoulder Elbow Surg 30(11):2455-2464 — PubMed PMID: 33774172
  16. Moosmayer S, Lund G, Seljom US, et al. (2014). Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up. J Bone Joint Surg Am 96(18):1504-14 — PubMed PMID: 25232074
  17. Moosmayer S, Lund G, Seljom US, et al. (2019). At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears. J Bone Joint Surg Am 101(12):1050-1060 — PubMed PMID: 31220021
  18. Lambers Heerspink FO, van Raay JJ, Koorevaar RC, et al. (2015). Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial. J Shoulder Elbow Surg 24(8):1274-81 — PubMed PMID: 26189808
  19. Ryösä A, Laimi K, Äärimaa V, et al. (2017). Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Disabil Rehabil 39(14):1357-1363 — PubMed PMID: 27385156
  20. Karjalainen TV, Jain NB, Heikkinen J, et al. (2019). Surgery for rotator cuff tears. Cochrane Database Syst Rev 12(12):CD013502 — PubMed PMID: 31813166
  21. Coombes BK, Bisset L, Vicenzino B (2010). Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 376(9754):1751-67 — PubMed PMID: 20970844
  22. Zadro J, Rischin A, Johnston RV, et al. (2021). Image-guided glucocorticoid injection versus injection without image guidance for shoulder pain. Cochrane Database Syst Rev 8(8):CD009147 — PubMed PMID: 34435661
  23. Hurley ET, Hannon CP, Pauzenberger L, et al. (2019). Nonoperative Treatment of Rotator Cuff Disease With Platelet-Rich Plasma: A Systematic Review of Randomized Controlled Trials. Arthroscopy 35(5):1584-1591 — PubMed PMID: 31000394
  24. A Hamid MS, Sazlina SG (2021). Platelet-rich plasma for rotator cuff tendinopathy: A systematic review and meta-analysis. PLoS One 16(5):e0251111 — PubMed PMID: 33970936
  25. Shaw G, Lee-Barthel A, Ross ML, et al. (2017). Vitamin C-enriched gelatin supplementation before intermittent activity augments collagen synthesis. Am J Clin Nutr 105(1):136-143 — PubMed PMID: 27852613
  26. Carr A, Cooper C, Campbell MK, et al. (2017). Effectiveness of open and arthroscopic rotator cuff repair (UKUFF): a randomised controlled trial. Bone Joint J 99-B(1):107-115 — PubMed PMID: 28053265
  27. Beard DJ, Rees JL, Cook JA, et al. (2018). Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. Lancet 391(10118):329-338 — PubMed PMID: 29169668
  28. Paavola M, Malmivaara A, Taimela S, et al. (2018). Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ 362:k2860 — PubMed PMID: 30026230
  29. Mihata T, Lee TQ, Watanabe C, et al. (2013). Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears. Arthroscopy 29(3):459-70 — PubMed PMID: 23369443
  30. Viswanath A, Bale S, Trail I (2021). Reverse total shoulder arthroplasty for irreparable rotator cuff tears without arthritis: A systematic review. J Clin Orthop Trauma 17:267-272 — PubMed PMID: 33936948
  31. Boileau P, Brassart N, Watkinson DJ, et al. (2005). Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am 87(6):1229-40 — PubMed PMID: 15930531
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PubMed Topic Searches

The links below run live searches on PubMed, the U.S. National Library of Medicine's database of biomedical literature.

  1. PubMed: Conservative rotator cuff treatment
  2. PubMed: Rotator cuff rehabilitation physical therapy
  3. PubMed: Asymptomatic rotator cuff tear natural history
  4. PubMed: Rotator cuff re-tear rates arthroscopic

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