Aetiology

• Usually occurs in older patients (> 40 years)
• The tendons of the rotator cuff can tear with minimal or no trauma as a consequence of degenerate changes in the tendons
• Acute tear - fall on outstretched arm, sudden jerk (e.g. holding a rail on a bus which suddenly stops)
• Degenerative tear - wearing down over time
  • At least 20% of over 60 year olds have asymptomatic cuff tears due to tendon degeneration
• Rotator cuff tendons can tear in young patients due to a significant injury (including shoulder dislocation) although this is very uncommon

Pathophysiology

Type of tear

• Tears can be partial or full thickness
• Tears usually involve supraspinatus
• Large tears can extend into subscapularis and infraspinatus

Clinical features

Symptoms

• Pain in front of shoulder that radiates down arm
• Associated weakness

Signs

• Wasting of supraspinatus
• Tenderness in subdeltoid region
• Tests: Jobe's test, infraspinatus, subscapularis

Investigations