Shoulder impingement and the rotator cuff

Abstract

The rotator cuff muscles include supraspinatus, infraspinatus, subscapularis and teres minor. The action of their tendons enables the complex movement of the shoulder joint. Rotator cuff disorders are common and can result in significant shoulder dysfunction and pain. Supraspinatus is the most frequently affected tendon. Subacromial impingement syndrome (SIS) represents a spectrum of pathology including subacromial bursitis, rotator cuff tendinopathy, partial thickness and full thickness tears. These are investigated using ultrasound or magnetic resonance imaging. Rotator cuff tears are not always related to SIS and can be divided into traumatic and degenerative. Treatment for tendinopathy and partial tears is normally non-operative through physiotherapy and corticosteroid injections. Full thickness and some partial thickness tears may require surgical repair, which is commonly performed arthroscopically. This involves mobilizing the torn or detached tendon and repairing it back to the native footprint with bone anchors or transosseous sutures. Repairs can be achieved using single or double row anchor techniques. Where tendon repair is not possible, other surgical solutions can be considered. These include patch repair augmentation, superior capsular reconstruction or tendon transfers. Cases of chronic rotator cuff tears can lead to cuff tear arthropathy, which ultimately can be treated with reverse total shoulder replacement.