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Rotator Cuff Tendinopathy

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Orthopaedic Sports Medicine

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Abstract

Rotator cuff tendinopathy refers to a progressive disease of the rotator cuff tendons, encompassing acute tendinitis, tendinosis with degeneration, and partial thickness tearing, and may result in a full-thickness tear. Rotator cuff tendinopathy can be the result of extrinsic or intrinsic factors. Tendinopathy caused by extrinsic factors is commonly referred to as impingement syndrome. Patients typically present with pain and weakness on external rotation and elevation of the shoulder. Diagnosis involves clinical tests as well as imaging including X-ray, ultrasound, and magnetic resonance imaging. Rotator cuff tendinopathy is typically treated conservatively through use of NSAIDs, a graduated exercise program, or injection therapy. The medium and where to deliver the injection remain controversial. Surgical intervention is only performed after 4–6 months of failed conservative treatment and, depending on the pathology, typically consists of an acromioplasty or a subacromial decompression. An understanding of the anatomy of the rotator cuff tendons, histology of chronic tendinopathy, and extrinsic and intrinsic causes of tendinopathy are required to fully understand how to accurately diagnose and treat rotator cuff tendinopathy.

In 1983, Neer described the pathophysiology of rotator cuff disease in three stages: impingement syndrome, partial-thickness tear, and complete rotator cuff tears [1]. More recently, Lewis suggested a continuum of disease from reactive to disrepair and finally degenerative tendinopathy [2]. The term tendinopathy describes a painful condition that develops potentially due to an imbalance between pathologic responses from tendon overuse and regenerative changes, leading to impaired functional mobility [3]. While histological evidence suggests little or no inflammation is present, chronic changes include degeneration and disorganization of collagen fibers, increased cellularity, and tendon thickening [4]. Extrinsic and intrinsic mechanisms have been identified that lead to the development of rotator cuff tendinopathy. Extrinsic factors (i.e., bony or soft tissue) can cause compression of the rotator cuff tendons, while intrinsic mechanisms (e.g., aging, decreased vascularity, tendon overuse) are commonly associated with degeneration of the rotator cuff tendon. These factors can contribute to tendon wear and fraying and manifest as a range of subacromial pathologies, including partial-thickness rotator cuff tears, rotator cuff tendinosis, calcific tendinitis, and subacromial bursitis.

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Authors and Affiliations

  1. Plancher Orthopaedics and Sports Medicine, New York, NY, USA

    Sarah A. Commaroto, Kathryn A. Dotterweich, Clifford Voight, William Murrell & Kevin D. Plancher

  2. Orthopaedic Foundation, Stamford, CT, USA

    Stephanie C. Petterson & Karen K. Briggs

  3. Department of Orthopaedics, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA

    Kevin D. Plancher

  4. Department of Orthopaedics, Weill Cornell Medical College, New York, NY, USA

    Kevin D. Plancher

  5. Orthopaedic Foundation, Stamford, CT, USA

    Clifford Voight, William Murrell & Kevin D. Plancher

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  1. Sarah A. Commaroto
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Correspondence to Kevin D. Plancher .

Editor information

Editors and Affiliations

  1. Espregueira-Mendes Sports Centre, Clínica do Dragão, Porto, Portugal

    João Espregueira-Mendes

  2. Dept. Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden

    Jón Karlsson

  3. UPMC Freddie Fu SportsMed Ctr, Orth Surg, University of Pittsburgh, Pittsburgh, PA, USA

    Volker Musahl

  4. McMaster University, Hamilton, ON, Canada

    Olufemi R. Ayeni

Section Editor information

  1. Department of Medical Surgical Sciences, University of Milano, IRCCS Policlinico San Donato, Milan, Italy

    Pietro Randelli

  2. Universidade Federal de São Paulo- Centro de Traumatologia do Esporte, São Paulo - SP, Brasil

    Carina Cohen

  3. Universidad Autónoma, Madrid, Madrid, Spain

    Emilio Calvo

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Commaroto, S.A. et al. (2023). Rotator Cuff Tendinopathy. In: Espregueira-Mendes, J., Karlsson, J., Musahl, V., Ayeni, O.R. (eds) Orthopaedic Sports Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-65430-6_119-1

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