Rotator cuff disorders

Abstract

While the pathophysiology of rotator cuff tendinopathy continues to be investigated, current management of rotator cuff disorders emphasizes traditional principles. Inflammation and bursitis are an important component of the pathology and initial management is focused on relief of these symptoms. The majority of patients will have satisfactory results with nonoperative management, including physical therapy and anti-inflammatory medication. The cause of rotator cuff tendinopathy remains unknown. Surgical management is directed at both relieving the subacromial impingement (extrinsic cause) and restoring continuity and function of the rotator cuff tendons (intrinsic cause). With current operative techniques, rotator cuff repair can provide significant functional improvement and pain relief in the majority of patients. Important principles include performing anterior acromioplasty, bursal resection, rotator cuff mobilization, and tension-free repair to the greater tuberosity with nonabsorbable sutures.These principles are important whether the repair is performed through arthroscopic or open techniques. In cases of large or massive tears where the deltoid must be taken down, a meticulous deltoid repair must be performed, and the coracoacromial ligament should be repaired to prevent anterosuperior instability. Partial repair of the rotator cuff is recommended over performing transfer procedures. Postoperative rehabilitation requires avoidance of active exercises for 6 weeks and weights for 3 months. With these techniques, 84% to 96% satisfactory results can be expected.