💪 Rotator cuff pathology is a common cause of shoulder pain, particularly in middle-aged and older adults.
It most often involves the supraspinatus tendon
📖 About
- The rotator cuff is made of 4 muscles (SITS): Supraspinatus, Infraspinatus, Teres minor, Subscapularis.
- They stabilise the glenohumeral joint and allow fine shoulder movements.
- Degeneration and impingement are the most common causes of pathology in adults.
🧬 Aetiology
- Impingement of the supraspinatus tendon beneath the acromion → supraspinatus tendonitis.
- Repetitive overhead activity (e.g., painters, swimmers, athletes).
- Age-related degeneration of tendons and subacromial bursa.
- Acute trauma can cause partial or full-thickness cuff tears.
🩺 Clinical Features
- Painful arc: Pain between 60–120° of abduction (classic exam finding).
- Pain worse with overhead activity and at night (particularly lying on the shoulder).
- Weakness: Especially when lifting or rotating the arm.
- Reduced active movement but preserved passive movement (helps distinguish from frozen shoulder).
🧪 Investigations
- X-ray: May show calcification (calcific tendonitis) or acromial spurs.
- Ultrasound: First-line imaging for tendon tears or bursitis.
- MRI: Gold standard for full-thickness rotator cuff tears.
💊 Management
- Conservative: Rest, analgesia (NSAIDs), physiotherapy (strengthening & mobility exercises).
- Injections: Subacromial steroid injection for persistent pain.
- Surgery: Arthroscopic decompression or cuff repair if conservative measures fail.
- Referral: Orthopaedics or rheumatology depending on chronicity and severity.
📚 References
🔄 Revision Pearls
- 🌟 Painful arc = classic for supraspinatus tendonitis.
- 💡 Passive movement preserved → differentiates from frozen shoulder.
- 📌 Ultrasound is quick, non-invasive, and often first-line in UK practice.
- 🛠️ Consider occupation (manual workers, overhead athletes) in history.
