For citation purposes: Haviv B. Rotator cuff tears, evaluation and treatment: a critical review. OA Sports Medicine 2013 Oct 01;1(2):20.

Critical review

Epidemiology of Sports Injuries

Rotator cuff tears, evaluation and treatment: a critical review

B Haviv,

Authors affiliations

(1) Arthroscopy and Sports Injuries Unit, Hasharon Hospital, Rabin Medical Center, Petach-Tikva, Israel

(2) Orthopedic Department, Sackler Faculty of Medicine, Tel-Aviv University P.O. Box 39040, Tel Aviv 6997801, Israel

* Corresponding author Email:



Rotator cuff tears are a common cause for shoulder pain in the older population. The aetiology and pathophysiology are not fully understood. Theories for tear evolvement are divided into intrinsic (e.g. recurrent microtrauma) and extrinsic (e.g. subacromial impingement). The subacromial bursa is probably the source of pain in symptomatic patients with rotator cuff tears. It is uncertain whether the tear itself can produce pain because of the high prevalence of asymptomatic tears. Typically, there is a gradual increase in shoulder pain and weakness; however, it can present acutely due to an injury. Difficulties in overhead activities and night pain are common. Imaging such as ultrasound and magnetic resonance are required for accurate evaluation of RCTs in patients with ongoing pain and limitations. Primary treatment includes activity modifications, pain relief and physical therapy. Surgery is advised for acute tears in active patients or chronic symptomatic tears in patients that fail to improve. This article discusses the evaluation and treatment of rotator cuff tears.


Symptoms of pain and weakness about the shoulder imply on rotator cuff tear. There are typical impingement signs in physical evaluation together with limited range of motion and weakness. Plain radiography is required to rule out other pathologies and observe acromion morphology, while ultrasound and magnetic resonance imaging are used to define the tear and tendon quality before surgical intervention. Most repairs are currently performed in an all-arthroscopic minimally invasive technique with easier rehabilitation and less pain compared to the traditional open surgery.

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