Last Updated: Wednesday, January 26, 2005
In discussing the broad spectrum of clinical involvement of the rotator cuff it is useful to speak of eight clinical entities which can be easily identified by simple criteria.
Eight clinical entities
- Asymptomatic cuff failure: the shoulder does not bother the patient but imaging studies document a full thickness defect in the cuff tendon.
- Posterior capsular tightness: the shoulder is limited in its range of internal rotation in abduction (see figure 1) cross-body adduction (see figure 2) internal rotation up the back (see figure 3) and flexion (see figure 4) (in approximate order of decreasing frequency).
- Subacromial abrasion (without a significant defect in the cuff tendon): the shoulder demonstrates symptomatic crepitus as the humerus is rotated beneath the acromion (see figures 5 and 6); isometric testing of the cuff muscles (see figure 7) reveals no pain or weakness.
- Partial thickness cuff lesion: resisted isometric contraction of the involved cuff muscles is painful or weak (see figure 7); associated posterior capsular tightness is common (see figures 1 2 and 3); imaging studies may indicate cuff tendon thinning but the lesion does not extend through the full thickness of the tendon.
- Full thickness cuff tear: resisted isometric contraction of one or more of the cuff muscles is painful or weak (see figure 7); a full thickness defect of one or more of the cuff tendons is demonstrated on ultrasonography arthrography MRI arthroscopy or open surgery.
- Cuff tear arthropathy: resisted isometric contraction of the cuff muscles is weak (see figure 7); acromiohumeral (see figures 5 and 6) and often glenohumeral movements produce crepitance; radiographs demonstrate superior translation of the head of the humerus with respect to the acromion loss of the articular cartilage of the superior humeral head direct articulation of the head with the coracoacromial arch "femoralization" of the proximal humerus and "acetabularization" of the upper glenoid and coracoacromial arch (see figures 8 through 12).
- Failed acromioplasty: the patient is dissatisfied with the result from a previous arthroscopic or open acromioplasty and presents for consideration of additional surgery.
- Failed cuff surgery: the patient is dissatisfied with the result from a previous arthroscopic or open operation on the rotator cuff and presents for consideration of additional surgery.