The four tendons that enfold the articular surface of the humeral head are the supraspinatus, infraspinatus, teres minor and subscapularis tendons. They constitute a vital part of an ‘‘elaborate system’’ in the human shoulder that is always activated during external and internal rotation of the joint, shoulder abduction and when lifting heavy weights. This mechanism is the rotator cuff, on account of which, approximately 2 million men and women with vastly heterogeneous symptoms, in 2013 and in the US alone, had to visit an orthopedist.

Rotator cuff tears, in other words rupture (laceration) of the contiguous structure of the tendon, is a common injury amongst the worldwide general population aged 40 and older. In fact, an increasing number of patients doesn’t display severe symptoms at all, and as a result, rotator cuff tears are frequent accidental discoveries of shoulder MRI scans, and mostly in the predominantly used arm.
The above demographic statistic provides explanation to why degenerative rotator cuff tears are more common, since they occur from the natural wearing down of the rotator cuff tendons who lose their elasticity in the course of time – the supraspinatus tendon is more ‘‘vulnerable’’ to lesions, inflammation (tendonitis and bursitis) and injuries, possibly because of its anatomic position, poor blood supply and function.
However, repetitive shoulder movements (for example in tennis players or carpenters) can culminate in rotator cuff tears. Likewise, acute rotator cuff tears are caused by falls or impact of the upper extremity with the ground, and subsequently to intense strength training (for example weightlifting). Traumatic rotator cuff tears can be accompanied by additional lesions involving the shoulder girdle, such as fractures and dislocations.

The clinical presentation of rotator cuff tears is manifested by the presence of shoulder pain around the injured joint that may extend to the elbow –usually intensified during sleep or when the patient is at rest–, stiffness, weakness and pain caused by certain shoulder movements. Under any circumstances, the clinical examination must be performed by the orthopedist, who is assisted by recommended X-rays and possibly an MRI scan, in order to identify the type of rotator cuff tear (partial or total), as well as determine the appropriate treatment. 

Conventional treatment is usually recommended in cases of partial-thickness rotator cuff tears and includes activity modification, painkillers, physiotherapy and a specific and personalized exercise program. However, the anatomic contiguous structure of the rotator cuff tendons is generally repaired surgically, particularly in the cases of acute rotator cuff tears, symptoms that last over 3 months, tears that are larger than 3 cm, significant loss of function in the shoulder, or patients with high functional demands, for example athletes.
Acute rotator cuff tears are sufficiently treated arthroscopically with the use of plastic or metal ‘‘anchors’’, which essentially are customized absorbable suture screws. On the contrary, in cases of chronic rotator cuff tears due to muscle degeneration, assistance for the repair of the rotator cuff might be necessary with growth factor therapy or stem cells, autologous therapies which stimulate the body’s own healing process.
In relation to the type of rotator cuff tear, the repair treatment and the functional demands, the patient may attain a desirable outcome in a period of 3 to 6 months. However postoperatively, the patient must follow a rehabilitation program that includes physiotherapy, kinesiotherapy as well as muscle strengthening exercises.

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