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Rotator Cuff Disorders

Rotator cuff pathology from tendinopathy to irreparable tears, including management of structural failure and selection between repair, tendon transfer, or arthroplasty.

Overview

Rotator cuff disease is a widespread condition with prevalence increasing with age [2]. While untreated chronic tears can lead to arthrosis [2], both surgical and nonsurgical treatments remain effective options [2]. Arthroscopic rotator cuff repair is favored for improving shoulder function in degenerative disease, whereas other procedures or intraarticular treatments offer no significant benefit [17]. The procedure carries a low incidence of short-term complications [3], and salvage options exist for advanced disease [2].

Clinical decision-making is influenced by factors beyond tear morphology. Mental health demonstrates a stronger association with patient-reported pain and function than tear size in full-thickness tears [13]. Patient demographics at initial presentation are more predictive of treatment allocation to surgical or nonoperative approaches than patient-derived outcome scores for activity level and disability [91]. Furthermore, a direct relation exists between patient expectations and surgical outcomes [90], while natural history studies monitored by MRI may assist in determining treatment indications [23].

Long-term prognostication requires careful interpretation of follow-up data. One-year follow-up does not determine long-term outcomes of rotator cuff repair [5], and definitive predictors of repair success remain elusive due to low methodological quality in existing studies [73]. Short-term clinical outcomes for revision repair are similar to those of primary repair [6, 7]. In cases of glenohumeral osteoarthritis with an intact rotator cuff, over 90% of patients undergoing reverse shoulder arthroplasty experience substantial clinical benefit [85].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Rotator cuff repair must restore normal capsular anatomy to provide normal biomechanics of the joint and thus a positive clinical outcome [69]. In the setting of an irreparable supraspinatus tear, superior capsular reconstruction restores key biomechanical parameters of the shoulder to intact levels [37]. Both subacromial balloon spacer and superior capsular reconstruction function to decrease superior humeral head migration and to restore more normal glenohumeral joint position and forces during various abduction positions [82]. Dynamic superior migration of the humeral head during abduction occurs in patients with rotator cuff tears [60], while glenohumeral decentering is significantly associated with diminished shoulder function and active range of motion in all planes [56]. Biomechanical changes of passive glenohumeral joint motion occur in the glenohumeral joint with as little as 5% glenohumeral internal rotation deficit (GIRD) [44]. In massive rotator cuff tear, the pectoralis major and latissimus dorsi muscles are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures [71]. Latissimus dorsi transfer (LDT) may restore native glenohumeral kinematics more sufficiently than latissimus dorsi transfer (LDT), potentially leading to improved postoperative functional outcomes [72]. Increasing humeral component retroversion did not affect the muscle force requirements for scaption across the shoulder [65].

Osseous and Soft Tissue Reconstruction

A posterior acromial bone block is biomechanically effective at restoring the force required to translate the humeral head posteriorly in a cadaveric, posterior glenohumeral instability model [79]. A physiological remodeling process leads to restoration of a more natural glenoid anatomy following arthroscopic implant-free bone grafting for shoulder instability with glenoid bone loss [83]. Glenoid morphology can be normalized during the intermediate to long-term postoperative period, even in shoulders with a smaller fragment, after arthroscopic repair of chronic osseous Bankart lesions [86]. The modified position of the scapula is maintained during the entire range of motion after the Latarjet procedure, suggesting a shoulder-stabilizing kinematic effect [61]. Findings regarding alterations in shoulder function observed with rotator cuff and other shoulder injuries in an animal model are consistent with those observed in humans [80].

Clinical Correlations and Diagnostic Challenges

No correlations between functional outcomes and radiographic shoulder findings were identified at mid-term follow-up in superior capsular reconstruction using xenograft [27]. Clinical evaluation of altered shoulder kinematics remains complicated [31]. Recurrent posterior instability of the shoulder is difficult to diagnose and technically challenging to treat [70]. Updates on the anatomy, mechanics, pathomechanics, and treatment of the thrower's shoulder are essential for clinicians and researchers [32]. Advances in understanding shoulder biomechanics, pathophysiology, and diagnostic techniques are necessary for clinicians to properly prevent and treat common shoulder injuries in throwing athletes [42].

Classification

MRI Assessment: Twenty-six different criteria described by multiple classification systems have been identified for the magnetic resonance assessment of rotator cuff after repair [10].

Acromial Morphology: The acromial morphology classification system is an unreliable method to assess the acromion [11]. The acromial index shows no association with the presence of rotator cuff disease [11].

Comprehensive Tear Classification: A comprehensive rotator cuff tear classification scheme encompassing 97% of all tears was described to facilitate anatomic repair [34].

Coracoid Morphology: A study created a classification system to divide coracoids according to their morphology and relative risk of associated subscapularis tears [43].

Partial Subscapularis Tears: A novel classification for partial subscapularis tendon tears was presented to enable more detailed and reproducible description [75].

Long Head of Biceps (LHB): LHB instability was associated with LHB lesions and rotator cuff tear size, leading to the creation of a new arthroscopic classification [63].

Glenoid Defects: The formation of clusters based on glenoid morphology indicates that patterns exist in the types of glenoid defects, highlighting a need to further investigate a three-dimensional classification system [67]. Alternative glenoid classification systems or predictive models should be considered to provide more precise prognoses for patients before and after shoulder arthroplasty performed for osteoarthritis with an intact rotator cuff [76].

SLAP Lesions: For experienced shoulder surgeons, the Snyder classification is a reliable system for identifying SLAP lesions [81].

Other Considerations: Currently described rotator cuff classification systems have little interobserver agreement among experienced shoulder surgeons, with the exception of distinguishing partial-thickness from full-thickness rotator cuff tears and identifying the side (articular vs bursal) of involvement with partial-thickness tears [48].

Clinical Presentation

Rotator cuff disease is widespread, with prevalence increasing with age [2], and untreated chronic tears can lead to arthrosis [2]. The duration of symptoms does not correlate with rotator cuff tear severity or other patient-related features associated with the disease [4]. Asymptomatic and symptomatic tears carry similar rates of progression over time [8]. Baseline characteristics are associated with outcomes following corticosteroid injection [15]. In adolescents, rotator cuff injuries may be overlooked as a cause of disability, leading to significant diagnostic delays [49].

Subjective mechanical symptoms are a common complaint in patients with suspected rotator cuff pathology [33]. Disorders of the long head of the biceps tendon are a significant source of shoulder pain and dysfunction [45] and can exist in conjunction with several other shoulder pathologies [45]. In the context of rotator cuff disease, anterior shoulder pain with macroscopic biceps changes relates to the complex interaction of the tendon and surrounding soft tissues rather than a single entity [14]. Isolated tears of the anterosuperior labrum represent a subtle cause of pain and dysfunction that is very difficult to diagnose clinically [51]. Coracoid impingement is a known yet uncommon cause of anterior shoulder pain [40], though it is a rare finding [39]. Precise diagnosis remains difficult due to multifactorial pathologies and a paucity of supporting evidence [40], yet identification and proper management can yield excellent pain relief and functional outcomes [39].

Recognition and treatment of associated pathologies such as glenoid bone loss, humeral head bone loss, rotator interval pathology, and rotator cuff tears are necessary to improve function, alleviate pain, and confer anterior shoulder stability [12]. Rotator cuff disease, shoulder instability, and associated lesions are common pathologic conditions involving soft tissues [36]. When a diagnosis remains unclear after thorough history and physical examination, the patient's symptom (e.g., 'shoulder pain') should be used as the diagnosis to prevent unwarranted invasive procedures [35]. Scapular dyskinesis appearances may be of particular relevance in the early screening of chronic shoulder disorders in the rugby population [53].

The Crank Test and the O'Brien Test results were often falsely positive for patients with other shoulder conditions, including impingement or rotator cuff tears [41]. The acromial morphology classification system is an unreliable method to assess the acromion [11], and the acromial index shows no association with the presence of rotator cuff disease [11]. The purpose of establishing an evidence-based clinical pathway is to consider factors such as duration of symptoms, acuity and size of the tear, and patient age [52]. The Korean Shoulder Scoring System (KSS) is a useful measurement tool that combines subjective and objective evaluations for shoulder function related to rotator cuff disorders [46]. There is currently little evidence to support or refute the efficacy of commonly used treatment methods for rotator cuff disease [52].

Investigations

Plain radiography: Radiography serves as a screening tool for significant glenoid bone loss [103]. While it cannot discriminate between traumatic and nontraumatic rotator cuff lesions, the presence of a rotator cuff tear influences progression in Hamada grade, though the magnitude of radiographic progression is not influenced by tear severity or enlargement at midterm time points [30].

MRI: Magnetic resonance imaging is the primary modality for assessing rotator cuff pathology, with twenty-six different criteria described by multiple classification systems for post-repair assessment [10]. MRI can discriminate between traumatic and nontraumatic lesions, whereas radiography cannot [66]. Magnetic resonance arthrography improves the differentiation of rotator cuff degeneration from partial or complete tears [101]. Specific MRI findings associated with the irreparability of large and massive tears include tendon retraction to or beyond the glenoid, increased inferior glenohumeral distance, and a positive tangent sign [108]. The presence of a partial cuff tear on preoperative MRI does not significantly affect function after anatomic total shoulder replacement in the medium term [99]. For patients with tendinopathy undergoing arthroscopy, the presence and severity of cartilage lesions may be underestimated on noncontrast MRI [98]. The MRI tendinosis grade is associated with stiffness assessed using sonoelastography in these patients [102]. A quantitative cutoff on MRI for the size of infraspinatus involvement predicts symptomatic structural failure of arthroscopic repairs [113]. Imaging based on stump classification reflects degeneration and fragility, with Type 3 stumps showing increased signal intensity changes [110]. The integration of 3D imaging and volumetric analysis offers a novel advancement in diagnosing and classifying injuries, challenging conventional 2D reliance [97]. Furthermore, 3D MR reconstructions improve the accuracy of characterizing tear shape compared with current 2D techniques [106].

CT: CT arthrography results (CT-ARCR) are comparable to conventional ARCR for similar-sized tears without calcific tendonitis [111]. 3D MRI could serve as a radiation-free and reliable alternative to preoperative CT for measuring glenoid bone loss [109].

Bone scan: Shoulders with a symptomatic rotator cuff tear demonstrate higher radioisotope uptake on bone scintigraphy than those with an asymptomatic tear [107].

Other Considerations: No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified in shoulders undergoing superior capsular reconstruction using xenograft [27]. When bicipital groove morphology and subscapularis tendon tear are found in preoperative images, the clinician should evaluate the patient for an LHB tendon disorder as a pain generator [112]. The diagnostic accuracy of MRI decreases when chronic pectoralis major ruptures are evaluated [104]. A variety of imaging modalities provide clinically acceptable accuracy in diagnosing and quantifying Hill-Sachs lesions and determining their potential to cause persistent anterior shoulder instability [105].

Treatment

Rotator cuff disease prevalence increases with age [2], and untreated chronic tears can lead to arthrosis [2]. Both surgical and nonsurgical treatments can be effective for rotator cuff disease [2], with salvage options existing for advanced cases [2]. At 13 years after diagnosis, about 90% of patients treated conservatively for rotator cuff tears had no or only slight pain, and about 70% had no disturbance in activities of daily life [9]. Nonoperative treatment remains a viable option for certain patients with traumatic rotator cuff tears [26], though it demonstrates a considerable early failure rate [26]. For chronic, full-thickness tears, nonoperative treatment is an effective and lasting option for many patients [47], with a specific physical therapy protocol effective in approximately 75% of patients with atraumatic tears followed for 2 years [87]. Mental health has a stronger association with patient-reported shoulder pain and function than tear size in patients with full-thickness rotator cuff tears [13], and comorbidity affects self-assessed function in patients with chronic tears, requiring consideration during treatment and outcome analysis [16].

Regarding injections, there is little reproducible evidence to support the efficacy of subacromial corticosteroid injection in managing rotator cuff disease [50]. Currently limited evidence suggests that in the short term, PRP injections may not be beneficial for nonoperative treatment of chronic rotator cuff disease [94]. Caution should be taken when deciding to inject a patient with corticosteroids, and this treatment should be withheld if a rotator cuff repair is to be performed within the following 6 months [95].

Operative

Indications: Arthroscopic rotator cuff repair (ARCR) is an effective and safe option to treat symptoms of rotator cuff tears [38]. Nonoperative treatment of traumatic rotator cuff tears demonstrates a considerable early failure rate [26], while operative treatment is no better than conservative treatment regarding non-traumatic supraspinatus tears at one-year follow-up [88]. Conservative treatment should be considered as the primary method of treatment for non-traumatic supraspinatus tears [88]. Chronic massive rotator cuff tears without glenohumeral arthritis can be managed nonsurgically or with subacromial débridement, rotator cuff repair, or rotator cuff reconstruction [62]. The reverse shoulder prosthesis should be reserved for the treatment of arthropathies with a massive rotator cuff tear [68]. The reverse shoulder prosthesis appears to be contraindicated in patients with rheumatoid arthritis [68]. Rotator cuff repair in patients aged 75 years and older could achieve high clinical success rates with good outcomes and pain relief [54]. Patient-specific risk factors for repair failure and poor functional outcome after rotator cuff repair should be carefully considered in treatment planning [92].

Surgical Approach / Technique: Arthroscopic rotator cuff repair is favored for improving shoulder function [17]. Other procedures or intraarticular treatments offer no significant benefits compared to arthroscopic rotator cuff repair for improving shoulder function [17]. Arthroscopic treatment of rotator cuff lesions leads to good results after 36 months [55]. Clinical results from arthroscopic rotator cuff repair are durable with time [38]. Tuberoplasty for massive irreparable rotator cuff tears results in good clinical outcomes with significant pain relief in select populations [57]. Partial repair of a shoulder rotator cuff tear is an effective treatment for reducing patient pain and improving function in nonarthritic patients with massive or irreparable tears by restoring balance to the force couple [96]. Concomitant surgical treatment of nonmassive rotator cuff tears with moderate shoulder stiffness in a single stage may have comparable results to the surgical treatment of isolated rotator cuff tears [89].

Other Considerations: Failure rates for large-to-massive rotator cuff tears remain high despite advances in surgical options and rehabilitation [58]. Patients with impingement syndrome or a repaired rotator cuff should avoid shoulder motions that cause subacromial impingement [93].

Complications

Natural History and Disease Progression: Untreated chronic rotator cuff tears can lead to arthrosis [2], though asymptomatic and symptomatic tears carry similar rates of tear progression over time [8]. In the general population, 20.7% of 1,366 shoulders had full-thickness rotator cuff tears [22]. Surgical intervention has the potential to alter the early natural history of degenerative rotator cuff disease, with patients demonstrating clinically relevant differences in pain and functional outcomes compared to nonoperative treatment [21]. However, one-year follow-up does not determine long-term outcomes of rotator cuff repair [5].

Infection (PJI): Rotator cuff repair has a low incidence of short-term complications [3].

Stiffness / Arthrofibrosis: Outcomes after repair of partial- and full-thickness rotator cuff tears using a bioinductive implant show safety and efficacy at 1-year follow-up [74]. There was no evidence of progression of intrinsic rotator cuff pathologic conditions at a mean follow-up of 4.5 years for partial-thickness tears treated with acromioplasty without repair [29].

Other Considerations: Long-term outcomes from primary tendon repair remained superior to physiotherapy up to 15 years of follow-up for small-to-medium-sized rotator cuff tears [18]. Nonoperative treatment for traumatic full-thickness rotator cuff tears has a considerable early failure rate [26]. In cases of rotator cuff tears treated conservatively, about 90% of patients had no or only slight pain at 13 years after diagnosis, and about 70% had no disturbance in activities of daily life [9]. Short-term clinical outcomes of patients undergoing revision rotator cuff repair are similar to those of primary rotator cuff repair [6, 7], and revision repair provides significant pain relief and improvement in functional scores at long-term follow-up (minimum 10 years) [24]. Repair of a large or massive tear of the rotator cuff can have a satisfactory long-term outcome [20]. Rotator cuff repair in patients fifty years of age and younger is associated with long-term pain relief but not significant long-term improvement in motion, and a large proportion of this demographic have an unsatisfactory long-term result [19]. Comorbidity may influence the evaluation of results of surgical treatment of rotator cuff tears [16], and individuals with a family history of rotator cuff tearing were more likely to have repair failures [25].

Recovery

Light activity (weeks): Patients typically resume desk work, driving, and light activities of daily life within the first few weeks post-operatively, as short-term complications following rotator cuff repair are low [3].

Full activity (months): Functional recovery follows a predictable trajectory, with patients achieving approximately 60% of ultimate functional recovery at 3 months and approximately 75% at 6 months after surgery [78]. While surgical intervention can alter the early natural history of degenerative rotator cuff disease compared to nonoperative treatment [21], one-year follow-up does not reliably determine long-term outcomes [5].

Complete recovery / outcome plateau (months): Long-term outcomes stabilize over extended periods, with primary tendon repair remaining superior to physiotherapy for small-to-medium tears up to 15 years of follow-up [18]. Revision rotator cuff reconstruction improves clinical outcomes and shoulder function at midterm follow-up (minimum 2 years) [64], while revision repair provides significant pain relief and functional improvement at long-term follow-up (minimum 10 years) [24]. Repair of large or massive tears can also yield satisfactory long-term outcomes [20]. However, in patients fifty years of age and younger, repair is associated with long-term pain relief but not significant long-term improvement in motion, and a large proportion of this demographic experience unsatisfactory long-term results [19].

Rehabilitation protocol: Evidence regarding specific immobilisation durations or weight-bearing progression is not provided in the current dataset. However, baseline characteristics have been associated with outcomes following corticosteroid injection in rotator cuff disease [15], and there is a correlation between preoperative shoulder injections and revision rotator cuff repair, with frequency and time dependence observed [114].

Functional milestones: Conservative management of rotator cuff tears demonstrates that at 13 years after diagnosis, about 90% of patients have no or only slight pain and about 70% have no disturbance in activities of daily life [9]. Short-term clinical outcomes for revision rotator cuff repair are similar to primary repair [6, 7].

Other Considerations: Predictors of failure and progression include a family history of rotator cuff tearing, which is associated with higher likelihood of repair failure [25]. Regarding tear progression, asymptomatic and symptomatic tears carry similar rates over time [8], and the magnitude of radiographic progression in degenerative tears is not influenced by tear severity or enlargement at midterm time points [30]. Furthermore, there is no evidence of progression of intrinsic rotator cuff pathologic conditions at a mean follow-up of 4.5 years for partial-thickness tears treated with acromioplasty without repair [29].

Key Evidence

  • [L4] Rotator cuff repair has a low incidence of short-term complications. (10.1016/j.arthro.2017.10.040)
  • [L3] There is only a weak relationship between the duration of symptoms and features associated with rotator cuff disease. (10.1016/j.jse.2013.10.001)
  • [L5] One-year follow-up is not the last word for rotator cuff repair outcomes; patients must live with the long-term outcomes of surgical procedures, and authors are obliged to evaluate these long-term outcomes. (10.1016/j.arthro.2024.12.040)
  • [L3] The short term clinical outcomes of patients undergoing revision rotator cuff repair were similar to primary rotator cuff repair. (10.1177/2325967114s00016)
  • [L3] Short-term clinical outcomes of patients undergoing revision rotator cuff repair were similar to primary rotator cuff repair. (10.1016/j.jse.2015.05.015)
  • [L4] Asymptomatic and symptomatic rotator cuff tears carry similar rates of tear progression over time. (10.1016/j.arthro.2018.07.031)
  • [L2] In cases of rotator cuff tears treated conservatively, at 13 years after diagnosis, about 90% of patients had no or only slight pain and about 70% had no disturbance in activities of daily life. (10.1016/j.jse.2011.10.012)
  • [L4] Twenty-six different criteria described by multiple classification systems have been identified for the magnetic resonance assessment of rotator cuff after repair. (10.1007/s00167-014-3486-3)
  • [L3] The acromial morphology classification system is an unreliable method to assess the acromion, and the acromial index shows no association with the presence of rotator cuff disease. (10.1016/j.jse.2011.09.028)
  • [L5] Recognition and treatment of associated pathologies such as glenoid bone loss, humeral head bone loss, rotator interval pathology, and rotator cuff tears are necessary to improve function, alleviate pain, and confer anterior shoulder stability. (10.1016/j.arthro.2014.06.014)
  • [L2] Further studies are needed to determine its effect on the outcome of the treatment of rotator cuff disease. (10.2106/jbjs.o.00444)
  • [L4] In the context of rotator cuff disease, the etiology of anterior shoulder pain with macroscopic changes in the biceps tendon is related to the complex interaction of the tendon and surrounding soft tissues, rather than a single entity. (10.1016/j.jse.2008.05.044)
  • [L2] Baseline characteristics were associated with outcome after corticosteroid injection in rotator cuff disease. (10.1186/1471-2474-11-239)
  • [L1] This effect may ultimately influence the evaluation of the results of surgical treatment of rotator cuff tears and should be considered when treating patients and analyzing outcomes. (10.2106/00004623-200402000-00020)
  • [L1] Arthroscopic rotator cuff repair is favored for improving shoulder function, while other procedures or intraarticular treatments offer no significant benefits. (10.1186/s13018-024-05129-5)
  • [L1] Long-term outcomes from primary tendon repair remained superior to physiotherapy up to 15 years of follow-up, supporting its use as the primary treatment for small-to-medium-sized rotator cuff tears. (10.2106/jbjs.24.00065)
  • [L4] Rotator cuff repair in young patients is associated with long-term pain relief but not significant long-term improvement in motion, and a large proportion of patients have an unsatisfactory long-term result. (10.2106/00004623-200410000-00012)
  • [L3] Repair of a large or massive tear of the rotator cuff can have a satisfactory long-term outcome. (10.2106/00004623-199907000-00012)
  • [L2] Surgical intervention has the potential to alter the early natural history of degenerative rotator cuff disease, with patients demonstrating clinically relevant differences in pain and functional outcomes compared to nonoperative treatment. (10.1016/j.jse.2024.05.056)
  • [L3] 20.7% of 1,366 shoulders had full-thickness rotator cuff tears in the general population. (10.1016/j.jse.2009.04.006)
  • [L3] The results of the present study may be useful for determining the indications for treatment of rotator cuff tears. (10.1016/j.jse.2014.01.037)
  • [L4] Revision rotator cuff repair provides significant pain relief and improvement in functional scores at long-term follow-up. (10.1016/j.jse.2023.06.009)
  • [L2] Individuals with a family history of rotator cuff tearing were more likely to have repair failures. (10.1016/j.jse.2016.02.019)
  • [L4] Nonoperative treatment remains a viable option for certain patients with traumatic rotator cuff tears; however, the results of our study demonstrate a considerable early failure rate. (10.1016/j.jse.2023.11.012)
  • [L5] No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified. (10.1016/j.arthro.2025.07.020)
  • [L4] There was no evidence of progression of intrinsic rotator cuff pathologic conditions at a mean follow-up of 4.5 years. (10.1177/03635465020300021801)
  • [L2] Whereas the presence of a rotator cuff tear influences progression in Hamada grade, the magnitude of radiographic progression is not influenced by tear severity or enlargement at midterm time points. (10.1016/j.jse.2016.07.022)
  • [L2] A clinical evaluation of altered shoulder kinematics is still complicated. (10.3390/ijerph17082974)
  • [L5] Updates on the thrower's shoulder, including anatomy, mechanics, pathomechanics, and treatment, are essential for clinicians and researchers treating or investigating the shoulder. (10.1016/j.arthro.2022.02.024)
  • [L2] Subjective mechanical symptoms in the affected shoulder are a common complaint in patients with suspected rotator cuff pathology. (10.1016/j.jse.2024.02.024)
  • [L4] A comprehensive rotator cuff tear classification scheme encompassing 97% of all tears was described to facilitate anatomic repair. (10.1016/j.arthro.2007.05.002)
  • [Letter] When a patient's diagnosis remains unclear after thorough history and physical examination, it is best to use the patient's symptom (e.g., 'shoulder pain') as the diagnosis to prevent unwarranted invasive procedures. (10.1016/j.jse.2011.10.018)
  • [L5] In the setting of an irreparable supraspinatus tear, superior capsular reconstruction restores key biomechanical parameters of the shoulder to intact levels. (10.1016/j.jse.2020.03.007)
  • [L4] ARCR appears to be an effective and safe option to treat the symptoms of rotator cuff tears and to provide successful clinical results durable with time. (10.1007/s00167-014-3234-8)
  • [L5] Coracoid impingement is a rare finding, and identification and proper management of this condition can yield excellent pain relief and functional outcomes in the patient with ongoing anterior shoulder pain. (10.5435/00124635-201104000-00003)
  • [L5] Coracoid impingement is a known yet uncommon cause of anterior shoulder pain, but precise diagnosis remains difficult due to multifactorial pathologies and a paucity of supporting evidence in the literature. (10.1007/s00167-012-2013-7)
  • [L3] Results were often falsely positive for patients with other shoulder conditions, including impingement or rotator cuff tears. (10.1177/03635465020300060901)
  • [L5] Advances in understanding shoulder biomechanics, pathophysiology, and diagnostic techniques, along with improvements in surgical methods like arthroscopy, are necessary for clinicians to properly prevent and treat common shoulder injuries in throwing athletes. (10.1177/03635465000280022301)
  • [L3] This study was the first to create a classification system to divide coracoids according to their morphology and relative risk of associated subscapularis tears. (10.1016/j.jse.2020.01.074)
  • [L5] Biomechanical changes of passive glenohumeral joint motion occur in the glenohumeral joint with as little as 5% GIRD. (10.1177/0363546512462012)
  • [L5] Disorders of the long head of the biceps tendon can exist in conjunction with several other shoulder pathologies and are a significant source of shoulder pain and dysfunction. (10.1016/j.jse.2011.07.016)
  • [L4] The KSS is a useful measurement tool that combines subjective and objective evaluations for shoulder function related to rotator cuff disorders. (10.1016/j.jse.2008.11.019)
  • [L2] Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. (10.1016/j.jse.2017.10.009)
  • [L2] With the exception of distinguishing partial-thickness from full-thickness rotator cuff tears and identifying the side (articular vs bursal) of involvement with partial-thickness tears, currently described rotator cuff classification systems have little interobserver agreement among experienced shoulder surgeons. (10.1177/0363546506298108)
  • [L4] Rotator cuff injuries in adolescents may be overlooked as a cause of disability, leading to significant delays in diagnosis. (10.1177/0363546504269033)
  • [L1] This systematic review of the available literature indicates that there is little reproducible evidence to support the efficacy of subacromial corticosteroid injection in managing rotator cuff disease. (10.5435/00124635-200701000-00002)
  • [L4] Isolated tears of the anterosuperior labrum represent a subtle cause of shoulder pain and dysfunction that is very difficult to diagnose clinically. (10.1016/j.arthro.2010.05.022)
  • [L5] The purpose of this review is to establish an evidence-based clinical pathway for patients with rotator cuff disease, considering factors such as duration of symptoms, acuity and size of the tear, and patient age, as there is currently little evidence to support or refute the efficacy of commonly used treatment methods. (10.1177/0363546506295079)
  • [L2] These appearances may be of particular relevance in the early screening of chronic shoulder disorders in the rugby population. (10.1016/j.jse.2011.11.032)
  • [L4] Rotator cuff repair in patients aged >75 years could achieve high clinical success rates with good outcomes and pain relief. (10.3389/fpubh.2022.1060700)
  • [L3] The arthroscopic treatment of rotator cuff lesions leads to good results after 36 months. (10.1016/j.arthro.2009.04.007)
  • [L3] Glenohumeral decentering is significantly associated with diminished shoulder function and active range of motion in all planes. (10.1016/j.jse.2025.03.038)
  • [L1] Tuberoplasty for the treatment of massive irreparable rotator cuff tears results in good clinical outcomes with significant pain relief in select populations. (10.1016/j.arthro.2023.11.032)
  • [L5] Despite advances in surgical options and rehabilitation, failure rates for large-to-massive rotator cuff tears remain high. (10.2106/jbjs.20.00177)
  • [L3] This study confirms dynamic superior migration of the humeral head during abduction in patients with rotator cuff tears using in vivo 3D kinematic analysis. (10.1016/j.arthro.2015.08.031)
  • [L3] The modified position of the scapula was maintained during the entire range of motion, suggesting a shoulder-stabilizing kinematic effect in addition to the bony, sling and bumper effects. (10.1016/j.jse.2024.02.022)
  • [L5] Chronic massive rotator cuff tears without glenohumeral arthritis can be managed nonsurgically or with subacromial débridement, rotator cuff repair, or rotator cuff reconstruction. (10.5435/00124635-200309000-00005)
  • [L4] LHB instability was associated with LHB lesions and rotator cuff tear size, leading to the creation of a new arthroscopic classification. (10.1016/j.arthro.2006.08.025)
  • [L4] Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. (10.1177/0363546518786006)
  • [L5] Increasing retroversion did not affect the muscle force requirements for scaption across the shoulder. (10.1016/j.jse.2011.07.027)
  • [L2] MRI, but not radiography, can be used to help discriminate between traumatic and nontraumatic rotator cuff lesions. (10.1016/j.jse.2015.06.005)
  • [L4] The formation of clusters based on glenoid morphology indicates that patterns exist in the types of glenoid defects, highlighting a need to further investigate a three-dimensional classification system and potentially new standardized revision implant component designs. (10.1016/j.jse.2026.04.002)
  • [L3] The reverse shoulder prosthesis should be reserved for the treatment of arthropathies with a massive rotator cuff tear, and it appears to be contraindicated in patients with rheumatoid arthritis. (10.2106/jbjs.e.00851)
  • [L5] They conclude that rotator cuff repair must restore normal capsular anatomy to provide normal biomechanics of the joint and thus a positive clinical outcome. (10.1016/j.arthro.2016.08.011)
  • [L5] Recurrent posterior instability of the shoulder is difficult to diagnose and technically challenging to treat, but improved understanding of anatomy, biomechanics, and advanced arthroscopic techniques have allowed for relatively reliable surgical results. (10.1177/0363546510384232)
  • [L5] In massive rotator cuff tear, the pectoralis major and latissimus dorsi muscles are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures. (10.1016/j.jse.2013.11.030)
  • [L5] LTT may restore native glenohumeral kinematics more sufficiently than LDT, potentially leading to improved postoperative functional outcomes. (10.1016/j.jse.2022.05.003)
  • [L4] Despite the large number of outcomes and prognostic factors evaluated, it was not possible to reach any definitive conclusion regarding the most relevant predictors of outcome of rotator cuff repair due to low methodological quality of included studies. (10.1007/s00167-015-3700-y)
  • [L4] Outcomes after repair of partial- and full-thickness rotator cuff tears using a bioinductive implant show safety and efficacy at 1-year follow-up. (10.1016/j.arthro.2019.02.019)
  • [L3] The study presents a novel classification for partial subscapularis tendon tears to enable more detailed and reproducible description. (10.1007/s00167-020-05989-4)
  • [L3] Alternative glenoid classification systems or predictive models should be considered to provide more precise prognoses. (10.1016/j.jse.2023.08.029)
  • [L3] Functional recovery based on clinical outcomes showed approximately 60% of ultimate recovery at 3 months and approximately 75% recovery at 6 months after rotator cuff repair. (10.1007/s00167-020-06019-z)
  • [L5] A posterior acromial bone block is biomechanically effective at restoring the force required to translate the humeral head posteriorly in a cadaveric, posterior glenohumeral instability model. (10.1016/j.arthro.2024.01.014)
  • [L3] For experienced shoulder surgeons, the Snyder classification is a reliable system for identifying SLAP lesions. (10.1177/0363546510392332)
  • [L5] Both techniques function to decrease superior humeral head migration and to restore more normal glenohumeral joint position and forces during various abduction positions. (10.1016/j.arthro.2018.09.016)
  • [L4] A physiological remodeling process leads to restoration of a more natural glenoid anatomy. (10.1177/0363546515625283)
  • [L3] Over 90% of patients who underwent RSA for GHOA with an intact rotator cuff experienced substantial clinical benefit. (10.1016/j.jse.2024.01.027)
  • [L4] Glenoid morphology can be normalized during the intermediate to long-term postoperative period, even in shoulders with a smaller fragment. (10.2106/jbjs.n.01033)
  • [L4] Nonoperative treatment using this physical therapy protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for 2 years. (10.1016/j.jse.2013.01.026)
  • [L1] At one-year follow-up, operative treatment is no better than conservative treatment with regard to non-traumatic supraspinatus tears, and that conservative treatment should be considered as the primary method of treatment for this condition. (10.1302/0301-620x.96b1.32168)
  • [L2] Concomitant surgical treatment of nonmassive rotator cuff tears with moderate shoulder stiffness in a single stage may have comparable results to the surgical treatment of isolated rotator cuff tears. (10.1016/j.jse.2017.03.005)
  • [L4] These studies, however, do support that there is a direct relation between patient expectations and outcomes in rotator cuff surgery. (10.1016/j.arthro.2019.03.043)
  • [L3] Patient demographics at the time of initial presentation for a symptomatic rotator cuff tear are more predictive of treatment allocation to a surgical or nonoperative approach than the patient-derived outcome scores for activity level and shoulder disability. (10.1177/0363546515593954)
  • [L1] These factors should be carefully considered in treatment planning for patients undergoing rotator cuff repair. (10.1186/s12891-025-08608-w)
  • [L4] It is recommended that patients with impingement syndrome or a repaired rotator cuff avoid these shoulder motions. (10.1016/j.jse.2015.04.001)
  • [L2] The currently limited available evidence on PRP for nonoperative treatment of chronic rotator cuff disease suggests that in the short term, PRP injections may not be beneficial. (10.1016/j.arthro.2018.10.115)
  • [L1] Caution should be taken when deciding to inject a patient, and this treatment should be withheld if a rotator cuff repair is to be performed within the following 6 months. (10.1016/j.arthro.2019.12.006)
  • [L5] Partial repair of a shoulder rotator cuff tear is an effective treatment for reducing patient pain and improving function in nonarthritic patients with massive or irreparable tears by restoring balance to the force couple. (10.1016/j.arthro.2017.08.237)
  • [L4] The integration of 3D imaging and volumetric analysis offers novel advancement in diagnosing and classifying rotator cuff injuries, challenging the conventional reliance on 2D MRI. (10.1016/j.jse.2024.08.030)
  • [L1] Patients with rotator cuff tendinopathy undergoing arthroscopy should be informed that the presence and severity of cartilage lesions may be underestimated on MRI. (10.1016/j.jse.2014.01.048)
  • [L4] The presence of a partial cuff tear on preoperative MRI does not significantly affect function after anatomic total shoulder replacement in the medium term. (10.1016/j.jse.2020.07.037)
  • [L2] Magnetic resonance arthrography can improve the differentiation of rotator cuff degeneration from partial or complete rotator cuff tears. (10.2106/jbjs.e.00509)
  • [L3] The MRI tendinosis grade is associated with stiffness assessed using sonoelastography in patients with rotator cuff tendinopathy. (10.1016/j.jse.2015.10.019)
  • [L4] Radiography can be used for screening patients for significant glenoid bone loss. (10.1186/s12891-015-0607-1)
  • [L3] The diagnostic accuracy of MRI decreases when chronic tears are evaluated. (10.1016/j.jse.2015.08.037)
  • [L1] The current literature supports a variety of different imaging modalities that provide clinically acceptable accuracy in diagnosing and quantifying Hill-Sachs lesions, as well as determining whether they will cause persistent anterior shoulder instability. (10.1016/j.arthro.2020.08.005)
  • [L3] Our feasibility study has demonstrated that 3D MR reconstructions of the rotator cuff improve the accuracy of characterizing the shape of a rotator cuff tear compared with the current 2D MRI–based techniques. (10.1016/j.jse.2015.03.028)
  • [L3] Shoulders with a symptomatic rotator cuff tear showed higher radioisotope uptake on bone scintigraphy than those with an asymptomatic tear. (10.1177/0363546513494741)
  • [L3] MRI findings of tendon retraction to or beyond the glenoid, increased inferior glenohumeral distance, and a positive tangent sign are associated with irreparability of large and massive rotator cuff tears. (10.1007/s00167-013-2745-z)
  • [L3] This study shows that a 3D MRI could be a radiation-free and reliable alternative to a preoperative CT shoulder scan. (10.1016/j.arthro.2018.06.050)
  • [L4] Imaging based on stump classification reflects the degeneration and fragility of the torn rotator cuff site. (10.1177/03635465221090649)
  • [L3] CT-ARCR results were comparable to patients who received conventional ARCR for similar-sized rotator cuff tears that did not have calcific tendonitis. (10.1016/j.jse.2021.08.007)
  • [L2] When these are found in preoperative images, the clinician should evaluate the patient for the presence of an LHB tendon disorder as a pain generator. (10.1016/j.jse.2015.12.015)
  • [L3] There is also a quantitative cutoff on magnetic resonance imaging for the size of infraspinatus involvement that can be used clinically as a predicting factor. (10.1016/j.arthro.2016.01.067)
  • [L3] This study strongly suggests a correlation between preoperative shoulder injections and revision rotator cuff repair, with frequency and time dependence observed. (10.1016/j.arthro.2018.10.116)

See Also

References

[2] Chapter 3 Rotator Cuff Disease. 2019.

[3] Risk Factors for Short‐term Complications After Rotator Cuff Repair in the United States. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.10.040

[4] The duration of symptoms does not correlate with rotator cuff tear severity or other patient-related features: a cross-sectional study of patients with atraumatic, full-thickness rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.10.001

[5] Editorial Commentary: One‐Year Follow‐Up Does Not Determine Rotator Cuff Repair Long‐Term Outcome. Arthroscopy. 2025. DOI: 10.1016/j.arthro.2024.12.040

[6] Primary Versus Revision Arthroscopic Rotator Cuff Repair - An Analysis In 350 Consecutive Patients. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00016

[7] Primary vs. Revision Arthroscopic Rotator Cuff Repair: An Analysis in 360 Consecutive Patients. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.05.015

[8] Full‐Thickness Rotator Cuff Tears: What Is the Rate of Tear Progression? A Systematic Review. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.07.031

[9] Long-term follow-up of cases of rotator cuff tear treated conservatively. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.10.012

[10] Magnetic resonance imaging criteria for the assessment of the rotator cuff after repair: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-014-3486-3

[11] Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.09.028

[12] Identification and Treatment of Existing Copathology in Anterior Shoulder Instability Repair. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.06.014

[13] Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears. Journal of Bone and Joint Surgery. 2016. DOI: 10.2106/jbjs.o.00444

[14] Biceps tendinitis in chronic rotator cuff tears: A histologic perspective. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2008.05.044

[15] Clinical, socio-demographic and radiological predictors of short-term outcome in rotator cuff disease. BMC Musculoskeletal Disorders. 2010. DOI: 10.1186/1471-2474-11-239

[16] The Effect of Comorbidity on Self-Assessed Function in Patients with a Chronic Rotator Cuff Tear. The Journal of Bone & Joint Surgery. 2004. DOI: 10.2106/00004623-200402000-00020

[17] Arthroscopic procedures for degenerative rotator cuff disease: a systematic review and network meta-analysis. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-05129-5

[18] Fifteen-Year Results of a Comparative Analysis of Tendon Repair Versus Physiotherapy for Small-to-Medium-Sized Rotator Cuff Tears. Journal of Bone and Joint Surgery. 2024. DOI: 10.2106/jbjs.24.00065

[19] Rotator Cuff Repair in Patients Fifty Years of Age and Younger. The Journal of Bone & Joint Surgery. 2004. DOI: 10.2106/00004623-200410000-00012

[20] Long-Term Functional Outcome of Repair of Large and Massive Chronic Tears of the Rotator Cuff. The Journal of Bone & Joint Surgery*. 1999. DOI: 10.2106/00004623-199907000-00012

[21] Does surgical intervention alter the natural history of degenerative rotator cuff tears? Comparative analysis from a prospective longitudinal study. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.05.056

[22] Prevalence and risk factors of a rotator cuff tear in the general population. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.04.006

[23] Natural history of rotator cuff tears monitored by magnetic resonance imaging. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.01.037

[24] Long-term results of revision rotator cuff repair for failed cuff repair: a minimum 10-year follow-up study. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.06.009

[25] Identification of a genetic variant associated with rotator cuff repair healing. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.02.019

[26] Outcomes of initial nonoperative treatment of traumatic full-thickness rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.11.012

[27] Shoulder Superior Capsular Reconstruction Using Xenograft Shows No Deterioration in Functional Improvement at 5-Year Follow-Up. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2025. DOI: 10.1016/j.arthro.2025.07.020

[29] The Partial-Thickness Rotator Cuff Tear: Is Acromioplasty without Repair Sufficient?. The American Journal of Sports Medicine. 2002. DOI: 10.1177/03635465020300021801

[30] Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.07.022

[31] Scapular Dyskinesis: From Basic Science to Ultimate Treatment. International Journal of Environmental Research and Public Health. 2020. DOI: 10.3390/ijerph17082974

[32] Understanding the Disabled Throwing Shoulder Requires Updated Review of Anatomy, Mechanics, Pathomechanics, and Treatment. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2022. DOI: 10.1016/j.arthro.2022.02.024

[33] The significance of subjective mechanical symptoms in rotator cuff pathology. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.02.024

[34] Frequency of Various Tear Patterns in Full‐Thickness Tears of the Rotator Cuff. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.05.002

[35] Regarding the “Editor's Note”. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.10.018

[36] Chapter 24 Shoulder Instability, Rotator Cuff Disorders, Muscular Ruptures, Adhesive Capsulitis, Calcific Tendinitis. 2020.

[37] Biomechanical effects of superior capsular reconstruction in a rotator cuff–deficient shoulder: a cadaveric study. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.03.007

[38] Long‐term outcome after arthroscopic rotator cuff treatment. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3234-8

[39] Coracoid Impingement: Diagnosis and Treatment. Journal of the American Academy of Orthopaedic Surgeons. 2011. DOI: 10.5435/00124635-201104000-00003

[40] Coracoid impingement: current concepts. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2013-7

[41] The Crank Test, the O'Brien Test, and Routine Magnetic Resonance Imaging Scans in the Diagnosis of Labral Tears. The American Journal of Sports Medicine. 2002. DOI: 10.1177/03635465020300060901

[42] Injuries to the Shoulder in the Throwing Athlete. The American Journal of Sports Medicine. 2000. DOI: 10.1177/03635465000280022301

[43] Coracoid morphology and humeral version as risk factors for subscapularis tears. Journal of Shoulder and Elbow Surgery. 2020. DOI: 10.1016/j.jse.2020.01.074

[44] The Effect of Glenohumeral Internal Rotation Deficit Due to Posterior Capsular Contracture on Passive Glenohumeral Joint Motion. The American Journal of Sports Medicine. 2012. DOI: 10.1177/0363546512462012

[45] Disorders of the long head of biceps tendon. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.07.016

[46] The development and validation of an appraisal method for rotator cuff disorders: The Korean Shoulder Scoring System. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.11.019

[47] What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.10.009

[48] Interobserver Agreement in the Classification of Rotator Cuff Tears. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546506298108

[49] Rotator Cuff Tears in Adolescent Athletes. The American Journal of Sports Medicine. 2005. DOI: 10.1177/0363546504269033

[50] The Efficacy of Subacromial Corticosteroid Injection in the Treatment of Rotator Cuff Disease: A Systematic Review. Journal of the American Academy of Orthopaedic Surgeons. 2007. DOI: 10.5435/00124635-200701000-00002

[51] Anterosuperior Labral Tear Without Biceps Anchor Involvement: A Subtle Isolated Cause of a Painful Shoulder. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.05.022

[52] Indications for Repair of Full-Thickness Rotator Cuff Tears. The American Journal of Sports Medicine. 2007. DOI: 10.1177/0363546506295079

[53] Does scapular dyskinesis affect top rugby players during a game season?. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.11.032

[54] Repair of rotator cuff tears in patients aged 75 years and older: Does it make sense? A systematic review. Frontiers in Public Health. 2023. DOI: 10.3389/fpubh.2022.1060700

[55] Arthroscopic Repair of Cuff Tears with Associated Lesions of the Biceps Tendon‐ Technique and Results after 3 Years (SS‐06). Arthroscopy. 2009. DOI: 10.1016/j.arthro.2009.04.007

[56] Glenohumeral decentering in rotator cuff deficiency: relationship to rotator cuff muscle, scapula morphology, and shoulder function. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2025.03.038

[57] Massive Irreparable Rotator Cuff Tears Treated With a Tuberoplasty Yield Favorable Clinical Outcomes With Variable Rates of Complications: A Systematic Review. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.11.032

[58] An Update on Surgical Management of the Repairable Large-to-Massive Rotator Cuff Tear. Journal of Bone and Joint Surgery. 2020. DOI: 10.2106/jbjs.20.00177

[60] Alterations in Glenohumeral Kinematics in Patients With Rotator Cuff Tears Measured With Biplane Fluoroscopy. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.08.031

[61] Kinematic stabilization after the Latarjet procedure: beyond the triple blocking effect. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.02.022

[62] Chronic Massive Rotator Cuff Tears: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 2003. DOI: 10.5435/00124635-200309000-00005

[63] Anterior and Posterior Instability of the Long Head of the Biceps Tendon in Rotator Cuff Tears: A New Classification Based on Arthroscopic Observations. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.08.025

[64] Clinical Outcomes, Tendon Integrity, and Shoulder Strength After Revision Rotator Cuff Reconstruction: A Minimum 2 Years’ Follow-up. The American Journal of Sports Medicine. 2018. DOI: 10.1177/0363546518786006

[65] Humeral component retroversion in reverse total shoulder arthroplasty: a biomechanical study. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2011.07.027

[66] How to discriminate between acute traumatic and chronic degenerative rotator cuff lesions: an analysis of specific criteria on radiography and magnetic resonance imaging. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.06.005

[67] Three-Dimensional Characterization of Glenoid Defects in Failed Shoulder Arthroplasties. Journal of Shoulder and Elbow Surgery. 2026. DOI: 10.1016/j.jse.2026.04.002

[68] Reverse Total Shoulder Arthroplasty. The Journal of Bone & Joint Surgery. 2006. DOI: 10.2106/jbjs.e.00851

[69] The Rotator Cuff and the Superior Capsule: Why We Need Both. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.08.011

[70] Posterior Instability of the Shoulder. The American Journal of Sports Medicine. 2010. DOI: 10.1177/0363546510384232

[71] The role of pectoralis major and latissimus dorsi muscles in a biomechanical model of massive rotator cuff tear. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2013.11.030

[72] Biomechanical comparison of lower trapezius and latissimus dorsi transfer for irreparable posterosuperior rotator cuff tears using a dynamic shoulder model. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.05.003

[73] Prognostic factors influencing the outcome of rotator cuff repair: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3700-y

[74] Patient‐Reported Outcomes After Use of a Bioabsorbable Collagen Implant to Treat Partial and Full‐Thickness Rotator Cuff Tears. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.02.019

[75] A classification for partial subscapularis tendon tears. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-05989-4

[76] Prognostic value of the Walch classification for patients before and after shoulder arthroplasty performed for osteoarthritis with an intact rotator cuff. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.08.029

[78] Patients who have undergone rotator cuff repair experience around 75% functional recovery at 6 months after surgery. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06019-z

[79] A Posterior Acromial Bone Block Augmentation Is Biomechanically Effective at Restoring the Force Required To Translate the Humeral Head Posteriorly in a Cadaveric, Posterior Glenohumeral Instability Model. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.01.014

[80] Erratum_to_“Alterations_in_function_after_rotator_cuff_tears_in_an_animal_model”_S1058274609002973. n.d..

[81] Reproducibility and Reliability of the Snyder Classification of Superior Labral Anterior Posterior Lesions Among Shoulder Surgeons. The American Journal of Sports Medicine. 2011. DOI: 10.1177/0363546510392332

[82] The Subacromial Balloon Spacer Versus Superior Capsular Reconstruction in the Treatment of Irreparable Rotator Cuff Tears: A Biomechanical Assessment. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.09.016

[83] Arthroscopic Implant-Free Bone Grafting for Shoulder Instability With Glenoid Bone Loss. The American Journal of Sports Medicine. 2016. DOI: 10.1177/0363546515625283

[85] Predictors of poor and excellent outcomes following reverse shoulder arthroplasty for glenohumeral osteoarthritis with an intact rotator cuff. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2024.01.027

[86] Clinical Outcome and Glenoid Morphology After Arthroscopic Repair of Chronic Osseous Bankart Lesions. Journal of Bone and Joint Surgery. 2015. DOI: 10.2106/jbjs.n.01033

[87] Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2013.01.026

[88] Treatment of non-traumatic rotator cuff tears. The Bone & Joint Journal. 2014. DOI: 10.1302/0301-620x.96b1.32168

[89] One-stage surgical treatment for concomitant rotator cuff tears with shoulder stiffness has comparable results with isolated rotator cuff tears: a systematic review. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.03.005

[90] The Effect of Psychosocial Factors on Outcomes in Patients With Rotator Cuff Tears: A Systematic Review. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.03.043

[91] Surgical Versus Nonsurgical Management of Rotator Cuff Tears. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515593954

[92] Patient-specific risk factors for repair failure and poor functional outcome after rotator cuff repair - an umbrella review. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-025-08608-w

[93] Which shoulder motions cause subacromial impingement? Evaluating the vertical displacement and peak strain of the coracoacromial ligament by ultrasound speckle tracking imaging. Journal of Shoulder and Elbow Surgery. 2015. DOI: 10.1016/j.jse.2015.04.001

[94] Nonoperative Treatment of Rotator Cuff Disease With Platelet‐Rich Plasma: A Systematic Review of Randomized Controlled Trials. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.10.115

[95] Adverse Impact of Corticosteroid Injection on Rotator Cuff Tendon Health and Repair: A Systematic Review. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.12.006

[96] Editorial Commentary: Partial (Shoulder Rotator) Cuff Repair: May the Force (Couple) Be With You. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.08.237

[97] Volumetric classification: unveiling the true extent of rotator cuff tears. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.08.030

[98] Diagnostic accuracy of noncontrast MRI for detection of glenohumeral cartilage lesions: a prospective comparison to arthroscopy. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.01.048

[99] Preoperative partial-thickness rotator cuff tears do not compromise anatomic total shoulder replacement outcomes: medium-term follow-up. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.07.037

[101] The Use of Magnetic Resonance Arthrography to Detect Partial-Thickness Rotator Cuff Tears. Journal of Bone and Joint Surgery. 2005. DOI: 10.2106/jbjs.e.00509

[102] Real-time sonoelastography in the diagnosis of rotator cuff tendinopathy. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.10.019

[103] Imaging methods for quantifying glenoid and Hill-Sachs bone loss in traumatic instability of the shoulder: a scoping review. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0607-1

[104] Accuracy of magnetic resonance imaging in predicting the intraoperative tear characteristics of pectoralis major ruptures. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.08.037

[105] Accuracy and Reliability of Imaging Modalities for the Diagnosis and Quantification of Hill‐Sachs Lesions: A Systematic Review. Arthroscopy. 2020. DOI: 10.1016/j.arthro.2020.08.005

[106] Rotator cuff tear shape characterization: a comparison of two-dimensional imaging and three-dimensional magnetic resonance reconstructions. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.03.028

[107] Symptomatic Rotator Cuff Tears Show Higher Radioisotope Uptake on Bone Scintigraphy Compared With Asymptomatic Tears. The American Journal of Sports Medicine. 2013. DOI: 10.1177/0363546513494741

[108] Association between pre‐operative magnetic resonance imaging and reparability of large and massive rotator cuff tears. Knee Surgery, Sports Traumatology, Arthroscopy. 2013. DOI: 10.1007/s00167-013-2745-z

[109] Measurement of Glenoid Bone Loss With 3‐Dimensional Magnetic Resonance Imaging: A Matched Computed Tomography Analysis. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.06.050

[110] Biochemical Markers of Aging (Advanced Glycation End Products) and Degeneration Are Increased in Type 3 Rotator Cuff Tendon Stumps With Increased Signal Intensity Changes on MRI. The American Journal of Sports Medicine. 2022. DOI: 10.1177/03635465221090649

[111] Results of arthroscopic rotator cuff repair for calcific tendonitis: a comparative analysis. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2021.08.007

[112] Predictive factors of long head of the biceps tendon disorders—the bicipital groove morphology and subscapularis tendon tear. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2015.12.015

[113] Morphologic Risk Factors in Predicting Symptomatic Structural Failure of Arthroscopic Rotator Cuff Repairs: Tear Size, Location, and Atrophy Matter. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.01.067

[114] Injections Prior to Rotator Cuff Repair Are Associated With Increased Rotator Cuff Revision Rates. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2018.10.116

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Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.