The Etiology of Rotator Cuff Disease and Treatment of Partial-Thickness Pathology

The rotator cuff is the most common source of shoulder pain and disability. The majority of rotator cuff injuries are caused by overuse, with the supraspinatus, a small tendon with a poor blood supply, most commonly affected. The major function of the rotator cuff is to stabilize the glenohumeral joint during active arm elevation by opposing the superior vector of the deltoid’s force. As long as the ability to actively elevate the arm is maintained, all rotator cuff injuries, including full-thickness tears, are candidates for nonsurgical management, the basis of which is strengthening of the rotator cuff and scapulothoracic stabilizers. Surgery should be considered for those patients who fail to improve after at least 3 months of nonsurgical management. Arthroscopic rotator cuff debridement without acromioplasty has short-term and long-term results equal to, if not superior to, subacromial decompression. Avoidance of iatrogenic injury to the coracoacromial arch, which is a secondary static stabilizer of the humeral head against anterosuperior migration, contributes to a low complication rate.