Pathogenesis of rotator cuff tears, implications on treatment

Tears of the rotator cuff are a frequent cause of shoulder pain mainly based on degenerative changes within the rotator cuff tendon. Conservative treatment includes physical therapy, anti-inflammatory medication, rest, as well as subacromial and intra-articular injections. If conservative treatment fails, surgical treatment is considered depending on the pathology. Partial ruptures of the rotator cuff are treated with debridement and acromioplasty. In a substantial partial articular-sided tear, either trans-tendon repair or completion of the rupture to a full-thickness tear followed by repair is considered. In full-thickness rotator cuff tears, mini-open or arthroscopic rotator cuff repair is recommended. If the tear is not reparable, different treatment options like partial repair, debridement, biceps tenotomy, tendon transfers, scaffolds, and reverse total shoulder arthroplasty can be considered depending on tendon quality as well as patients' age and demands.