Dr. Rick Matsen’s review of clinical care options for patients with rotator-cuff failure was recently published in the New England Journal of Medicine. Rotator-cuff tears are the most common cause of shoulder pain and disability in the U.S.

Rotator-cuff tears are the most common cause of shoulder pain and disability, accounting for more than 4.5 million visits to physicians each year in the United States. In the May 15, 2008 issue of New England Journal of Medicine, Frederick Matsen, professor and chair of UW Medicine Orthopaedics and Sports Medicine, authors an invited Current Concepts Review of this important condition. He differentiates the acute, traumatic tear from the chronic rotator-cuff defect that comes on gradually over time with minimal injury. The acute rotator-cuff tear causes an abrupt onset of shoulder weakness and requires prompt diagnosis and surgical repair. While the rotator cuff cannot be seen on ordinary X-rays, a tear in the cuff tendons can be visualized using ultrasound or MRI.

Chronic cuff defects usually arise from age-related tendon degeneration. They may not be noticed by the patient, Matsen points out in his review. In fact, 30 percent of asymptomatic people older than age 60 have rotator-cuff defects, and 65 percent of asymptomatic people over age 70 have the defects. When they are symptomatic, chronic cuff tears provide an opportunity for a trial of non-operative management using exercises to restore comfort and function before considering a surgical approach. Surgery can help resolve problems of catching and stiffness. If good-quality cuff tissue remains, the tendon can be secured back to the bone from which it was torn.

Click here to view the New England Journal of Medicine.