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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.

111 citationsUpdated Aug 2026

For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Rotator cuff disease is widespread, with prevalence increasing with age [2]. Untreated chronic rotator cuff tears can lead to arthrosis [2]. Both surgical and nonsurgical treatments for rotator cuff disease can be effective [2]. Arthroscopic rotator cuff repair is favored for improving shoulder function, while other procedures or intraarticular treatments offer no significant benefits [19]. Rotator cuff repair has a low incidence of short-term complications [3].

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 patient-derived outcome scores for activity level and shoulder disability [97]. There is a direct relation between patient expectations and outcomes in rotator cuff surgery [96]. Mental health has a stronger association with patient-reported shoulder pain and function than tear size in patients with full-thickness rotator cuff tears [14]. Further studies are needed to determine the effect of mental health on the outcome of the treatment of rotator cuff disease [14].

One-year follow-up does not determine the long-term outcome of rotator cuff repair [5]. The short-term clinical outcomes of patients undergoing revision rotator cuff repair are similar to those of primary rotator cuff repair [6, 7]. It was not possible to reach a definitive conclusion regarding the most relevant predictors of outcome of rotator cuff repair due to the low methodological quality of included studies [79]. Salvage options exist for rotator cuff disease [2]. The natural history of rotator cuff tears monitored by magnetic resonance imaging may be useful for determining indications for treatment [25].

Anatomy & Pathophysiology

Kinematics and Biomechanics

Rotator cuff integrity is fundamental to joint mechanics; repair must restore normal capsular anatomy to provide normal biomechanics and positive clinical outcomes [75]. In the setting of an irreparable supraspinatus tear, superior capsular reconstruction (SCR) restores key biomechanical parameters of the shoulder to intact levels [40]. Both the subacromial balloon spacer and SCR function to decrease superior humeral head migration and restore more normal glenohumeral joint position and forces during various abduction positions [88]. Dynamic superior migration of the humeral head during abduction occurs in patients with rotator cuff tears, confirmed by in vivo 3D kinematic analysis [66]. Glenohumeral decentering is significantly associated with diminished shoulder function and active range of motion in all planes [62].

In massive rotator cuff tears, the pectoralis major and latissimus dorsi muscles are effective in improving glenohumeral kinematics and reducing acromiohumeral pressures [77]. Latissimus dorsi transfer (LDT) may restore native glenohumeral kinematics more sufficiently than other LDT techniques for irreparable posterosuperior rotator cuff tears, potentially leading to improved postoperative functional outcomes [78]. Biomechanical changes of passive glenohumeral joint motion occur in the glenohumeral joint with as little as 5% GIRD [51]. Clinical evaluation of altered shoulder kinematics remains complicated [32].

Surgical Reconstruction and Stability

Superior Capsular Reconstruction: Xenograft-based SCR shows no deterioration in functional improvement at 5-year follow-up [29]. No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified for SCR using xenograft [29].

Instability and Bone Block Procedures: 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 [85]. The modified position of the scapula was maintained during the entire range of motion after the Latarjet procedure, suggesting a shoulder-stabilizing kinematic effect in addition to bony, sling, and bumper effects [67]. 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 [76]. Glenoid morphology can be normalized during the intermediate to long-term postoperative period after arthroscopic repair of chronic osseous Bankart lesions, even in shoulders with a smaller fragment [92]. A physiological remodeling process leads to restoration of a more natural glenoid anatomy in arthroscopic implant-free bone grafting for shoulder instability with glenoid bone loss [89].

Reverse Total Shoulder Arthroplasty: Increasing humeral component retroversion did not affect the muscle force requirements for scaption across the shoulder in reverse total shoulder arthroplasty [71].

Throwing Athletes and Pathomechanics

Updates on the thrower's shoulder, including anatomy, mechanics, pathomechanics, and treatment, are essential for clinicians and researchers [33]. 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 [45]. Findings from an animal model of rotator cuff tears are consistent with alterations in shoulder function observed with rotator cuff and other shoulder injuries in humans [86].

Classification

MRI Assessment Criteria: Twenty-six different criteria described by multiple classification systems have been identified for the magnetic resonance assessment of rotator cuff status after repair [11].

Acromial Morphology: The acromial morphology classification system is an unreliable method to assess the acromion [12]. The acromial index shows no association with the presence of rotator cuff disease [12].

Comprehensive Tear Classification: A comprehensive rotator cuff tear classification scheme encompassing 97% of all tears was described to facilitate anatomic repair [35].

Coracoid Morphology: A classification system was created to divide coracoids according to their morphology and relative risk of associated subscapularis tears [48].

Interobserver Agreement: Currently described rotator cuff classification systems have little interobserver agreement among experienced shoulder surgeons, with the exception of distinguishing partial-thickness from full-thickness tears and identifying the side (articular vs bursal) of involvement with partial-thickness tears [56].

Long Head of Biceps Instability: A new arthroscopic classification for long head of the biceps (LHB) instability was created based on observations that LHB instability was associated with LHB lesions and rotator cuff tear size [69].

Glenoid Morphology: 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 [73]. Alternative glenoid classification systems or predictive models should be considered to provide more precise prognoses than the Walch classification for patients before and after shoulder arthroplasty performed for osteoarthritis with an intact rotator cuff [82].

Partial Subscapularis Tears: A novel classification for partial subscapularis tendon tears was presented to enable more detailed and reproducible description [81].

SLAP Lesions: The Snyder classification is a reliable system for identifying SLAP lesions among experienced shoulder surgeons [87].

Obstetric Brachial Plexus Palsy: The Gilbert grading system categorizes impairment of shoulder abduction in obstetric brachial plexus palsy, with grade 1 defined as shoulder abduction 54-58 degrees, grade 2 as 45-90 degrees, grade 3 as 90-120 degrees, and grade 4 as 120-150 degrees [103].

Glenoid Wear (GW): The GW (glenoid wear) grade classification includes subtypes for grade 3, specifically grade 3A, grade 3B, and grade 3C [108].

Coracoacromial Ligament Degeneration: The Royal Berkshire Hospital Classification categorizes coracoacromial ligament (CAL) degeneration into four grades: grade 0 (normal appearance), grade 1 (minor fraying), grade 2 (major fraying), and grade 3 (visualization of the bare bone under the CAL) [112].

Scapular Notching: The Sirveaux classification categorizes scapular notching in reverse shoulder arthroplasty into grades 1, 2, 3, and 4 [113].

Glenohumeral Osteoarthritis: The Modified Samilson and Prieto classification is used to grade the progression of glenohumeral osteoarthritis [115].

Clinical Presentation

Rotator cuff disease is a widespread soft-tissue pathology involving the shoulder, with prevalence increasing with age [2, 37]. The etiology of anterior shoulder pain often involves complex interactions between the tendon and surrounding soft tissues, particularly when macroscopic changes in the biceps tendon are present [15]. Disorders of the long head of the biceps tendon frequently coexist with other shoulder pathologies and serve as a significant source of pain and dysfunction [53]. Subjective mechanical symptoms are a common complaint in patients with suspected rotator cuff pathology [34].

Diagnosis requires integration of clinical assessment and imaging. Attending-level physicians with fellowship training determine tear presence clinically, while MRI confirms pathology [41]. However, imaging alone is insufficient for diagnosis, as structural abnormalities are common in asymptomatic individuals [41]. In patients with atraumatic, full-thickness tears, symptom duration does not correlate with tear severity or patient-related features [4]. Asymptomatic and symptomatic tears exhibit similar rates of progression over time [9]. Intrinsic pathologic conditions in partial-thickness tears treated with acromioplasty without repair showed no evidence of progression at a mean follow-up of 4.5 years [8].

Clinical presentation varies by tear size and patient age. Small tears may be observed in elderly asymptomatic individuals, whereas large or very large tears are symptomatic in younger, working-age populations [47]. Large or massive tears lead to weakness, are incompatible with manual labor, and are often resistant to nonoperative treatment [47]. These massive tears, defined as particularly difficult to repair with an uncertain prognosis, may cause incapacitating chronic pain and severe functional impairment [47]. Retears occur more frequently when the interval between symptom onset and operation is short; although retear patients improve preoperatively, their improvement is less than that of successful repairs [47].

Specific pathologies require distinct diagnostic considerations. Coracoid impingement is a rare, uncommon cause of anterior shoulder pain that is difficult to diagnose precisely due to multifactorial pathologies and limited evidence, yet proper management yields excellent outcomes [42, 43]. Isolated anterosuperior labral tears are subtle causes of dysfunction that are very difficult to diagnose clinically [59]. In anterior shoulder instability repair, recognition of associated pathologies—including glenoid and humeral head bone loss, rotator interval pathology, and rotator cuff tears—is necessary to improve function and stability [13].

Physical examination findings must be interpreted with caution. The Crank Test and O'Brien Test are often falsely positive in patients with other conditions, such as impingement or rotator cuff tears [44]. When diagnosis remains unclear after thorough history and physical examination, using the patient's symptom (e.g., 'shoulder pain') as the diagnosis prevents unwarranted invasive procedures [36]. Baseline characteristics are associated with outcomes after corticosteroid injection in rotator cuff disease [17]. Rotator cuff injuries in adolescents may be overlooked, leading to significant diagnostic delays [57]. Traumatic rotator cuff tears are defined by a clinical depiction of significant trauma and full-thickness MRI findings in patients undergoing repair within 12 months of injury [49].

Investigations

Plain radiography:

Plain radiography cannot discriminate between traumatic and nontraumatic rotator cuff lesions [72]. However, it is useful for screening patients for significant glenoid bone loss [111]. The presence of a rotator cuff tear influences progression in Hamada grade, although the magnitude of radiographic progression is not influenced by tear severity or enlargement at midterm time points [31].

MRI:

Magnetic resonance assessment utilizes twenty-six different criteria described by multiple classification systems for evaluating the rotator cuff after repair [11]. MRI helps discriminate between traumatic and nontraumatic rotator cuff lesions, whereas radiography cannot [72]. Magnetic resonance arthrography improves the differentiation of rotator cuff degeneration from partial or complete tears [109].

Advanced imaging techniques offer novel advancements. The integration of 3D imaging and volumetric analysis challenges conventional reliance on 2D MRI for diagnosing and classifying injuries [104]. 3D MR reconstructions improve the accuracy of characterizing tear shape compared with current 2D MRI-based techniques [119].

Specific MRI findings correlate with clinical status and surgical outcomes. 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 tears [121]. The presence of a partial cuff tear on preoperative MRI does not significantly affect function after anatomic total shoulder replacement in the medium term [106]. The presence and severity of cartilage lesions may be underestimated on MRI in patients with rotator cuff tendinopathy undergoing arthroscopy [105]. The MRI tendinosis grade is associated with stiffness assessed using sonoelastography in patients with rotator cuff tendinopathy [110].

Diagnostic accuracy varies by pathology. The diagnostic accuracy of MRI decreases when chronic pectoralis major ruptures are evaluated [114].

CT:

3D MRI serves as a radiation-free and reliable alternative to preoperative CT shoulder scans for measuring glenoid bone loss [122].

Bone scan:

Shoulders with a symptomatic rotator cuff tear show higher radioisotope uptake on bone scintigraphy than those with an asymptomatic tear [120].

Other Considerations:

Imaging modalities provide clinically acceptable accuracy in diagnosing and quantifying Hill-Sachs lesions, and can determine whether these lesions cause persistent anterior shoulder instability [118].

Imaging-based stump classification reflects the degeneration and fragility of the torn rotator cuff site. Type 3 rotator cuff tendon stumps with increased signal intensity changes on MRI have increased biochemical markers of aging (Advanced Glycation End Products) and degeneration [123].

Preoperative imaging guides comprehensive evaluation. When bicipital groove morphology and subscapularis tendon tear are found, the clinician should evaluate the patient for an LHB tendon disorder as a pain generator [125]. Tear size, location, and atrophy are morphologic risk factors in predicting symptomatic structural failure of arthroscopic rotator cuff repairs [126]. There is a quantitative cutoff on MRI for the size of infraspinatus involvement that can be used clinically as a predicting factor for symptomatic structural failure [126].

No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified [29]. CT-ARCR results were comparable to patients who received conventional ARCR for similar-sized rotator cuff tears that did not have calcific tendonitis [124].

Treatment

Non-Operative Management

Both surgical and nonsurgical treatments can be effective for rotator cuff disease [2]. Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear [55]. At 13 years after diagnosis, about 90% of patients treated conservatively for rotator cuff tears had no or only slight pain [10]. At 13 years after diagnosis, about 70% of patients treated conservatively for rotator cuff tears had no disturbance in activities of daily life [10]. Nonoperative treatment using a specific physical therapy protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for 2 years [93]. Nonoperative treatment remains a viable option for certain patients with traumatic rotator cuff tears, although there is a considerable early failure rate [28]. At one-year follow-up, operative treatment is no better than conservative treatment regarding non-traumatic supraspinatus tears, and conservative treatment should be considered as the primary method of treatment for this condition [94].

There is little reproducible evidence to support the efficacy of subacromial corticosteroid injection in managing rotator cuff disease [58]. 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 due to adverse impacts on tendon health and repair [101]. The currently limited available evidence on platelet-rich plasma (PRP) for nonoperative treatment of chronic rotator cuff disease suggests that in the short term, PRP injections may not be beneficial [100]. Mental health has a stronger association with patient-reported shoulder pain and function than tear size in patients with full-thickness rotator cuff tears [14]. The effect of mental health on the outcome of the treatment of rotator cuff disease requires further study [14].

Operative Management

Indications: Chronic massive rotator cuff tears without glenohumeral arthritis can be managed nonsurgically or with subacromial débridement, rotator cuff repair, or rotator cuff reconstruction [68]. The reverse shoulder prosthesis should be reserved for the treatment of arthropathies with a massive rotator cuff tear [74]. The reverse shoulder prosthesis appears to be contraindicated in patients with rheumatoid arthritis [74]. Patient-specific risk factors for repair failure and poor functional outcome after rotator cuff repair should be carefully considered in treatment planning [98].

Surgical Approach / Technique: Arthroscopic rotator cuff repair is favored for improving shoulder function, while other procedures or intraarticular treatments offer no significant benefits [19]. The arthroscopic treatment of rotator cuff lesions leads to good results after 36 months [61]. Tuberoplasty for the treatment of massive irreparable rotator cuff tears results in good clinical outcomes with significant pain relief in select populations [63]. 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 [102]. 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 [95]. Rotator cuff repair in patients aged >75 years could achieve high clinical success rates with good outcomes and pain relief [60].

Implant Selection: The reverse shoulder prosthesis should be reserved for the treatment of arthropathies with a massive rotator cuff tear [74]. The reverse shoulder prosthesis appears to be contraindicated in patients with rheumatoid arthritis [74].

Adjuncts: It is recommended that patients with impingement syndrome or a repaired rotator cuff avoid specific shoulder motions that cause subacromial impingement, as evaluated by vertical displacement and peak strain of the coracoacromial ligament [99].

Evidence Limitations and Considerations

Despite advances in surgical options and rehabilitation, failure rates for large-to-massive rotator cuff tears remain high [64]. Untreated chronic rotator cuff tears can lead to arthrosis [2]. Salvage options exist for rotator cuff disease [2]. The effect of comorbidity on self-assessed function in patients with a chronic rotator cuff tear may ultimately influence the evaluation of the results of surgical treatment and should be considered when treating patients and analyzing outcomes [18]. The results of monitoring the natural history of rotator cuff tears by magnetic resonance imaging may be useful for determining the indications for treatment [25]. The AAOS Rotator Cuff Clinical Practice Guideline is controversial and inconclusive due to a lack of adequate high-level evidence, and clear evidence based on additional research is required before conclusions can be characterized as guidelines [90].

Complications

Other Considerations: Rotator cuff repair generally demonstrates a low incidence of short-term complications [3]. However, one-year follow-up data does not determine the long-term outcome of the procedure [5]. Nonoperative treatment of traumatic full-thickness rotator cuff tears is associated with a considerable early failure rate [28].

Long-Term Outcomes and Revision: Revision rotator cuff repair provides significant pain relief and improvement in functional scores at long-term follow-up (minimum 10 years) [26]. Salvage options exist for shoulders with arthrosis resulting from untreated chronic tears [2].

Patient-Specific Risk Factors: Individuals with a family history of rotator cuff tearing are more likely to experience repair failures [27]. A large proportion of young patients (50 years and younger) have an unsatisfactory long-term result after rotator cuff repair [21]. While young patients achieve long-term pain relief, rotator cuff repair in this demographic is not associated with significant long-term improvement in motion [21].

Recovery

Light activity (weeks): Specific week ranges for light activity are not provided in the current evidence base.

Full activity (months): Specific month ranges for full activity are not provided in the current evidence base.

Complete recovery / outcome plateau (months): Patients who have undergone rotator cuff repair experience approximately 60% of ultimate functional recovery at 3 months and approximately 75% at 6 months [84]. One-year follow-up does not determine long-term outcomes of rotator cuff repair [5].

Rehabilitation protocol: Rehabilitation protocol details are not provided in the current evidence base.

Functional milestones: In cases of rotator cuff tears treated conservatively, about 90% of patients had no or only slight pain at 13 years after diagnosis [10]. In cases of rotator cuff tears treated conservatively, about 70% of patients had no disturbance in activities of daily life at 13 years after diagnosis [10]. 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 [20]. 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 [23]. Short-term clinical outcomes of patients undergoing revision rotatoruff repair are similar to those of primary rotator cuff repair [6, 7]. Revision rotator cuff reconstruction improves clinical outcomes and shoulder function at midterm follow-up (minimum 2 years) [70].

Other Considerations: 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 [21]. A large proportion of patients aged fifty years and younger have an unsatisfactory long-term result after rotator cuff repair [21]. Repair of a large or massive chronic tear of the rotator cuff can have a satisfactory long-term outcome [22]. Individuals with a family history of rotator cuff tearing were more likely to have repair failures [27]. Injections prior to rotator cuff repair are associated with increased rotator cuff revision rates, with frequency and time dependence observed [127].

Key Evidence

  • [L4] Rotator cuff repair has a low incidence of short-term complications. [3] (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. [4] (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. [5] (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. [6] (10.1177/2325967114s00016)
  • [L3] Short-term clinical outcomes of patients undergoing revision rotator cuff repair were similar to primary rotator cuff repair. [7] (10.1016/j.jse.2015.05.015)
  • [L4] There was no evidence of progression of intrinsic rotator cuff pathologic conditions at a mean follow-up of 4.5 years. [8] (10.1177/03635465020300021801)
  • [L4] Asymptomatic and symptomatic rotator cuff tears carry similar rates of tear progression over time. [9] (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] (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. [11] (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. [12] (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. [13] (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. [14] (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. [15] (10.1016/j.jse.2008.05.044)
  • [L2] Baseline characteristics were associated with outcome after corticosteroid injection in rotator cuff disease. [17] (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. [18] (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. [19] (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. [20] (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. [21] (10.2106/00004623-200410000-00012)
  • [L3] Repair of a large or massive tear of the rotator cuff can have a satisfactory long-term outcome. [22] (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. [23] (10.1016/j.jse.2024.05.056)
  • [L3] The results of the present study may be useful for determining the indications for treatment of rotator cuff tears. [25] (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. [26] (10.1016/j.jse.2023.06.009)
  • [L2] Individuals with a family history of rotator cuff tearing were more likely to have repair failures. [27] (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. [28] (10.1016/j.jse.2023.11.012)
  • [L5] No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified. [29] (10.1016/j.arthro.2025.07.020)
  • [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. [31] (10.1016/j.jse.2016.07.022)
  • [L2] A clinical evaluation of altered shoulder kinematics is still complicated. [32] (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. [33] (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. [34] (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. [35] (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. [36] (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. [40] (10.1016/j.jse.2020.03.007)
  • [L2] [41] (10.2106/jbjs.19.01112)
  • [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. [42] (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. [43] (10.1007/s00167-012-2013-7)
  • [L3] Results were often falsely positive for patients with other shoulder conditions, including impingement or rotator cuff tears. [44] (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. [45] (10.1177/03635465000280022301)
  • [L3] [47] (10.2106/00004623-200004000-00006)
  • [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. [48] (10.1016/j.jse.2020.01.074)
  • [L3] [49] (10.1016/j.jse.2021.03.134)
  • [L5] Biomechanical changes of passive glenohumeral joint motion occur in the glenohumeral joint with as little as 5% GIRD. [51] (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. [53] (10.1016/j.jse.2011.07.016)
  • [L2] Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. [55] (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. [56] (10.1177/0363546506298108)
  • [L4] Rotator cuff injuries in adolescents may be overlooked as a cause of disability, leading to significant delays in diagnosis. [57] (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. [58] (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. [59] (10.1016/j.arthro.2010.05.022)
  • [L4] Rotator cuff repair in patients aged >75 years could achieve high clinical success rates with good outcomes and pain relief. [60] (10.3389/fpubh.2022.1060700)
  • [L3] The arthroscopic treatment of rotator cuff lesions leads to good results after 36 months. [61] (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. [62] (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. [63] (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. [64] (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. [66] (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. [67] (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. [68] (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. [69] (10.1016/j.arthro.2006.08.025)
  • [L4] Revision RCR improves clinical outcomes and shoulder function at midterm follow-up. [70] (10.1177/0363546518786006)
  • [L5] Increasing retroversion did not affect the muscle force requirements for scaption across the shoulder. [71] (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. [72] (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. [73] (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. [74] (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. [75] (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. [76] (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. [77] (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. [78] (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. [79] (10.1007/s00167-015-3700-y)
  • [L3] The study presents a novel classification for partial subscapularis tendon tears to enable more detailed and reproducible description. [81] (10.1007/s00167-020-05989-4)
  • [L3] Alternative glenoid classification systems or predictive models should be considered to provide more precise prognoses. [82] (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. [84] (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. [85] (10.1016/j.arthro.2024.01.014)
  • [L3] For experienced shoulder surgeons, the Snyder classification is a reliable system for identifying SLAP lesions. [87] (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. [88] (10.1016/j.arthro.2018.09.016)
  • [L4] A physiological remodeling process leads to restoration of a more natural glenoid anatomy. [89] (10.1177/0363546515625283)
  • [L5] The authors argue that the AAOS Rotator Cuff Clinical Practice Guideline is controversial and inconclusive due to a lack of adequate high-level evidence, asserting that clear evidence based on additional research is required before conclusions can be characterized as guidelines. [90] (10.1016/j.arthro.2012.03.021)
  • [L3] Over 90% of patients who underwent RSA for GHOA with an intact rotator cuff experienced substantial clinical benefit. [91] (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. [92] (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. [93] (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. [94] (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. [95] (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. [96] (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. [97] (10.1177/0363546515593954)
  • [L1] These factors should be carefully considered in treatment planning for patients undergoing rotator cuff repair. [98] (10.1186/s12891-025-08608-w)
  • [L4] It is recommended that patients with impingement syndrome or a repaired rotator cuff avoid these shoulder motions. [99] (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. [100] (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. [101] (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. [102] (10.1016/j.arthro.2017.08.237)
  • [L4] [103] (10.1054/jhsb.1999.0282)
  • [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. [104] (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. [105] (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. [106] (10.1016/j.jse.2020.07.037)
  • [L4] [108] (10.1016/j.jse.2022.05.013)
  • [L2] Magnetic resonance arthrography can improve the differentiation of rotator cuff degeneration from partial or complete rotator cuff tears. [109] (10.2106/jbjs.e.00509)
  • [L3] The MRI tendinosis grade is associated with stiffness assessed using sonoelastography in patients with rotator cuff tendinopathy. [110] (10.1016/j.jse.2015.10.019)
  • [L4] Radiography can be used for screening patients for significant glenoid bone loss. [111] (10.1186/s12891-015-0607-1)
  • [L4] [112] (10.1016/j.jse.2016.02.026)
  • [L3] [113] (10.1016/j.jse.2008.02.010)
  • [L3] The diagnostic accuracy of MRI decreases when chronic tears are evaluated. [114] (10.1016/j.jse.2015.08.037)
  • [L3] [115] (10.1016/j.jse.2018.07.022)
  • [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. [118] (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. [119] (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. [120] (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. [121] (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. [122] (10.1016/j.arthro.2018.06.050)
  • [L4] Imaging based on stump classification reflects the degeneration and fragility of the torn rotator cuff site. [123] (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. [124] (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. [125] (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. [126] (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. [127] (10.1016/j.arthro.2018.10.116)

See Also

References

[2] Chapter 3 Rotator Cuff Disease. 2019.

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[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

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[25] 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

[26] 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

[27] 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

[28] 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

[29] 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

[31] 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

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

[33] 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

[34] 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

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

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

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

[40] 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

[41] Comparative Time to Improvement in Nonoperative and Operative Treatment of Rotator Cuff Tears. Journal of Bone and Joint Surgery. 2020. DOI: 10.2106/jbjs.19.01112

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

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

[44] 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

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

[47] The Results of Repair of Massive Tears of the Rotator Cuff†. The Journal of Bone and Joint Surgery-American Volume*. 2000. DOI: 10.2106/00004623-200004000-00006

[48] 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

[49] Early repair of traumatic rotator cuff tears improves functional outcomes. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2021.03.134

[51] 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

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

[55] 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

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

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

[58] 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

[59] 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

[60] 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

[61] 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

[62] 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

[63] 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

[64] 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

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

[67] 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

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

[69] 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

[70] 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

[71] 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

[72] 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

[73] 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

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

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

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

[77] 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

[78] 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

[79] 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

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

[82] 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

[84] 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

[85] 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

[86] Erratum_to_“Alterations_in_function_after_rotator_cuff_tears_in_an_animal_model”_S1058274609002973. Journal of Shoulder and Elbow Surgery. 2009.

[87] 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

[88] 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

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

[90] AAOS Rotator Cuff Clinical Practice Guideline Misses the Mark. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.03.021

[91] 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

[92] 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

[93] 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

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

[95] 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

[96] 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

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

[98] 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

[99] 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

[100] 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

[101] 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

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

[103] Classification of Impairment of Shoulder Abduction in Obstetric Brachial Plexus Palsy and its Clinical Significance. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.1999.0282

[104] 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

[105] 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

[106] 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

[108] Glenoid wear and its impact on clinical results after humeral head replacement using a single prosthesis in cuff tear arthropathy with more than 8 years of follow-up. Journal of Shoulder and Elbow Surgery. 2022. DOI: 10.1016/j.jse.2022.05.013

[109] 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

[110] 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

[111] 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

[112] Grade of coracoacromial ligament degeneration as a predictive factor for impingement syndrome and type of partial rotator cuff tear. Journal of Shoulder and Elbow Surgery. 2016. DOI: 10.1016/j.jse.2016.02.026

[113] Scapular notching in reverse shoulder arthroplasty. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2008.02.010

[114] 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

[115] Rotator cuff tear with early osteoarthritis: how does it affect clinical outcome after large to massive rotator cuff repair?. Journal of Shoulder and Elbow Surgery. 2019. DOI: 10.1016/j.jse.2018.07.022

[118] 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

[119] 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

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