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ABSTRACT
Disease of the rotator cuff is common. It is responsible for a high proportion of patients with shoulder pain presenting to general practice, causing work absenteeism and claims for sickness benefits. Rotator cuff disease often can be managed in primary health care services, although some cases may require secondary referral. There are both extrinsic and intrinsic factors to the cuff tendon thought to be involved in the pathogenesis leading on to a spectrum of conditions ranging from sub-acromial bursitis to mechanical failure of the cuff tendon itself. Careful history and examination followed by pertinent investigation are essential to establish the correct diagnosis. The main aim of treatment is to improve symptoms and restore function of the affected shoulder. The majority of patients suffering from rotator cuff disease can be managed by conservative means, but a shift in attitude has lead to significant number benefiting from invasive procedures from decompression of the sub-acromial space to major procedures reconstructing the tendon itself.
It has been shown that rotator cuff disease (RCD) has an incidence of 9.5 per 1000 of patients with shoulder pain presenting to primary care (Ostor et al., 2005). Of these patients it was found that 74% had signs of impingement and 85% had evidence of painful or torn rotator cuffs. A systematic review looking, more specifically, at rotator cuff tears has shown that in an unselected cadaveric population the incidence of both partial and full thickness tears is 30.24% (Reilly et al., 2006). Incidence of tears are regarded as increasing with age and many now consider this to be part of the normal ageing process (Milgrom et al., 1995).
Harvie et al convincingly demonstrated that there is a genetic susceptibility to RCD (Harvie et al., 2004). They have carried out a retrospective, cohort study of 205 patients with full thickness tears of the rotator cuff, using ultrasound to determine the prevalence of RCD in their siblings. They have shown that the relative risk of full-thickness tears in siblings versus controls was 2.42 and the relative risk of symptomatic full-thickness tears in siblings was 4.65. They suggest that the significant phenotypic expression is likely to occur at the level of the development of the ultrastructure of the tendon.
Calcific tendonitis most commonly...