Editing Rotator cuff (section)

==Clinical significance==

===Tear===
{{Main|Rotator cuff tear}}
The tendons at the ends of the rotator cuff muscles can become torn, leading to [[pain]] and restricted movement of the arm.  A torn rotator cuff can occur following trauma to the shoulder or it can occur through the "wear and tear" on tendons, most commonly the supraspinatus tendon found under the [[acromion]].

Rotator cuff injuries are commonly associated with motions that require repeated overhead motions or forceful pulling motions. Such injuries are frequently sustained by athletes whose actions include making repetitive throws, athletes such as [[Handball|handball players]], [[baseball]] [[pitcher]]s, [[softball]] [[pitchers]], [[American football]] players (especially [[quarterback]]s), [[firefighter]]s, [[cheerleaders]], weightlifters (especially [[powerlifters]] due to extreme weights used in the [[bench press]]), [[Rugby football|rugby]] players, [[volleyball]] players (due to their swinging motions),{{citation needed|date=June 2012}} [[water polo]] players, rodeo [[team roping|team ropers]], [[shot put]] throwers, [[swimmers]], [[Boxer (boxing)|boxer]]s, [[kayaker]]s, [[martial arts|martial artists]], [[Fast bowling|fast bowlers]] in cricket, [[tennis]] players (due to their service motion){{citation needed|date=June 2012}} and [[Tenpin Bowling|tenpin bowlers]] due to the repetitive swinging motion of the arm with the weight of a [[bowling ball]]. This type of injury also commonly affects [[orchestra conductor]]s, [[choral conductor]]s, and [[drummer]]s (due, again, to swinging motions).

As progression increases after 4–6 weeks, active exercises are now implemented into the rehabilitation process. Active exercises allow an increase in strength and further range of motion by permitting the movement of the shoulder joint without the support of a physical therapist.<ref name="Jobe, F.M. 1992">{{cite journal |vauthors=Jobe FW, Moynes DR |title=Delineation of diagnostic criteria and a rehabilitation program for rotator cuff injuries |journal=Am J Sports Med |volume=10 |issue=6 |pages=336–9 |year=1982 |pmid=7180952 |doi=10.1177/036354658201000602|s2cid=41784933 }}</ref> Active exercises include the Pendulum exercise, which is used to strengthen the Supraspinatus, Infraspinatus, and Subscapularis.<ref name="Jobe, F.M. 1992" /> External rotation of the shoulder with the arm at a 90-degree angle is an additional exercise done to increase control and range of motion of the Infraspinatus and Teres minor muscles. Various active exercises are done for an additional 3–6 weeks as progress is based on an individual case-by-case basis.<ref name="Jobe, F.M. 1992" /> At 8–12 weeks, [[strength training]] intensity will increase as free-weights and resistance bands will be implemented within the exercise prescription.<ref name="Escamilla09" />

===Impingement===
{{Main|Impingement syndrome}}
The accuracy of the physical examination is low.<ref name="pmid17720798">{{cite journal  |vauthors=Hegedus EJ, Goode A, Campbell S, etal |title=Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests |journal=British Journal of Sports Medicine |volume=42 |issue=2 |pages=80–92 |date=February 2008 |pmid=17720798 |doi=10.1136/bjsm.2007.038406|doi-access=free }}</ref> The [[Hawkins-Kennedy test]]<ref>{{cite web |url=http://www.shoulderdoc.co.uk/education/article.asp?article=580 |author1=ShoulderDoc.co.uk Shoulder |author2=Elbow Surgery |name-list-style=amp |title=Hawkins-Kennedy Test |access-date=2007-09-12 |url-status=dead |archive-url=https://web.archive.org/web/20071015085708/http://shoulderdoc.co.uk/education/article.asp?article=580 |archive-date=15 October 2007}} (video)</ref><ref name="Brukner14">{{cite web |url=http://www.clinicalsportsmedicine.com/chapters/14d.htm |title=Chapter 14: Shoulder Pain |access-date=2007-08-30 |vauthors=Brukner P, Khan K, Kibler WB |url-status=dead |archive-url=https://web.archive.org/web/20070810165243/http://www.clinicalsportsmedicine.com/chapters/14d.htm |archive-date=10 August 2007}}</ref> has a [[sensitivity (tests)|sensitivity]] of approximately 80% to 90% for detecting impingement. The infraspinatus and supraspinatus<ref>{{cite web |url=http://www.shoulderdoc.co.uk/education/article.asp?article=582 |title=Empty Can/Full Can Test |author1=ShoulderDoc.co.uk Shoulder |author2=Elbow Surgery |name-list-style=amp |access-date=2007-09-12 |url-status=dead |archive-url=https://web.archive.org/web/20071015085715/http://shoulderdoc.co.uk/education/article.asp?article=582 |archive-date=15 October 2007}} (video)</ref> tests have a [[specificity (tests)|specificity]] of 80% to 90%.<ref name="pmid17720798"/>

A common cause of shoulder pain in rotator cuff impingement syndrome is [[tendinosis]], which is an age-related and most often [[Self-limiting (biology)|self-limiting]] condition.<ref>{{Cite journal|last1=Mohamadi|first1=Amin|last2=Chan|first2=Jimmy J.|last3=Claessen|first3=Femke M. A. P.|last4=Ring|first4=David|last5=Chen|first5=Neal C.|date=January 2017|title=Corticosteroid Injections Give Small and Transient Pain Relief in Rotator Cuff Tendinosis: A Meta-analysis|journal=Clinical Orthopaedics and Related Research|volume=475|issue=1|pages=232–243|doi=10.1007/s11999-016-5002-1|issn=1528-1132|pmc=5174041|pmid=27469590}}</ref>

Studies show that there is moderate evidence that hypothermia (cold therapy) and exercise therapy used together are more effective than simply waiting for surgery and they suggest the best outcome for non-surgical treatment of subacromial impingement syndrome. The group of patients who participated in the exercise group were found to use significantly lower amounts of non-steroidal anti-inflammatory drugs (NSAIDS) and analgesics than the control group with no intervention. <ref>{{Cite journal|last1=Gebremariam|first1=Lukas|last2=Hay|first2=Elaine M.|last3=Sande|first3=Renske van der|last4=Rinkel|first4=Willem D.|last5=Koes|first5=Bart W.|last6=Huisstede|first6=Bionka M. A.|date=2014-08-01|title=Subacromial impingement syndrome—effectiveness of physiotherapy and manual therapy|url=https://bjsm.bmj.com/content/48/16/1202|journal=British Journal of Sports Medicine|language=en|volume=48|issue=16|pages=1202–1208|doi=10.1136/bjsports-2012-091802|issn=0306-3674|pmid=24217037|s2cid=27383041 |access-date=9 March 2021|archive-date=19 April 2021|archive-url=https://web.archive.org/web/20210419025001/https://bjsm.bmj.com/content/48/16/1202|url-status=live|url-access=subscription}}</ref>

===Inflammation and fibrosis===
The rotator interval is a triangular space in the shoulder that is functionally reinforced externally by the [[coracohumeral ligament]] and internally by the [[glenohumeral ligament|superior glenohumeral ligament]], and traversed by the intra-articular [[biceps tendon]]. On imaging, it is defined by the coracoid process at its base, the supraspinatus tendon superiorly and the subscapularis tendon inferiorly. Changes of [[adhesive capsulitis]] can be seen at this interval as [[edema]] and [[fibrosis]]. Pathology at the interval is also associated with glenohumeral and biceps instability.<ref>{{cite journal|last1=Petchprapa|first1=CN|last2=Beltran|first2=LS|last3=Jazrawi|first3=LM|last4=Kwon|first4=YW|last5=Babb|first5=JS|last6=Recht|first6=MP|title=The rotator interval: a review of anatomy, function, and normal and abnormal MRI appearance.|journal=AJR. American Journal of Roentgenology|date=September 2010|volume=195|issue=3|pages=567–76|pmid=20729432|doi=10.2214/ajr.10.4406}}</ref> Adhesive capsulitis or "frozen shoulder" is often secondary to rotator cuff injury due to post-surgical immobilization. Available treatment options include intra-articular corticosteroid injections to relieve pain in the short-term and electrotherapy, mobilizations, and home exercise programs for long-term pain relief. <ref>Challoumas D, Biddle M, McLean M, Millar NL. Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(12):e2029581. Published 2020 Dec 1. [http://doi:10.1001/jamanetworkopen.2020.29581 doi:10.1001/jamanetworkopen.2020.29581]{{Dead link|date=February 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref>