Rotator Cuff Pathology



Rotator Cuff Pathology


Patrick St. Pierre





IMPINGEMENT OR ROTATOR CUFF SYNDROME (33,34)



  • Stage I, as described by Neer, included edema and hemorrhage in the tendon. Tendinosis of the supraspinatus and, less frequently, the infraspinatus or subscapularis is involved.


  • Stage II consisted of fibrosis and tendonitis in the subacromial space. This is a secondary process resulting from the underlying etiology.


  • Stage III resulted in the development of spurs and eventually tendon rupture.


  • The long head of the biceps tendon may also be involved with pathology ranging from inflammation to rupture (12). Dislocation of the biceps tendon from the bicipital groove is pathognomonic for a tear of the upper border of the subscapularis muscle from its humeral insertion (17,18).


  • Pain will often occur along the anterior-lateral acromion, in the infraspinatus fossa, or distally at the deltoid insertion on the humerus. This pain is likely to be referred pain from the inflamed bursa, which irritates the deep deltoid. Pain referring proximally to the neck usually originates from the acromioclavicular (AC) joint (10,39,41,46).


  • There have been several other etiologies proposed for shoulder pain emanating from the subacromial space following Dr. Neer’s initial description (23,24,40). These different etiologies may or may not lead to actual impingement of the cuff by the acromion. Because multiple pathologies are often factors in this condition, including tendinosis and bursitis, the best global term to describe this condition is rotator cuff syndrome, reserving impingement syndrome for cases of true external impingement caused by AC arthritis or from the development of a coracoacromial (CA) ligament spur. Specific etiologies, as discussed later, may also be used.




May 22, 2016 | Posted by in SPORT MEDICINE | Comments Off on Rotator Cuff Pathology
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