Makindo Medical Notes

💪 Rotator cuff pathology is a common cause of shoulder pain, particularly in middle-aged and older adults. It most often involves the supraspinatus tendon

📖 About

• The rotator cuff is made of 4 muscles (SITS): Supraspinatus, Infraspinatus, Teres minor, Subscapularis.
• They stabilise the glenohumeral joint and allow fine shoulder movements.
• Degeneration and impingement are the most common causes of pathology in adults.

🧬 Aetiology

• Impingement of the supraspinatus tendon beneath the acromion → supraspinatus tendonitis.
• Repetitive overhead activity (e.g., painters, swimmers, athletes).
• Age-related degeneration of tendons and subacromial bursa.
• Acute trauma can cause partial or full-thickness cuff tears.

🩺 Clinical Features

• Painful arc: Pain between 60–120° of abduction (classic exam finding).
• Pain worse with overhead activity and at night (particularly lying on the shoulder).
• Weakness: Especially when lifting or rotating the arm.
• Reduced active movement but preserved passive movement (helps distinguish from frozen shoulder).

🧪 Investigations

• X-ray: May show calcification (calcific tendonitis) or acromial spurs.
• Ultrasound: First-line imaging for tendon tears or bursitis.
• MRI: Gold standard for full-thickness rotator cuff tears.

💊 Management

• Conservative: Rest, analgesia (NSAIDs), physiotherapy (strengthening & mobility exercises).
• Injections: Subacromial steroid injection for persistent pain.
• Surgery: Arthroscopic decompression or cuff repair if conservative measures fail.
• Referral: Orthopaedics or rheumatology depending on chronicity and severity.

📚 References

• NICE CKS – Shoulder pain
• Oxford Handbook of Clinical Specialties – Orthopaedics section

🔄 Revision Pearls

• 🌟 Painful arc = classic for supraspinatus tendonitis.
• 💡 Passive movement preserved → differentiates from frozen shoulder.
• 📌 Ultrasound is quick, non-invasive, and often first-line in UK practice.
• 🛠️ Consider occupation (manual workers, overhead athletes) in history.