[Clinical management of lesions of the rotator cuff]

Lesions of the rotator cuff are caused in most cases by degenerative changes in the critical area around the tuberosities of the humerus. Clinical examination reveals atrophy of the supra- and infraspinatus muscles, a painful arc of movement and, especially, pain at night. There are many clinical tests that can be helpful in the diagnosis. Both ultrasonography and arthrography have proved to be very sensitive methods for the detection of rotator cuff tears. Ultrasonography allows determination of the size and location in addition. Conservative treatment includes rest, physical therapy and anti-inflammatory medication. In many cases the symptoms are improved by many weeks of conservative treatment alone. Operative treatment becomes necessary when no pain relief and no satisfactory movement can be achieved. Complete correction of the tendon defect is important for postoperative care. Passive exercise must allow the tendon repair to remain intact without subjecting it to undue stress.