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Updated: Apr 18, 2026

Reverse Total Shoulder Arthroplasty
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Rotator cuff tears.

Asheesh Bedi1,2, Julie Bishop3, Jay Keener4

  • 1Department of Orthopedic Surgery, University of Chicago, Chicago, IL, USA.

Nature Reviews. Disease Primers
|February 8, 2024
PubMed
Summary
This summary is machine-generated.

Rotator cuff tears, common in the upper extremity, often stem from degeneration, not always requiring surgery. Understanding tear progression and muscle quality is key for effective patient management and surgical outcomes.

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Area of Science:

  • Orthopaedics
  • Musculoskeletal Research

Background:

  • Rotator cuff tears are a prevalent upper extremity condition, ranging from tendinopathy to full-thickness tears.
  • Most rotator cuff issues are degenerative, though some are traumatic.
  • Tear progression and symptomatology are not always correlated, complicating management algorithms.

Purpose of the Study:

  • To explore the complex pathophysiology of rotator cuff tears.
  • To investigate the factors influencing tear progression and patient symptoms.
  • To review current treatment strategies and identify areas for improvement in tendon-to-bone healing.

Main Methods:

  • Review of the current literature on rotator cuff tear pathophysiology and management.
  • Analysis of the interplay between tendon, bone, and muscle in tear development.
  • Evaluation of muscle quality indicators such as size and fatty infiltration.

Main Results:

  • Rotator cuff tears initiate as degenerative tendon changes with matrix disorganization and inflammation.
  • Tear progression involves partial-thickness to full-thickness tears.
  • Muscle quality significantly impacts symptoms, tear progression, and surgical outcomes.

Conclusions:

  • Non-operative management is sufficient for most symptomatic rotator cuff issues.
  • While arthroscopic repair has advanced, improving tendon-to-bone healing remains a challenge.
  • Further understanding of rotator cuff tear pathophysiology is needed for optimized patient care.