SN2 SHORT NOTE 5M ★ High-yield

Write a short note on Rotator Cuff Injury & Impingement.

General Surgery · Final Professional

Definition

The rotator cuff is the group of four muscles (supraspinatus, infraspinatus, teres minor, subscapularis — ‘sits’) whose tendons blend with the shoulder capsule to stabilise the glenohumeral joint and power its movement. Rotator cuff disease ranges from impingement/tendinopathy to partial and full-thickness tears, and is a very common cause of shoulder pain.

Impingement & Tears

In subacromial impingement, the cuff tendons (especially supraspinatus) are compressed beneath the acromion, causing a painful arc (pain in mid-abduction, roughly 60–120°) worse on overhead activity. A cuff tear (degenerative in the older patient, or traumatic) causes weakness — e.g. Difficulty initiating abduction (supraspinatus) with a positive ‘drop-arm’ test in large tears.

CLINICAL PEARL

A painful arc (60–120°) suggests subacromial impingement/supraspinatus tendinopathy; an inability to hold the arm abducted (a positive drop-arm test) suggests a significant full-thickness supraspinatus tear.

Management

Impingement/tendinopathy: conservative — activity modification, NSAIDs, physiotherapy (cuff strengthening and scapular control) and subacromial corticosteroid injection; refractory cases may need arthroscopic subacromial decompression. Tears: small/degenerate tears are treated conservatively, while significant tears in active patients (or acute traumatic tears) are considered for surgical cuff repair followed by rehabilitation.

Clinical Note

Rotator cuff problems are strongly age-related: impingement and tendinopathy predominate in younger, active patients, whereas degenerate full-thickness tears become common with age and may be surprisingly well tolerated. Distinguishing a stiff, painful shoulder from a genuinely weak one guides management, and imaging (ultrasound or MRI) confirms the presence and size of a tear when surgery is being considered.

CLINICAL PEARL

Let the two signs guide you: a painful arc in mid-abduction means impingement/tendinopathy, whereas a positive drop-arm test means a significant full-thickness tear that may need repair.

Painful arc between 60 and 120 degrees of abduction.

KEY POINT

Key points TO remember

Rotator cuff = supraspinatus, infraspinatus, teres minor, subscapularis (sits); stabilises the shoulder.
Impingement: painful arc 60–120°, worse overhead; tear: weakness, positive drop-arm test.
Supraspinatus most commonly affected.
Conservative (physio, NSAIDs, injection) first; repair significant/traumatic tears in active patients.

EXAM TIP

Sources: Maheshwari's Essential Orthopaedics; Apley & Solomon's System of Orthopaedics and Trauma; AO Principles of Fracture Management.

All questions in Miscellaneous & Rehabilitation

Every General Surgery chapter →