Shoulder Impingement and Rotator Cuff Disease

Brief Review:

• The rotator cuff is a group of four muscles: supraspinatus, infraspinatus, teres minor, and subscapularis.
• Physical examination include Neer sign, Hawkins sign and isolated testing such as empty can (supraspinatus), Napoleon (Tummy Pat) and lift-off test (Subscapularis)
• MRI is not routinely indicated with an intact rotator cuff clinically.
  • Try a course of physical therapy for 6 to 12 weeks before ordering MRI.
• More than ninety percent of patients with incomplete tears of the rotator cuff improve with the course of physical therapy, anti-inflammatory medications, or a subacromial injection.
  • If patients fail a 6- to 12-week course of conservative treatment, a corticosteroid injection should be considered before surgery.
• Platelet-rich plasma injections for partial rotator cuff tears and subacromial bursitis have not been proven in the literature