Talk:Rotator cuff tear

Editorial Comments
Anatomical structures should be linked to their own page using the double brackets.

Needs a section on incidence (how often does this occur? in whom?) toward the beginning of the article.

Under Anatomy, add in some subheadings using === triple equal signs. Scholarchanter (talk) 01:01, 1 June 2010 (UTC)

Peer review, May 10, 2012
The following corrections should be made to the article to improve its content. I could not find any corrections to be made, other than to simply where and if possible. I have no other suggestions at this time. The following are positive points of this article. This is one of the most well-developed, well cited, and well written wiki’s I have read. It is comprehensive, and provides adequate visual aids.

NHearn (talk) 05:54, 11 May 2012 (UTC)

3 positives: 1.The whole article is very thorough. It contains many sections such as presentation, mechanism of injury, pathophysiology, diagnosis, etc. 2.the article is well organized. On the diagnosis section, it is divided into symptoms, signs, MRI, ultrasound and in office testing. None of the sections repeat the information in other sections. 3.The pictures in the article are all has descriptions about what they are. All pictures are placed in the right sections. 3 problems: 1.The article is a little too long. It might be difficult for impatient readers to read. 2.The rehabilitation part is a little too short, and it could include some pictures of exercises. The surgery part is very detailed though. 3.The pictures that represent the anatomy of the site of injury is a little too small, it could have used bigger pictures. The x-ray pictures are also a bit small. Kin412a (talk) 08:30, 12 May 2012 (UTC)

I would like to add that the surgery part is inaccurate. Open rotator cuff surgery is considered old-school. Modern surgery for cuff tears is arthroscopic, and if not done arthroscopically, the patient is not set up for the best outcome. Also, repair of the tendons is not done with suture alone. A suture and anchor construct is used. The best procedure will utilize a 'double row' technique allowing for more compression or creating a larger 'foot print' over the area of reattachment. Surgery technique and procedure could be a page in itself as there are many ways to fix cuff tears. www.arthrex.com is the best source for shoulder procedures.

As for the augmenting the tendon tissue with an allograft, collagen is not used, and the other company I have never even heard of. Please remove because those are not options any surgeon would use.

Acromioplasty is to decompress, yes, but also to remove osteophytes and create a smooth surface. These osteophytes, bone spurs, along with inflammation and compress of tissue, is what created a chronic tear. I think it is misleading to say a portion of bone is removed. — Preceding unsigned comment added by 150.201.128.33 (talk) 00:41, 1 May 2013 (UTC)

Tendon layers
Does the description of tendon layers add anything, or simply add to overload for the average reader? Mdscottis (talk) 05:01, 19 February 2013 (UTC)

In office testing - rotator cuff impingement syndrome
The use of subacromial corticosteroid injection is not restricted to the 'rotator cuff impingement syndrome' and I don't think it indicates what the article says it does. Note that there is no associated citation. It would be better, in my opinion, if the specific tests - painful arc, Neer's and Hawkins, were described together with the fact that if symptoms arising from those tests are blocked by the use of local anesthesia, then the diagnosis is much more likely. Comments would be helpful. Thanks. --Mdscottis (talk) 04:52, 23 February 2013 (UTC)

Signs
This section lists 8 physical exam tests, and then ranks them, or combinations of them, for certain purposes. However, only three of them are described, and then briefly. It seems that they should all be described for the benefit of the reader, or the section simply omitted. If they are to be described, then the section will become quite lengthy, in a subject that has already ballooned significantly. That would seem to be more fitting for a textbook rather than an encyclopedia, but I am prepared to be corrected. I would personally favor dropping the section to improve overall readability. Advice would be appreciated Mdscottis (talk) 03:37, 25 July 2014 (UTC)

Motion to Redirect Rotator Cuff Tear to Rotator Cuff Tendinopathy
Rotator cuff tendinopathy subsumes several other categories that currently have their own page, and Rotator Cuff Tear is one of those categories. The word "tear" is used to refer to thinning and defects of the tendon that can occur with acute trauma but are usually attritional and degenerative. Acute rupture of the tendons usually occurs in people of the age to have tendinopathy rather than a normal tendon and so can be included in this larger topic. Another reason for including acute tears is that it is not always possible to discern degenerative defects from acute tears.

DellMedWikiProject (talk) 19:42, 3 March 2022 (UTC)

Requested move 11 May 2023

 * The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: Not Moved (non-admin closure) >>> Extorc . talk  15:30, 1 June 2023 (UTC)

Rotator cuff tear → Rotator cuff tendinopathy – We propose changing the title from “rotator cuff tear” to “rotator cuff tendinopathy” because most rotator cuff defects are related to degenerative changes in the tendon (tendinopathy) that are expected with increased age (senescence). In other words, holes in the tendon are usually part of tendon senescence (rotator cuff tendinopathy) and not due to injury(rotator cuff tear).

A secondary source reviewed the existing evidence regarding prevalence of rotator cuff tendinopathy and rotator cuff defects and found that 62% of people 80 years and older have evidence of tendinopathy.[1] Acute traumatic ruptures do occur, but they are relatively uncommon, usually result from an injury of notable intensity, involve more than one tendon, and are associated with ecchymosis, edema, and other signs of acute injury.[2,3]

Use of the word “tear” implies injury. New symptoms from established pathophysiology are often misinterpreted as new pathophysiology, and they are often misinterpreted as an injury.[4,5]

Misinterpretation of symptoms is a key contributor to greater levels of discomfort and incapability.[6,7] It’s healthful to limit reinforcing these common misconceptions.[8,9]

Tendinopathy refers to disease of tendon, which is generally mucoid degeneration rather than inflammation or injury.[10,11] It is a much more accurate term with less potential to reinforce unhelpful thinking and distress regarding symptoms that are known contributors to greater symptoms and incapability among people presenting for care of rotator cuff disease.[12]

References

1. Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014 Dec;23(12):1913-1921. doi: 10.1016/j.jse.2014.08.001. PMID: 25441568.

2. Gutman MJ, Joyce CD, Patel MS, Kirsch JM, Gutman BS, Abboud JA, Namdari S, Ramsey ML. Early repair of traumatic rotator cuff tears improves functional outcomes. J Shoulder Elbow Surg. 2021 Nov;30(11):2475-2483. doi: 10.1016/j.jse.2021.03.134. Epub 2021 Mar 24. PMID: 33774173.

3. Aagaard KE, Abu-Zidan F, Lunsjo K. High incidence of acute full-thickness rotator cuff tears. Acta Orthop. 2015;86(5):558-62. doi: 10.3109/17453674.2015.1022433. PMID: 25708526; PMCID: PMC4564777.

4. Lemmers M, Versluijs Y, Kortlever JTP, Gonzalez AI, Ring D. Misperception of Disease Onset in People with Gradual-Onset Disease of the Upper Extremity. J Bone Joint Surg Am. 2020 Dec 16;102(24):2174-2180. doi: 10.2106/JBJS.20.00420. PMID: 33027085.

5. Liu TC, Leung N, Edwards L, Ring D, Bernacki E, Tonn MD. Patients Older Than 40 Years With Unilateral Occupational Claims for New Shoulder and Knee Symptoms Have Bilateral MRI Changes. Clin Orthop Relat Res. 2017 Oct;475(10):2360-2365. doi: 10.1007/s11999-017-5401-y. Epub 2017 Jun 9. PMID: 28600690; PMCID: PMC5599397.

6. Miner H, Rijk L, Thomas J, Ring D, Reichel LM, Fatehi A. Mental-Health Phenotypes and Patient-Reported Outcomes in Upper-Extremity Illness. J Bone Joint Surg Am. 2021 Aug 4;103(15):1411-1416. doi: 10.2106/JBJS.20.01945. PMID: 34357891.

7. Teunis T, Ramtin S, Gwilym SE, Ring D, Jayakumar P. Unhelpful thoughts and distress regarding symptoms are associated with recovery from upper extremity fracture. Injury. 2023 Apr;54(4):1151-1155. doi: 10.1016/j.injury.2023.02.035. Epub 2023 Feb 18. PMID: 36822916.

8. Bossen JK, Hageman MG, King JD, Ring DC. Does rewording MRI reports improve patient understanding and emotional response to a clinical report? Clin Orthop Relat Res. 2013 Nov;471(11):3637-44. doi: 10.1007/s11999-013-3100-x. Epub 2013 Jun 13. PMID: 23761176; PMCID: PMC3792273.

9. Farmer C, O'Connor DA, Lee H, et alConsumer understanding of terms used in imaging reports requested for low back pain: a cross-sectional surveyBMJ Open 2021;11:e049938. doi: 10.1136/bmjopen-2021-049938

10. Bruni DF, Pierson SR, Sarwar F, Ring D, Ramtin S. Are the Pathologic Features of Enthesopathy, Tendinopathy, and Labral and Articular Disc Disease Related to Mucoid Degeneration? A Systematic Review. Clin Orthop Relat Res. 2023 Apr 1;481(4):641-650. doi: 10.1097/CORR.0000000000002499. Epub 2022 Dec 23. PMID: 36563131; PMCID: PMC10013668.

11. Leopold SS. Editor's Spotlight/Take 5: Are the Pathologic Features of Enthesopathy, Tendinopathy, and Labral and Articular Disc Disease Related to Mucoid Degeneration? A Systematic Review. Clin Orthop Relat Res. 2023 Apr 1;481(4):636-640. doi: 10.1097/CORR.0000000000002604. Epub 2023 Feb 28. PMID: 36853888; PMCID: PMC10013662.

12. Rohrback M, Ramtin S, Abdelaziz A, Matkin L, Ring D, Crijns TJ, Johnson A. Rotator cuff tendinopathy: magnitude of incapability is associated with greater symptoms of depression rather than pathology severity. J Shoulder Elbow Surg. 2022 Oct;31(10):2134-2139. doi: 10.1016/j.jse.2022.03.007. Epub 2022 Apr 21. PMID: 35461981. WarriorDO14 (talk) 04:39, 11 May 2023 (UTC) — Relisting.  ❯❯❯  Raydann  (Talk)   05:24, 18 May 2023 (UTC)  — Relisting. Captain Jack Sparrow (talk) 17:49, 25 May 2023 (UTC)
 * Weak oppose per a bad case of WP:TLDR ... and umm "we"? Steel1943  (talk) 17:34, 13 May 2023 (UTC)
 * We want to be respectful and there are many aspects to the rationale for the proposed title change. WarriorDO14 (talk) 19:15, 27 May 2023 (UTC)
 * ...Again with that "we". See my comment below in the discussion why that's an issue. Steel1943  (talk) 20:02, 27 May 2023 (UTC)
 * Note: WikiProject Medicine has been notified of this discussion.  ❯❯❯  Raydann  (Talk)   05:23, 18 May 2023 (UTC)


 * Probable support. I believe this is arguing WP:MEDTITLE and WP:PRECISION. (However, arguments to the effect that medical professionals ought to avoid the terminology "tear," or that the term causes harm, are not the relevant standard. It would be better to simply cite a few sources saying that the proposed title is the generally accepted medical terminology.) Additionally, the common name "rotator cuff tear" still needs to be included in the first sentence as an alternative. Keep in mind that Wikipedia is written for a general audience (and that the editors reviewing requested moves are generally laypersons). SilverLocust (talk) 09:30, 18 May 2023 (UTC)
 * We think that patients who seek out this information will more likely be experiencing age-related tendinopathy than traumatic rupture. The WP:Medtitle and WP:Precision standards definitely apply. Thanks for pointing us to those. WarriorDO14 (talk) 19:17, 27 May 2023 (UTC)


 * Oppose My understanding is that tendinopathy is different from a tear. Tears are less common but occur in young people in certain occupations (eg. professional gymnastics). this source explains the difference. I suppose it is possible to cover both tears and tendinopathy on one page that could be titled something like "Rotator cuff injury". (t &#183; c)  buidhe  14:25, 24 May 2023 (UTC)
 * That is exactly the type of misconception that we think will be addressed by a name change. Discussion of acute rupture vs. senescent/attritional defect as more accurate descriptive terms than "tear" would be useful and can be added. Dr311 (talk) 17:35, 26 May 2023 (UTC)
 * ...There's that "we" again... Steel1943  (talk) 14:11, 27 May 2023 (UTC)


 * Oppose, common and easily understood name. Randy Kryn (talk) 00:02, 26 May 2023 (UTC)
 * It is commonly misunderstood. Perhaps more often than accurately understood. Dr311 (talk) 17:35, 26 May 2023 (UTC)
 * oppose per Randy Kryn rationale--Ozzie10aaaa (talk) 11:36, 27 May 2023 (UTC)
 * Comment ICD-11 (and 10 before it) uses rotator cuff syndrome for non-traumatic ruptures. OSIICS 14 uses the term rotator cuff tendon pathology (arguably close to the proposed move title). Note: I am not trained in the OSIICS classification system, but it is open access and provides cross maps to codes from the ICD. Little pob (talk) 14:08, 27 May 2023 (UTC)
 * Comment: Well, editors here are still referring to themselves as "we", so here's why that is a problem: Saying "we" hints either a shared account or what's known as "meat puppetry", both of which are not allowed on Wikipedia. If either one of these apply, they need to be declared and/or resolved immediately. Steel1943  (talk) 20:01, 27 May 2023 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.
 * Oppose While I wouldn't necessarily oppose calling it Rotator cuff injury per User:Buidhe, "tendinopathy" is far too much of a specialized medical term to pass WP:COMMONNAME policy and should be roundly rejected. ᴢxᴄᴠʙɴᴍ (ᴛ) 17:15, 29 May 2023 (UTC)

Intro paragraph improvements
The first two sentences of this article,

"Rotator cuff tendinopathy is a process of senescence. The pathophysiology is mucoid degeneration."

Probably don't make sense to most people. I know for sure it didn't mean anything to me, and I learned nothing about the condition after reading it, except for some new words to add to my vocabulary. Seems best to me to make it something like,

Rotator cuff tear (tendinopathy) is a condition characterized by injury to the tendon...

Or similar, following the style of other medical condition articles. For example, the first 2 sentences of Retinal detachment,

"Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness."

This is much clearer and immediately summarizes what it is.

Any objections to editing it? Unfortunately I don't know much about this so I would have to research first. Unpicked6291 (talk) 12:33, 9 June 2023 (UTC)


 * Hi. These sentences are our edits. You’re right, there’s too much jargon. Thanks for your help. We will make additional edits.
 * FYI: We are a group led by an academic orthopaedic surgeon working on a project to align the musculoskeletal health information on Wikipedia with best evidence. In particular, we are interested in highlighting the evidence that indicates how we differentiate and interpret our sensations from our aging which are a key determinant of our comfort and capability.
 * Suggested revision intro:
 * As the rotator cuff tendons deteriorate with age, a hole or defect may form in the tendons. In other words, rotator cuff tendinopathy is a process of aging also referred to as senescence. Most people develop rotator cuff tendinopathy within their lifetime.
 * The pathophysiology is described as a disorganization of the tissue in the tendon (mucoid degeneration) rather than inflammation or tear. As part of rotator cuff tendinopathy, the tendon can thin and develop a defect. This defect is often referred to as a rotator cuff tear. The word tear incorrectly and unhelpfully implies injury. New pains are often misinterpreted as new injuries and the word “tear” can unhelpfully reinforce that misinterpretation.
 * Acute, traumatic rupture of the rotator cuff tendons can also occur, but is less common. Traumatic rupture of the rotator cuff usually involves the tendons of more than one muscle. MRI, traumatic ruptures can be identified by muscle quality (age-related defects are associated with muscle atrophy and fat infiltration), bleeding and swelling, and a tendon that appears wavy.
 * Rotator cuff tendinopathy is, by far, the most common reason people seek care for shoulder pain. Pain related to rotator cuff tendinopathy is typically on the front side of the shoulder, down to the elbow, and worse reaching the hand upwards or backwards. Diagnosis is based on symptoms and examination. Medical imaging is used mostly to plan surgery and is not needed for diagnosis.
 * Treatment may include pain medication such as NSAIDs and specific exercises. It is recommended that people who are unable to raise their arm above 90 degrees after two weeks should be further assessed. Surgery may be offered for acute ruptures and large attritional defects with good quality muscle. The benefits of surgery for smaller defects are unclear as of 2019. WarriorDO14 (talk) 03:25, 13 July 2023 (UTC)
 * Treatment may include pain medication such as NSAIDs and specific exercises. It is recommended that people who are unable to raise their arm above 90 degrees after two weeks should be further assessed. Surgery may be offered for acute ruptures and large attritional defects with good quality muscle. The benefits of surgery for smaller defects are unclear as of 2019. WarriorDO14 (talk) 03:25, 13 July 2023 (UTC)