목록

전문의 칼럼 | 척추질환

(article) Rotator Cuff Tears

작성: 새기준병원 척추센터

관련 의료진: 장한진 대표원장, 홍현진 원장

2026.05.22

Rotator Cuff Tears:

Diagnosis, Differential from Frozen Shoulder, and Timing of Arthroscopic Repair

Dong-Hee Kim, MD

Orthopedic Surgeon — Foot & Ankle, Knee, Shoulder, Lower Extremity Alignment

Certified Sports Medicine Specialist

Member: Korean Orthopaedic Association · Korean Foot and Ankle Society · Korean Society of Sports Medicine

Member: Korean Knee Society · Korean Hip Society · Korean Arthroscopy Society

New Standard Hospital Joint Center, Yongin-si, Gyeonggi-do, Republic of Korea  |  May 2026

 

Abstract

Rotator cuff tears (RCTs) represent one of the most common causes of shoulder pain and dysfunction in adults over 40, with MRI studies demonstrating a prevalence of 30-40% in individuals over 60, including asymptomatic tears. Differentiating RCTs from adhesive capsulitis (frozen shoulder) is essential, as inappropriate conservative treatment can worsen tear progression. This article provides a clinical framework for diagnosis, differential diagnosis, staging-based treatment selection, and current evidence supporting arthroscopic repair timing.

Keywords: rotator cuff tear; frozen shoulder; arthroscopic repair; supraspinatus; surgical timing; lower extremity alignment

 

1. Introduction

The rotator cuff consists of four tendons that insert onto the humeral head: the supraspinatus, infraspinatus, subscapularis, and teres minor. These tendons function collectively to stabilize the glenohumeral joint and facilitate shoulder rotation and elevation.

Rotator cuff tears are among the most prevalent musculoskeletal conditions in adults over 40. A landmark community-based MRI cohort study demonstrated that approximately 30-40% of individuals over 60 harbor rotator cuff tears, many asymptomatic.

Yamamoto A, et al. J Shoulder Elbow Surg. 2010;19(1):116-120.

From the perspective of lower extremity alignment and gait assessment — a clinical emphasis of this author — shoulder pathology rarely exists in isolation. Patients presenting with shoulder pain may also demonstrate altered upper extremity loading patterns secondary to compensatory gait mechanics, particularly in those with concurrent foot, ankle, or knee pathology. A comprehensive musculoskeletal evaluation considers these interdependencies.

 

2. Differential Diagnosis: Rotator Cuff Tear vs. Frozen Shoulder

The single most important clinical differentiator is passive range of motion (PROM):

•         Frozen shoulder: both active AND passive ROM are restricted in all planes

•         Rotator cuff tear: active ROM is restricted, but passive ROM is preserved

 

Table 1. Clinical Differentiation: Frozen Shoulder vs. Rotator Cuff Tear

Feature

Frozen Shoulder

Rotator Cuff Tear

Active ROM

Restricted

Restricted (active)

Passive ROM

Restricted

Preserved

Pain arc

Global movement

60-120 degrees

Natural history

Self-resolving

Progressive tear possible

MRI finding

Capsular thickening

Tendon discontinuity

 

Clinical pearl: If the examiner can passively elevate the arm while the patient cannot actively do so, suspect rotator cuff tear over frozen shoulder. Misapplication of frozen shoulder stretching protocols to a rotator cuff tear can worsen tear size and delay definitive treatment.

3. Clinical Staging and Treatment Algorithm

Stage 1 — Partial Tear, Mild Symptoms

Conservative management includes NSAIDs, physical therapy, extracorporeal shockwave therapy (ESWT), and corticosteroid injection for short-term pain relief. Where appropriate and indicated, intravenous nutritional therapy (IVNT) may be considered as an adjunct to support recovery, based on assessment of the patient's nutritional status, fatigue level, and overall systemic condition — not as a standalone pain treatment.

Stage 2 — Moderate Tear, Treatment Failure

When conservative management fails after 3-6 months, or when serial imaging demonstrates tear progression, surgical planning is indicated. A PROSPERO-registered systematic review demonstrated that early arthroscopic repair is associated with lower retear rates and superior functional outcomes.

Early Rotator Cuff Repair Yields Lower Retear Rates. PMC. 2025. (CRD42024528249)

Stage 3 — Full-Thickness or Massive Tear

Full-thickness tears carry the risk of progressive fatty infiltration and muscle atrophy. Once irreversible muscle changes occur, primary arthroscopic repair may no longer be feasible, necessitating reverse total shoulder arthroplasty.

 

4. Arthroscopic Rotator Cuff Repair — Evidence

A systematic review at minimum 10-year follow-up demonstrated patient satisfaction rates of 85.7-100% following arthroscopic repair.

Arthroscopy. 2022. doi:10.1016/j.arthro.2022.06.016

Postoperative rehabilitation: sling immobilization weeks 1-6, progressive ROM weeks 6-12, return to ADLs months 3-4, return to sports month 6+.

Hu CW, et al. BMC Musculoskelet Disord. 2024;25:974.

 

5. Conclusion

Rotator cuff tears are progressive lesions that do not reliably heal spontaneously, particularly when full-thickness. Accurate differentiation from frozen shoulder, timely MRI assessment, and stage-appropriate treatment are the cornerstones of optimal outcomes. In the author's clinical practice, shoulder evaluation is integrated within a broader assessment of lower extremity alignment and gait patterns, reflecting the clinical philosophy that musculoskeletal conditions are best understood within the context of whole-body mechanics.

 

References

1. Yamamoto A, et al. Prevalence and risk factors of a rotator cuff tear. J Shoulder Elbow Surg. 2010;19(1):116-120.

2. Early Rotator Cuff Repair Yields Lower Retear Rates. PMC. 2025. (PROSPERO: CRD42024528249)

3. Arthroscopic Rotator Cuff Repair at 10-Year Follow-Up. Arthroscopy. 2022.

4. Hu CW, et al. Early versus delayed mobilization. BMC Musculoskelet Disord. 2024;25:974.

5. Longo UG, et al. Revision rates after arthroscopic repair. Knee Surg Sports Traumatol Arthrosc. 2025.

 

 

Dong-Hee Kim, MD is an orthopedic surgeon at New Standard Hospital Joint Center, specializing in foot and ankle, knee, shoulder disorders, lower extremity alignment, and gait balance. Certified specialist in sports medicine. Member of the Korean Orthopaedic Association, Korean Foot and Ankle Society, Korean Society of Sports Medicine, Korean Knee Society, Korean Hip Society, and Korean Arthroscopy Society.

(c) 2026 Dong-Hee Kim, MD. For educational purposes only. Does not constitute individual medical advice.

 
목록