Rotator cuff tears are classified according to their severity, location, and cause:

1. Partial tear: Only part of the tendon is affected, either on the upper or lower side.
2. Complete tear: The tendon is completely severed, leading to a significant loss of function.
3. Traumatic tear: Occurs suddenly due to injuries such as falls or heavy strains.
4. Degenerative tear: Develops slowly due to age-related wear or chronic overuse.
5. Massive tear: Several tendons of the rotator cuff are affected simultaneously.
6. Chronic tear: A long-standing injury that can lead to muscle atrophy and joint stiffness.

The causes of a rotator cuff tear are varied and can be divided into acute and chronic factors:

- Acute causes:

- Sudden stresses, such as those occurring during falls or heavy lifting movements.

- Direct trauma, for example, from an accident or sports injuries.

- Chronic causes:

- Degenerative changes due to aging that weaken the tendons.

- Repeated overhead movements in sports such as tennis, swimming, or weightlifting.

- Impingement syndromes that permanently irritate and weaken the tendons.

- Contributing factors:

- Anatomical peculiarities such as bony protrusions.

- Muscle imbalances or weaknesses in the shoulder region.

The symptoms of a rotator cuff tear vary depending on the severity and type of injury, but often include:

- **Pain:** Localized pain in the shoulder, often radiating into the arm.

- **Loss of strength:** Difficulty lifting the arm or performing overhead tasks.

- **Movement restrictions:** Limited mobility in abduction and rotation of the arm.

- **Night pain:** Increased discomfort when lying on the affected shoulder.

- **Cracking or snapping noises:** Occurring during movements, especially with complete tears.

- **Muscle atrophy:** In chronic tears, visible wasting of the shoulder muscles may occur.

The diagnosis is made through a combination of medical history, clinical examination, and imaging techniques:

- Medical history:

- The doctor inquires about the course of the symptoms, possible injuries, and stressful activities.

- Physical examination:

- Special tests such as the Jobe test or the Hawkins-Kennedy test to check the function of the rotator cuff.

- Palpation of the shoulder for tenderness and movement restrictions.

- Imaging:

- MRI: Detailed depiction of tendon damage, muscle atrophy, and fluid accumulation.

- Ultrasound: Detection of tears and changes in tendon structure.

- X-ray: To assess bony changes or calcifications.

Conservative Therapy

For partial tears or minor symptoms, non-operative treatment is often sufficient:

• Medication Therapy:
  • NSAIDs: To relieve pain and inflammation.
• Physiotherapy:
  • Exercises to strengthen the rotator cuff and restore mobility.
  • Manual therapy to improve shoulder stability.
• Pain Management:
  • Heat or cold therapy to relax the muscles.
• Injections:
  • Corticosteroids to reduce inflammation and pain.

Surgical Therapy

For complete tears, persistent pain, or loss of function, surgery is necessary:

• Arthroscopic Repair: Minimally invasive technique to restore the tendon.
• Open Repair: Used for more complex or larger tears.
• Tendon Transfer: Replacement of an irreparable tendon with adjacent tissue.
• Shoulder Prostheses: For massive damage or irreparable tears.

The following measures are suitable for preventing rotator cuff tears:

1. Strengthening the shoulder: Targeted training of the rotator cuff and surrounding muscles.
2. Avoiding overstrain: Protecting the shoulder from repeated or intense stress.
3. Warming up before activities: Preparing the shoulder for sports or occupational stress.
4. Correcting poor posture: Improving posture and movement patterns.
5. Regular check-ups: Timely treatment of initial complaints or pre-existing conditions.