Snapshot A 70-year-old man presents to his physician for left shoulder pain for the past several months. He reports that he cannot reach above his head without any pain. As a retired carpenter, he reports that this has significantly impacted his quality of life. Additionally, he is unable to lie on his left side at night due to shoulder pain. On physical exam, there is focal tenderness over the left anterolateral shoulder. Radiography reveals reduced space between the acromion and humeral head. Introduction Clinical definition injury to 1 or more of the rotator cuff muscles login to view 22 more bullets Epidemiology Incidence the supraspinatus muscle is most commonly injured Demographics adults Risk factors older age smoking repetitive overhead reaching Etiology Pathogenesis acute avulsion injuries login to view 1 more bullet chronic degenerative tears login to view 2 more bullets Associated conditions biceps tendinopathy osteoarthritis Presentation Symptoms shoulder pain login to view 3 more bullets limited function of the shoulder Physical exam severe focal tenderness at the insertion of supraspinatus (anterolateral shoulder) decreased active elevation with normal passive range of motion Hawkins impingement test login to view 2 more bullets Neer impingement test login to view 2 more bullets painful arc sign login to view 1 more bullet empty can test login to view 4 more bullets Imaging Radiography indication login to view 1 more bullet findings login to view 1 more bullet Magnetic resonance imaging (MRI) indications login to view 3 more bullets Studies Making the diagnosis most cases are clinically diagnosed Differential Adhesive capsulitis distinguishing factor login to view 1 more bullet Treatment Conservative physical therapy login to view 2 more bullets Medical nonsteroidal anti-inflammatory drugs (NSAIDs) login to view 3 more bullets steroid injections login to view 2 more bullets Operative surgical repair login to view 3 more bullets Complications Functional limitations Adhesive capsulitis Prognosis Re-tear may occur