Diagnosis and Treatment of Rotator Cuff Syndrome: A Narrative Review

Rotator cuff disorders constitute one of the most frequent causes of shoulder pain and functional limitation, with a high prevalence in the adult population and a significant impact on quality of life. These conditions include a broad clinical spectrum ranging from tendinopathy and partial tears to full-thickness ruptures, and their clinical presentation does not always maintain a direct relationship with the magnitude of structural damage observed in imaging studies. A thorough clinical assessment should remain the basis of the diagnosis, with imaging tests used wisely to support clinical findings rather than replace them. In addition, psychosocial factors, such as anxiety, depression, and unhelpful beliefs about pain, can considerably shape how patients experience and interpret their level of disability and should be considered when making therapeutic decisions. ​Conservative treatment is considered the initial strategy in most patients; it has been shown to have beneficial functional and quality-of-life outcomes, as compared to surgery, in the medium and long term, especially in degenerative or non-traumatic tears. Surgery should be reserved for selected cases, such as failure of non-surgical management or the presence of extensive lesions with a risk of irreversible progression, considering the high structural failure rates described. ​Overall, the management of rotator cuff syndrome must be individualized and centered on function, incorporating clinical evaluation, patient expectations, and the best available evidence, with the goal of optimizing clinical results and quality of life.