Shoulder Conditions
From rotator cuff tears to shoulder instability: evidence-based diagnosis and treatment by a shoulder specialist in Vienna and Tulln.
The shoulder – mobility at the cost of stability
The shoulder is the most mobile joint in the human body – and consequently the most unstable. Its wide range of motion is achieved at the cost of bony constraint: the shallow glenoid (socket) covers only 25–30% of the humeral head. Stability depends on the rotator cuff, labrum, capsule-ligament complex and surrounding musculature. When any of these structures fail, pain and dysfunction follow.
Shoulder conditions are among the most common musculoskeletal complaints, affecting up to 30% of the population at some point in their lives. Correct diagnosis – distinguishing between rotator cuff pathology, instability, calcific tendinitis, frozen shoulder, AC joint problems and referred pain – is the foundation of effective treatment.
- Rotator cuff tears (partial and full-thickness)
- Shoulder impingement syndrome
- Calcific tendinitis (Kalkschulter)
- Frozen shoulder (adhesive capsulitis)
- Shoulder instability and Bankart lesions
- SLAP lesions
- AC joint injuries and arthritis
- Shoulder arthritis (glenohumeral osteoarthritis)
- Proximal humerus fractures
Rotator cuff tears
The rotator cuff consists of four muscles (supraspinatus, infraspinatus, teres minor, subscapularis) that stabilise and move the shoulder. Tears are classified as partial or full-thickness, and by size (small <1 cm, medium 1–3 cm, large 3–5 cm, massive >5 cm). Prevalence increases with age: full-thickness tears are present in approximately 25% of people over 60 years, many of whom are asymptomatic.
Treatment depends on tear size, patient age, activity level and symptoms. Small to medium tears in older patients often respond well to structured physiotherapy. Large and massive tears in active patients, and tears in younger patients, are more likely to benefit from surgical repair. Arthroscopic repair is the standard technique, with good to excellent outcomes in appropriately selected patients.
Shoulder instability (Bankart lesion)
Anterior shoulder dislocation tears the anteroinferior labrum from the glenoid – the Bankart lesion. Recurrence risk without surgery is 50–90% in young athletes. Arthroscopic Bankart repair is the gold standard for soft-tissue instability without significant bone loss. When glenoid bone loss exceeds 15–20%, the Latarjet procedure (coracoid transfer) is superior, with recurrence rates of approximately 3%.
Calcific tendinitis
Calcium deposits in the supraspinatus tendon cause acute or chronic shoulder pain. The acute phase (resorptive) is intensely painful; the chronic phase may be relatively asymptomatic. Most cases resolve spontaneously within 12–18 months. Ultrasound-guided needling (barbotage) is the most effective non-surgical treatment, with randomised trial evidence supporting its use. Surgery (arthroscopic calcium removal) is reserved for refractory cases after 6–12 months of conservative management.
Diagnosis
Clinical examination includes assessment of active and passive range of motion, strength testing (empty can, Jobe, lift-off, belly press), impingement tests (Neer, Hawkins-Kennedy) and instability tests (apprehension, relocation, anterior drawer). Ultrasound is the first-line imaging for rotator cuff assessment – dynamic, real-time and cost-effective. MRI provides superior soft tissue detail and is the investigation of choice for labrum, cartilage and complex pathology. MR arthrography (contrast injection into the joint) is the gold standard for labral assessment. X-rays assess bone, calcification and joint space.
Frequently asked questions
Does a rotator cuff tear always need surgery?
No. Many rotator cuff tears – especially in older patients and those with partial tears – respond well to structured physiotherapy. Surgery is indicated for large tears in active patients, tears in younger patients, and tears that have failed adequate conservative management.
What is the difference between Bankart repair and Latarjet?
Bankart repair reattaches the torn labrum arthroscopically – the gold standard for soft-tissue instability without bone loss. The Latarjet procedure transfers the coracoid process to the front of the glenoid, enlarging the socket and providing a triple-blocking effect. It is indicated when glenoid bone loss exceeds 15–20% or in high-risk contact athletes.
How long does shoulder surgery recovery take?
After Bankart repair: sling for 3–4 weeks, return to contact sport after 5–6 months. After rotator cuff repair: sling for 4–6 weeks, return to sport after 6–9 months. After Latarjet: sling for 3 weeks, return to contact sport after 4–5 months. Exact timelines depend on the procedure and individual healing.
References & Evidence
- Tashjian RZ. Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med 2012;31:589–604. PMID: 23040548
- Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg 2013;22:1371–1379. PMID: 23540577
- An VV, Sivakumar BS, Phan K, Trantalis J. A systematic review and meta-analysis of clinical and patient-reported outcomes following two procedures for recurrent traumatic anterior instability of the shoulder: Latarjet procedure vs. Bankart repair. J Shoulder Elbow Surg 2016;25:853–863. PMID: 26778120
- Paavola M, Malmivaara A, Taimela S, et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ 2018;362:k2860. PMID: 30054268
- Rangan A, Handoll H, Brealey S, et al. Surgical vs nonsurgical treatment of adults with displaced fractures of the proximal humerus: the PROFHER randomized clinical trial. JAMA 2015;313:1037–1047. PMID: 25756440
- Iannotti JP, Codsi MJ, Kwon YW, Derwin K, Ciccone J, Brems JJ. Porcine small intestine submucosa augmentation of surgical repair of chronic two-tendon rotator cuff tears. J Bone Joint Surg Am 2006;88:1238–1244. PMID: 16757758
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