Rotator cuff tear may have significance include os acromiale and acromial spurs. Environmental factors implicated include increasing age, shoulder overuse, smoking, and any medical condition that affects circulation or impairs the inflammatory and healing response, such as diabetes mellitus. Intrinsic factors refer to injury mechanisms that occur within the rotator cuff itself. The principal is a degenerative-microtrauma model, which supposes that age-related tendon damage compounded by chronic microtrauma results in partial tendon tears that then develop into full rotator cuff tears. As a result of repetitive microtrauma in the setting of a degenerative rotator cuff tendon, inflammatory mediators alter the local environment, and
Rotator cuff tear extension, or vertical abduction, it is less likely to suffer from a tear of the tendon. Those suspected of having a rotator cuff tear may have operative or non-operative treatment. No evidence of benefit is seen from early rather than delayed surgery, and many with partial tears and some with complete tears will respond to nonoperative management. Consequently, many recommend initial, nonsurgical management. However, early surgical treatment may be considered in significant (>1 cm-1.5 cm) acute tears or in young patients with full-thickness tears who have a significant risk for the development of irreparable rotator cuff changes. A review in