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Soft tissue lesions of the shoulder

Last updated: August 11, 2021

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Soft tissue lesions of the shoulder are usually caused by the narrowing of the subacromial or subcoracoid space and subsequent entrapment of soft tissues. These structural changes in the shoulder joint are often the result of overuse (e.g., engaging in overhead activities) and degenerative or inflammatory processes. The main symptom of soft tissue involvement is shoulder pain related to movement, which is often caused by pinching or “impingement” of soft tissues, most commonly of the supraspinatus tendon, during a 60–120° abduction of the arm. Further symptoms include nocturnal pain, pain on palpation, and stiffness of the joint. Chronic entrapment of the tendons can lead to tendinitis, which increases the risk of tendon rupture, especially of the rotator cuff tendons. Soft tissue injuries of the shoulder are usually diagnosed clinically. Additional imaging tests (X-ray, MRI) can be used to determine the extent of damage/involvement. Management involves avoiding overhead activities, NSAIDs, and physical therapy. Intra-articular corticosteroid injections and surgical measures may be required in refractory cases.


Subacromial impingement syndrome

Rotator cuff tendinitis

Frozen shoulder (adhesive capsulitis)

Calcific tendinitis

Calcific tendinitis is covered in detail in BCP crystal deposition diseases.

Biceps tendinitis


Clinical examination

This section provides a brief overview of possible clinical findings. For detailed explanations of the clinical tests, see “Orthopedic shoulder examination”.

Instrumental diagnostics


Glucocorticoid injections should be administered with caution since they can lead to tendon degeneration.

Rotator cuff tear

  • Etiology
    • Chronic degenerative tear seen in older adults (> 50 years)
    • Acute injury seen mostly in athletes (e.g., infraspinatus tear in baseball pitchers)
    • Inflammatory: a complication of rotator cuff tendinitis
  • Clinical features
    • Most commonly affects the supraspinatus tendon
    • Acute ruptures: acute severe pain and loss of strength
    • Degenerative ruptures: chronic pain; loss of strength less pronounced
    • Restriction of ROM (depending on which muscle is involved)
  • Diagnostics
  • Treatment
    • Treatment of degenerative rupture, especially in elderly, inactive patients, can be conservative (see “Conservative treatment” above).
    • Surgical repair; of the rotator cuff is recommended in cases of traumatic rupture, especially in physically active patients , or treatment-refractory cases.


We list the most important complications. The selection is not exhaustive.

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  8. Epidemiology of the rotator cuff tears: a new incidence related to thyroid disease. Updated: November 17, 2014. Accessed: February 16, 2017.