Accuracy of the critical shoulder angle for predicting rotator cuff tears in patients with nontraumatic shoulder pain

Review written by Andrew Cuff info

Key Points

  1. Non-traumatic rotator cuff (RC) tears are multifactorial and appear to be associated with both non-anatomic (i.e. lifestyle factors, metabolic factors) and anatomic (i.e. bony morphology) factors.
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Rotator cuff (RC) tears are common in the asymptomatic population and are also commonly diagnosed in people presenting with shoulder pain. Management of a person with a RC tear is historically considered to be different depending on whether the onset is traumatic or non-traumatic, whilst considering age of the person and their level of demand.

For traumatic RC tears in a younger person with high levels of demand, it is currently considered best practice (1) to refer these patients for an early surgical opinion. At the other end of this continuum are non-traumatic tears in an older person with lower levels of demand, where non-surgical management has been shown to be an effective first line option (2). Whilst non-traumatic RC tears are multifactorial, this paper sought to determine whether anatomic factors could predict the presence of a non-traumatic RC tear in a person with shoulder pain.

Non-surgical management has been shown to be an effective first line option for non-traumatic rotator cuff tears in people with lower levels of demand.
A higher critical shoulder angle on x-ray may raise suspicion of a possible underlying RC tear which may influence referral decision.


A retrospective, case-control, cross sectional study was performed with 601 patients included. Following presentation with shoulder pain, all patients had an ultrasound scan and were divided into an RC tear group (n = 301) and no RC tear group (n

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