Integrating Tendinous Pathophysiology Into Rotator Cuff Tears And Greater Trochanteric Pain Syndrome: A Narrative Review

Abstract

This narrative review aims to use the similarities between the shoulder and hip joints to better understand why rotator cuff (RC) tendinopathy and hip abductor tendinopathy occur and inform about diagnosis and treatment of both orthopedic complaints. A search of the literature was conducted using GoogleScholar and Pubmed and initially followed a systematic review protocol, but the nature of the topic, current literature and data necessitated a narrative review. Reports that discussed pathomechanics of RC and gluteal tendinopathy individually, together and with other muscles groups were reviewed. It was found that the methods measuring and describing the processes of tendinopathy differ significantly, for each individual joint and between all joints. A review of a large body of quantifiable measures and theoretical ideas regarding tendinopathy was performed to address this lack of consensus in current literature. Initial literature yielded 74 articles. After review, only 43 articles were used from a broad range of approaches and methodologies. The review found a body of evidence suggesting that fibrocartilage overgrowth and compressive forces over bony structures cause tendonous pathology of the RC and hip abductor tendons. These findings support the idea that tendinopathy is often caused by intrinsic factors rather than the traditional view of external factors. Earlier treatment and improved outcomes without surgery are possible using current imaging technology to identify these intrinsic factors that affect tendinous properties.