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Trauma can cause rotator cuff injury by the following mechanisms:
– any force that rotates the arm internally against a resistance or that prevents the arm from turning externally, as may occur during team handball, American football, or wrestling;
– falling directly on the shoulder or on an outstretched arm;
– lifting or throwing heavy objects.


Rotator cuff tears can be of different degrees and distinct types. The location of the tear is important: rotator cuff tears can be located on the bursa surface of the tendon (the bursal side) or on the undersurface of the tendon (the articular side). The tear can also be partial or complete, connecting the articular and bursal sides.

– Primary compressive cuff disease is associated with a type III hooked acromion, degenerative spurs, or a thick coracoacromial ligament. A cuff tear originating on the bursal side of the tendon can be the result.
– Secondary compressive cuff disease is usually due to associated glenohumeral (shoulder joint) instability.
– Tensile lesions occur on the articular side and are believed to occur secondary to cuff resistance to the high deceleration forces that occur during activities such as the later stages of throwing. There is a higher
incidence of articular side tears in throwing athletes.

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