Rotator Cuff Injuries in Physically Active Individuals: Diagnosis, Conservative Management, and Return to Sport - A Narrative Review

Abstract

Background. Rotator cuff disorders commonly cause pain, weakness, and reduced performance in active individuals. Assessment is challenging because structural abnormalities may be asymptomatic and demands differ between recreational and competitive athletes.
Aim. To summarize evidence on diagnosis, conservative management, and return-to-sport criteria in individuals with rotator cuff tendinopathy or tears.
Material and methods. A targeted narrative review included 25 open-access PubMed articles published in 2007–2024. The evidence comprised reviews, meta-analyses, consensus statements, cohorts, and clinical articles on diagnosis, imaging, rehabilitation, prognosis, and return to sport.
Results. Diagnosis requires combined interpretation of history, physical examination, and imaging, as no single test can confirm or exclude a rotator cuff tear. Ultrasonography and magnetic resonance imaging are highly accurate for full-thickness tears, whereas partial-thickness lesions are harder to characterize. Exercise-based rehabilitation is the mainstay of conservative treatment and may improve pain and function in tendinopathy, partial-thickness tears, and many atraumatic full-thickness tears. Rehabilitation should restore mobility, rotator cuff and scapular strength, kinetic-chain function, and tolerance to sport-specific loads. Return-to-sport decisions should not rely on time alone, because return to participation is more common than return to preinjury performance, particularly in competitive overhead athletes.
Conclusions. An individualized, criteria-based pathway is preferable to decisions based only on imaging or elapsed time. Conservative rehabilitation should be the initial strategy for non-traumatic and partial-thickness disorders. Prompt specialist assessment is indicated after acute traumatic loss of function, marked weakness, or failure of adequate rehabilitation.