Talk:Rotator cuff tear

Requested move 11 May 2023

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: Not Moved (non-admin closure) >>> Extorc.talk 15:30, 1 June 2023 (UTC)

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Rotator cuff tear → Rotator cuff tendinopathy – We propose changing the title from “rotator cuff tear” to “rotator cuff tendinopathy” because most rotator cuff defects are related to degenerative changes in the tendon (tendinopathy) that are expected with increased age (senescence). In other words, holes in the tendon are usually part of tendon senescence (rotator cuff tendinopathy) and not due to injury(rotator cuff tear).

A secondary source reviewed the existing evidence regarding prevalence of rotator cuff tendinopathy and rotator cuff defects and found that 62% of people 80 years and older have evidence of tendinopathy.[1] Acute traumatic ruptures do occur, but they are relatively uncommon, usually result from an injury of notable intensity, involve more than one tendon, and are associated with ecchymosis, edema, and other signs of acute injury.[2,3]

Use of the word “tear” implies injury. New symptoms from established pathophysiology are often misinterpreted as new pathophysiology, and they are often misinterpreted as an injury.[4,5]

Misinterpretation of symptoms is a key contributor to greater levels of discomfort and incapability.[6,7] It’s healthful to limit reinforcing these common misconceptions.[8,9]

Tendinopathy refers to disease of tendon, which is generally mucoid degeneration rather than inflammation or injury.[10,11] It is a much more accurate term with less potential to reinforce unhelpful thinking and distress regarding symptoms that are known contributors to greater symptoms and incapability among people presenting for care of rotator cuff disease.[12]

References

1. Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. J Shoulder Elbow Surg. 2014 Dec;23(12):1913-1921. doi: 10.1016/j.jse.2014.08.001. PMID: 25441568.

2. Gutman MJ, Joyce CD, Patel MS, Kirsch JM, Gutman BS, Abboud JA, Namdari S, Ramsey ML. Early repair of traumatic rotator cuff tears improves functional outcomes. J Shoulder Elbow Surg. 2021 Nov;30(11):2475-2483. doi: 10.1016/j.jse.2021.03.134. Epub 2021 Mar 24. PMID: 33774173.

3. Aagaard KE, Abu-Zidan F, Lunsjo K. High incidence of acute full-thickness rotator cuff tears. Acta Orthop. 2015;86(5):558-62. doi: 10.3109/17453674.2015.1022433. PMID: 25708526; PMCID: PMC4564777.

4. Lemmers M, Versluijs Y, Kortlever JTP, Gonzalez AI, Ring D. Misperception of Disease Onset in People with Gradual-Onset Disease of the Upper Extremity. J Bone Joint Surg Am. 2020 Dec 16;102(24):2174-2180. doi: 10.2106/JBJS.20.00420. PMID: 33027085.

5. Liu TC, Leung N, Edwards L, Ring D, Bernacki E, Tonn MD. Patients Older Than 40 Years With Unilateral Occupational Claims for New Shoulder and Knee Symptoms Have Bilateral MRI Changes. Clin Orthop Relat Res. 2017 Oct;475(10):2360-2365. doi: 10.1007/s11999-017-5401-y. Epub 2017 Jun 9. PMID: 28600690; PMCID: PMC5599397.

6. Miner H, Rijk L, Thomas J, Ring D, Reichel LM, Fatehi A. Mental-Health Phenotypes and Patient-Reported Outcomes in Upper-Extremity Illness. J Bone Joint Surg Am. 2021 Aug 4;103(15):1411-1416. doi: 10.2106/JBJS.20.01945. PMID: 34357891.

7. Teunis T, Ramtin S, Gwilym SE, Ring D, Jayakumar P. Unhelpful thoughts and distress regarding symptoms are associated with recovery from upper extremity fracture. Injury. 2023 Apr;54(4):1151-1155. doi: 10.1016/j.injury.2023.02.035. Epub 2023 Feb 18. PMID: 36822916.

8. Bossen JK, Hageman MG, King JD, Ring DC. Does rewording MRI reports improve patient understanding and emotional response to a clinical report? Clin Orthop Relat Res. 2013 Nov;471(11):3637-44. doi: 10.1007/s11999-013-3100-x. Epub 2013 Jun 13. PMID: 23761176; PMCID: PMC3792273.

9. Farmer C, O'Connor DA, Lee H, et alConsumer understanding of terms used in imaging reports requested for low back pain: a cross-sectional surveyBMJ Open 2021;11:e049938. doi: 10.1136/bmjopen-2021-049938

10. Bruni DF, Pierson SR, Sarwar F, Ring D, Ramtin S. Are the Pathologic Features of Enthesopathy, Tendinopathy, and Labral and Articular Disc Disease Related to Mucoid Degeneration? A Systematic Review. Clin Orthop Relat Res. 2023 Apr 1;481(4):641-650. doi: 10.1097/CORR.0000000000002499. Epub 2022 Dec 23. PMID: 36563131; PMCID: PMC10013668.

11. Leopold SS. Editor's Spotlight/Take 5: Are the Pathologic Features of Enthesopathy, Tendinopathy, and Labral and Articular Disc Disease Related to Mucoid Degeneration? A Systematic Review. Clin Orthop Relat Res. 2023 Apr 1;481(4):636-640. doi: 10.1097/CORR.0000000000002604. Epub 2023 Feb 28. PMID: 36853888; PMCID: PMC10013662.

12. Rohrback M, Ramtin S, Abdelaziz A, Matkin L, Ring D, Crijns TJ, Johnson A. Rotator cuff tendinopathy: magnitude of incapability is associated with greater symptoms of depression rather than pathology severity. J Shoulder Elbow Surg. 2022 Oct;31(10):2134-2139. doi: 10.1016/j.jse.2022.03.007. Epub 2022 Apr 21. PMID: 35461981. WarriorDO14 (talk) 04:39, 11 May 2023 (UTC) — Relisting. ❯❯❯ Raydann^(Talk) 05:24, 18 May 2023 (UTC) — Relisting. Captain Jack Sparrow (talk) 17:49, 25 May 2023 (UTC)

• Weak oppose per a bad case of WP:TLDR ... and umm "we"? Steel1943 (talk) 17:34, 13 May 2023 (UTC)

  We want to be respectful and there are many aspects to the rationale for the proposed title change. WarriorDO14 (talk) 19:15, 27 May 2023 (UTC)

  ...Again with that "we". See my comment below in the discussion why that's an issue. Steel1943 (talk) 20:02, 27 May 2023 (UTC)

Note: WikiProject Medicine has been notified of this discussion. ❯❯❯ Raydann^(Talk) 05:23, 18 May 2023 (UTC)

• Probable support. I believe this is arguing WP:MEDTITLE and WP:PRECISION. (However, arguments to the effect that medical professionals ought to avoid the terminology "tear," or that the term causes harm, are not the relevant standard. It would be better to simply cite a few sources saying that the proposed title is the generally accepted medical terminology.) Additionally, the common name "rotator cuff tear" still needs to be included in the first sentence as an alternative. Keep in mind that Wikipedia is written for a general audience (and that the editors reviewing requested moves are generally laypersons). SilverLocust (talk) 09:30, 18 May 2023 (UTC)

  We think that patients who seek out this information will more likely be experiencing age-related tendinopathy than traumatic rupture. The WP:Medtitle and WP:Precision standards definitely apply. Thanks for pointing us to those. WarriorDO14 (talk) 19:17, 27 May 2023 (UTC)

Oppose My understanding is that tendinopathy is different from a tear. Tears are less common but occur in young people in certain occupations (eg. professional gymnastics). this source explains the difference. I suppose it is possible to cover both tears and tendinopathy on one page that could be titled something like "Rotator cuff injury". (t · c) buidhe 14:25, 24 May 2023 (UTC)

That is exactly the type of misconception that we think will be addressed by a name change. Discussion of acute rupture vs. senescent/attritional defect as more accurate descriptive terms than "tear" would be useful and can be added. Dr311 (talk) 17:35, 26 May 2023 (UTC)

...There's that "we" again... Steel1943 (talk) 14:11, 27 May 2023 (UTC)

• Oppose, common and easily understood name. Randy Kryn (talk) 00:02, 26 May 2023 (UTC)

  It is commonly misunderstood. Perhaps more often than accurately understood. Dr311 (talk) 17:35, 26 May 2023 (UTC)

• oppose per Randy Kryn rationale--Ozzie10aaaa (talk) 11:36, 27 May 2023 (UTC)
• Comment ICD-11 (and 10 before it) uses rotator cuff syndrome for non-traumatic ruptures. OSIICS 14 uses the term rotator cuff tendon pathology (arguably close to the proposed move title). Note: I am not trained in the OSIICS classification system, but it is open access and provides cross maps to codes from the ICD. Little pob (talk) 14:08, 27 May 2023 (UTC)

Comment: Well, editors here are still referring to themselves as "we", so here's why that is a problem: Saying "we" hints either a shared account or what's known as "meat puppetry", both of which are not allowed on Wikipedia. If either one of these apply, they need to be declared and/or resolved immediately. Steel1943 (talk) 20:01, 27 May 2023 (UTC)

• Oppose While I wouldn't necessarily oppose calling it Rotator cuff injury per User:Buidhe, "tendinopathy" is far too much of a specialized medical term to pass WP:COMMONNAME policy and should be roundly rejected. ᴢxᴄᴠʙɴᴍ (ᴛ) 17:15, 29 May 2023 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Intro paragraph improvements

The first two sentences of this article,

"Rotator cuff tendinopathy is a process of senescence. The pathophysiology is mucoid degeneration."

Probably don't make sense to most people. I know for sure it didn't mean anything to me, and I learned nothing about the condition after reading it, except for some new words to add to my vocabulary. Seems best to me to make it something like,

Rotator cuff tear (tendinopathy) is a condition characterized by injury to the tendon...

Or similar, following the style of other medical condition articles. For example, the first 2 sentences of Retinal detachment,

"Retinal detachment is a disorder of the eye in which the retina peels away from its underlying layer of support tissue. Initial detachment may be localized, but without rapid treatment the entire retina may detach, leading to vision loss and blindness."

This is much clearer and immediately summarizes what it is.

Any objections to editing it? Unfortunately I don't know much about this so I would have to research first. Unpicked6291 (talk) 12:33, 9 June 2023 (UTC)

Hi. These sentences are our edits. You’re right, there’s too much jargon. Thanks for your help. We will make additional edits.

FYI: We are a group led by an academic orthopaedic surgeon working on a project to align the musculoskeletal health information on Wikipedia with best evidence. In particular, we are interested in highlighting the evidence that indicates how we differentiate and interpret our sensations from our aging which are a key determinant of our comfort and capability.

Suggested revision intro:

As the rotator cuff tendons deteriorate with age, a hole or defect may form in the tendons. In other words, rotator cuff tendinopathy is a process of aging also referred to as senescence. Most people develop rotator cuff tendinopathy within their lifetime.

The pathophysiology is described as a disorganization of the tissue in the tendon (mucoid degeneration) rather than inflammation or tear. As part of rotator cuff tendinopathy, the tendon can thin and develop a defect. This defect is often referred to as a rotator cuff tear. The word tear incorrectly and unhelpfully implies injury. New pains are often misinterpreted as new injuries and the word “tear” can unhelpfully reinforce that misinterpretation.

Acute, traumatic rupture of the rotator cuff tendons can also occur, but is less common. Traumatic rupture of the rotator cuff usually involves the tendons of more than one muscle. MRI, traumatic ruptures can be identified by muscle quality (age-related defects are associated with muscle atrophy and fat infiltration), bleeding and swelling, and a tendon that appears wavy.

Rotator cuff tendinopathy is, by far, the most common reason people seek care for shoulder pain. Pain related to rotator cuff tendinopathy is typically on the front side of the shoulder, down to the elbow, and worse reaching the hand upwards or backwards. Diagnosis is based on symptoms and examination. Medical imaging is used mostly to plan surgery and is not needed for diagnosis.

Treatment may include pain medication such as NSAIDs and specific exercises. It is recommended that people who are unable to raise their arm above 90 degrees after two weeks should be further assessed. Surgery may be offered for acute ruptures and large attritional defects with good quality muscle. The benefits of surgery for smaller defects are unclear as of 2019. WarriorDO14 (talk) 03:25, 13 July 2023 (UTC)

Resumed discussion, August 2026

Adding on to these edits, we included a sentence after the first two sentences clarifying the statement "most people develop rotator cuff tendinopathy within their lifetime" with evidence to support it and age ranges. Diff:https://en.wikipedia.org/w/index.php?title=Rotator_cuff_tear&diff=prev&oldid=1367549311 Felix Halloran (talk) 20:33, 3 August 2026 (UTC)

Notice from the above talk section Requested move 11 May 2023, Steel1943 (user page says is retired) gave alerts about the use of "we" on talk page comments, which are again repeated today by Felix Halloran. "We" implies offline collaboration to edit the article, a case of meatpuppetry which has also occurred on Golfer's elbow and Tennis elbow. Editing Wikipedia articles is understood to be the work of one editor alone doing independent research and editing.

For the rotator cuff tear article, Special:Diff/1152589099 from April 2023 was made by the same meatpuppet group, including Ischyros7 and JThompson.Utexas, now headed by Serio31 as noted on Felix Halloran's talk page and Serio31's talk page.

A common theme for this and other articles is to promote this publication from the Univ of Texas-Austin and the unconventional belief that "mucoid degeneration" - a condition of aging - explains all these injuries occurring across age groups from teens to midlife. The evidence for mucoid deterioration in youth groups doesn't exist.

These users and their Univ of Texas colleagues should observe the conflict of interest guidelines, and make the same declarations on each of their talk pages and the talk pages of articles they wish to edit. Admins have been notified. Zefr (talk) 03:01, 4 August 2026 (UTC)

@Zefr: I'm still around, I'm just not editing as much as I used to. But, to your point: In my opinion, it's getting to a point where articles that are targeted by this group of editors should be extended confirmed protected (or at the minimum pending changes protection) when necessary since most of the accounts involved with this group of editors are probably now at least autoconfirmed, which makes semi-protection useless. Steel1943 (talk) 03:40, 4 August 2026 (UTC)

Also, I'm trying to assume good faith, but ... look at this WP:REDACT failure: Steel1943 (talk) 09:33, 4 August 2026 (UTC)

@Zefr @Steel1943: I appreciate yall's willingness to help editors abide by Wikipedia guidelines. I also appreciate trying to assume good faith.

After reviewing Wikipedia's conflict of interest and meetpuppetry policies, I would like more clarification on what you view "meatpuppetry" to be. Members are not being brought into disputes for the purpose of overrepresenting one viewpoint. All editors have now added a disclosure to their talk page explaining the connection between us as well per guidance by Wikipedia moderators. We are also not paid to conduct edits and we represent out own viewpoints. Can you expand upon why you believe our group is violating Wikipedia guidelines as this seems to be at the root of disputes on this page as well as the tennis elbow and golfer's elbow pages?

So far, we have not received any communication by a volunteer moderator to discontinue editing and instead have just been instructed to disclose our involvement (which has been done). Awradloff (talk) 20:03, 6 August 2026 (UTC)

Awradloff - please observe WP:NOTFORUM on this talk page which is intended specifically for discussion to improve the article. The meatpuppet issue can be addressed on your talk page.

As a note, any continued editing by you, Felix Halloran, Serio31 or other members of your research group working on tendinopathies will require a conflict of interest disclosure on this talk page and your user's talk page. Zefr (talk) 21:28, 6 August 2026 (UTC)

Current first ¶ of lede is a gross distortion requiring redact.

Mucoid degeneration is a rare condition which the given source only speculates to be related some other conditions. I thought this sounded funny when i first saw it but accepted it at face value and just came back to follow up. I no longer edit mainspace or I'd pull it myself, but will let it be entertainment. Lycurgus (talk) 23:38, 14 August 2024 (UTC)

It was OK before the edit by a v6 ip in March '23. 75.246.220.29 (talk) 00:58, 15 August 2024 (UTC)