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Abstract
Although many factors influence the treatment of rotator cuff tears, understanding the anatomy and how it relates to function is the most important one. Indeed, fundamental to rotator cuff surgery is knowledge of the normal anatomic relations. Both the osseous and soft-tissue structures have a significant impact on rotator cuff function. The rotator cuff is a conjoint tendon lying over the top of the shoulder capsule and inserting into the tuberosities of the humerus. It is a four musculotendinous structure arising from both the anterior and posterior aspects of the scapula to insert into a hemispheric fashion about the lateral aspect of the proximal humerus. The rotator cuff is formed from the coalescence of the tendinous insertions of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles into one continuous band near their insertions on the greater and lesser tuberosities of the proximal humerus. This arrangement suggests that the muscles of the cuff function in concert. In fact, the name 2rotator3 cuff may be a misnomer; the major function of the rotator cuff is to depress and stabilize the humeral head, effectively compressing the glenohumeral joint to provide a stable fulcrum for arm movement. Although rotator cuff surgical repair has been performed for over 90 years, the relationship that linked altered mechanics to rotator cuff pathology was introduced by Neer in 1972. His notion that most rotator cuff tears are due to end-stage mechanical impingement of the cuff by the coracoacromial arch during arm elevation has been the cornerstone of diagnosis and treatment of rotator cuff dysfunction