Which rotator cuff tendon is most commonly torn in rotator cuff disease?

• A. Supraspinatus
• B. Infraspinatus
• C. Subscapularis
• D. Teres minor

Answer: (A)

The tendon most commonly torn in rotator cuff disease is the supraspinatus. Its location as it passes beneath the acromion puts it at risk for impingement, especially with overhead activity. It also has a relatively poor blood supply in its critical zone near the insertion on the greater tuberosity, making it more susceptible to degeneration over time. Functionally, it initiates the first phase of arm abduction, bearing the highest tensile load during the initial 15 degrees of elevation, so repetitive motion and impingement syndrome preferentially damage this tendon. Over time, these factors lead to partial-thickness or full-thickness tears of the supraspinatus.

The other tendons can tear as well, but less commonly in isolation. The subscapularis is involved less frequently and often in the setting of larger cuff pathology or instability; teres minor tears are rare; and infraspinatus tears occur but are not as prevalent as supraspinatus tears.