text:
Talk:Chondoist Chongu Party

Untitled
This article mentions nothing about the fact that it is a prop of the North Korean totalitarian dictatorship and is little more than a puppet organization. It is NOT "democratic." --Sesel 18:59, 10 Dec 2004 (UTC)

It does, though, link to the Juche page which clearly details the KWP's role in the state. --Dafyddyoung 22:44, 18 Dec 2004 (GMT)

The article completly lacks real background info, and needs to be rewritten. This party was a major political force in North Korea directly after WWII, and played a role in the initial years of DPRK. It is only at a later stage it was completly suppressed and maintained as a show-case party of the regime. --212.60.73.3 12:46, 11 July 2005 (UTC)

Demographics?
This article claims that 10.1% of the population follows Cheongdoism, but the Naver reference for that is not about 천도교 but rather about 천주교, Cheonjukyo, which is another way of referring to the Roman Catholic Church. The Korean version of this same article gives the number of adherants in Cheondoism at about 45,000. —Preceding unsigned comment added by 222.110.249.24 (talk) 12:52, 6 October 2010 (UTC)

Unexplained revert of my edit
Hi Jayaguru-Shishya! “What just happened here?” – Answer: My attempt to improve the article. If I've overlinked, please only fix the part you deem inappropriate, instead of reverting my entire edit. Since I don't know what in particular you disagree with, I'm going to reinstate most of my edit and add some more things, and you're very welcome to fix what you think is bad – I hope you don't think all of my changes to the article are bad.

I guess one of the things you didn't like about my edit was overlinking. I am going to reduce that this time, but I really think at least the link to Chondoism (which you had removed earlier) should stay. WP:OLINK advises against linking names of religions “unless they are particularly relevant”, which I think is the case for an organization that has its roots in Chondoism, is named after it and whose leadership overlaps with that of the religious association.

Have a nice weekend! 82.83.109.11 (talk) 02:59, 15 August 2014 (UTC)

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title: Talk:Chondoist Chongu Party


text:
Dark fantasy

Dark fantasy is a subgenre of fantasy literary, artistic, and cinematic works that incorporates disturbing and frightening themes. It often combines fantasy with elements of horror, possessing a dark and gloomy tone or a gothic atmosphere of dread.

Definition
A strict definition for dark fantasy is difficult to pin down. Gertrude Barrows Bennett has been called "the woman who invented dark fantasy". Both Charles L. Grant and Karl Edward Wagner are credited with having coined the term "dark fantasy"—although both authors were describing different styles of fiction. Brian Stableford argues "dark fantasy" can be usefully defined as subgenre of stories that attempt to "incorporate elements of horror fiction" into the standard formulae of fantasy stories. Stableford also suggests that supernatural horror set primarily in the real world is a form of "contemporary fantasy", whereas supernatural horror set partly or wholly in "secondary worlds" should be described as "dark fantasy".

Additionally, other authors, critics, and publishers have adopted dark fantasy to describe various other works. However, these stories rarely share universal similarities beyond supernatural occurrences and a dark, often brooding, tone. As a result, dark fantasy cannot be solidly connected to a defining set of tropes. The term itself may refer collectively to tales that are either horror-based or fantasy-based.

Some writers also use "dark fantasy" (or "Gothic fantasy") as an alternative description to "horror", because they feel the latter term is too lurid or vivid.

Concept and history
Charles L. Grant is often cited as having coined the term "dark fantasy". Grant defined his brand of dark fantasy as "a type of horror story in which humanity is threatened by forces beyond human understanding". He often used dark fantasy as an alternative to horror, as horror was increasingly associated with more visceral works.

Dark fantasy is sometimes also used to describe stories told from a monster's point of view, or that present a more sympathetic view of supernatural beings usually associated with horror. Anne Rice's The Vampire Chronicles, Chelsea Quinn Yarbro's Saint-Germain, and Neil Gaiman's The Sandman are early examples of this style of dark fantasy. This is in contrast to the traditional horror model, which focuses more on the victims and survivors.

In a more general sense, dark fantasy is occasionally used as a synonym for supernatural horror, to distinguish horror stories that contain elements of the supernatural from those that do not. For example, a story about a werewolf or vampire could be described as dark fantasy, while a story about a serial killer would simply be horror.

Stableford suggests that the type of horror conveyed by fantasy stories such as William Beckford's Vathek and Edgar Allan Poe's The Masque of the Red Death "is more aesthetic than visceral or existential", and that such stories should be considered "dark fantasies" rather than the "supernaturalized thrillers" of conventional horror fiction.

Karl Edward Wagner is often credited for creating the term "dark fantasy" when used in a more fantasy-based context. Wagner used it to describe his fiction about the Gothic warrior Kane. Since then, "dark fantasy" has sometimes been applied to sword and sorcery and high fantasy fiction that features anti-heroic or morally ambiguous protagonists. Another good example under this definition of dark fantasy is Michael Moorcock's saga of the albino swordsman Elric.

The fantasy work of H. P. Lovecraft, Clark Ashton Smith and their emulators have been specified as "dark fantasy", since the imaginary worlds they depicted contain many horror elements.

Dark fantasy is occasionally used to describe fantasy works by authors whom the public primarily associates with the horror genre. Examples of these are Stephen King's The Dark Tower series, Peter Straub's Shadowland and Clive Barker's Weaveworld. Alternatively, dark fantasy is sometimes used for "darker" fiction written by authors best known for other styles of fantasy; Raymond Feist's Faerie Tale and Charles de Lint's novels written as Samuel M. Key would fit here.

Roald Dahl's novel The Witches (and its film adaptations) is described as dark fantasy. Dahl's poetic reworking of "Cinderella" (which features in his poetry collection Revolting Rhymes) sees him upend the happy tale.

Anime and manga
Berserk, a manga and anime franchise by Kentaro Miura that debuted in 1989, is frequently noted as an example of the genre due to its depictions of extreme violence, moral ambiguity, apocalyptic storylines and anti-hero protagonists.

Attack on Titan is a dark fantasy for its intense violence and the dystopian world it takes place in.

Films
Ridley Scott's film Legend (1985) has been described as a "dark fairy tale" fantasy film. Guillermo del Toro's fantasy film Pan's Labyrinth (2006) has been described as a "sort of a dark spin on Alice in Wonderland".

Video games
The 2013 fantasy action role-playing game Dragon's Crown contains many elements of dark fantasy, such as werewolves, vampires, zombies, homonculi, and human-monster hybrids.

Modern games from Japanese game development and publishing company FromSoftware are lauded as exceptional representations of the dark fantasy genre, notably the Dark Souls series along with Bloodborne and later Elden Ring.

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: Dark fantasy


text:
User:Dabbler

Why Dabbler?
Dabbler by name because I am a Dabbler by nature. I like to know a little about a lot and it shows!

My interests
Some specific interests:
 * Royal Navy 1775-1816,
 * Trampolining as a sport,
 * Isle of Man,
 * Arthur Ransome,
 * Patrick O'Brian,
 * Fixing spelling errors

My DYKs
The DYK project (nominate) 18:04, 28 April 2011 (UTC)

Under construction
Under construction John Thomson Under construction Skipton Climo

title: User:Dabbler


text:
Talk:Korean Social Democratic Party

The only "paradoxical" thing is this article
The article displays the usual western bias about that everything in DPRK is an absolute totalitarian sham and absolutely anything that happens is a centrally controlled fake - yet at the same time promotes that the Social Democratic Party calls for multi-candidate elections and better minority rights and so "doesn't actually always support the government". Which one is it? It's a total fake or it has legitimate critisicism? Make the US propagandist make up their minds. --181.26.41.141 (talk) 19:31, 27 January 2021 (UTC)

Untitled
This article mentions nothing about the fact that it is a prop of the North Korean totalitarian dictatorship and is little more than a puppet organization. It is NOT "democratic." --Sesel 19:01, 10 Dec 2004 (UTC)

"democratic" is part of the name of the party, you can't deny that!!!

KDP was not a puppet from the beginning, but now it actually is. I removed NPOV template and added a few history bits.. And, who wants to hear opinion from some Anonymous? -- Caffelice 11:10, 26 Jan 2005 (UTC)

"out of the masses’ anti-imperialist, anti-feudal aspirations and demands" is typical pap that comes from North Korea. This article is propaganda.

Social Democratic Party was formerly called Democratic Party, it changed its name in 1990s. (See broadleft.org)

Why does it have to be merged though? you guys want to merge the democratic party of sk and social democratic party of nk? they're not even allies... -kichul chen

 * The proposed merger tag has been here for ages and is trying to merge two entirely different political parties, so I'm going to remove it.--82.45.163.18 21:10, 9 October 2006 (UTC)

I found the name of the current (as of January 2007) leader of the KSDP in the news from the DPRK this morning so I thought I'd add it in. kev. 11:46, 31 January 2007 (UTC)

The last line, "North Korea, while claiming to be communist and therefore democratic, is actually a single-party dictatorship, in which the Social Democratic Party has no real influence" is biased. It states as fact that North Korea that North Korea isn't communist, or tries to imply that communists reject it. This sounds like a commie (I'm also one, BTW) trying to save face. However, what counts as communist or socialist is a very controversial subject among communists and socialists. The important information - that the Social Democratic Party has no real power - should be included somewhere above in the rest of the article. -MQDuck 14:51, 9 February 2007 (UTC)

 * Here's a proposion of how the fix the last line.

"Most people claim that the party has no real influence over politics in North Korea." --Jonte-- 20:02, 9 February 2007 (UTC)

 * Well, for what it's worth, I don't have a problem with your proposal Jonte. As for what or who is or is not communist at least as of the 1980s-1990s Kim Il Sung never claimed that they were communists.  They were trying for it, but multiple references to moves for 'capturing and occupying the material and ideological fortress of communism...' in volume 8 of the English edition of the Selected Works; indicate that he believed they were still in the transitional socialist period and had not achieved the principle of 'each according to his ability, to each according to his needs....' kev. 10:56, 19 February 2007 (UTC)

"the masses’ anti-imperialist, anti-feudal aspirations and demands to eliminate the aftermath of Japanese imperialist military rule and build a new democratic society." this sounds like it is written by the North Korean news agency. What is the actual role of the party, since obviously NK isn't your standard multi-party democracy?/Marxmax 13:09, 14 May 2007 (UTC)

I don't want to start a big thing here but IMHO we could use a couple of citations for some of the things in this little article. kev. 10:33, 18 September 2007 (UTC)

I also remember reading something about the Worker's Party being formed by a merger between the Democratic Party and the Communist Party back before the war (the one with the UN not the one with the Japanese). I'll have to look it up again when I get the chance. I just bring that up because of the last line in the first paragraph. From what I remember neither the Communist nor the Democratic parties kept a separate identity after the merger so I'm wondering if the Democratic Party referenced in this article (before the 1980s name change) is somehow linked to--or a continuation of--that Democratic Party that merged with the C.P. or if it's a different entity? Again, I'll have to go back and find the articles about the merger and re-read them again. kev. 10:48, 18 September 2007 (UTC)

More and better sources
This entire article is based on North Korean goverment sites - like the claim it was founded "by medium and small entrepreneurs, merchants, handicraftsmen, petit-bourgeoisie, some peasants, and Christians," (exact copy paste from http://www.korea-dpr.com). That this is a puppet party is obvious, but since the allways fascinated me - like their history. I would love some real facts in to this article. And ofcourse less based on North Korean propaganda. 213.89.254.144 (talk) 08:13, 21 December 2013 (UTC)

Encyclopedia of Korean Culture quotation
As requested, the quote is: "1948년 5월 10일의 제헌의원선거에 조선민주당측에서 부당수인 이윤영을 비롯하여 5명이 출마하였으나 이윤영만이 서울 종로갑구에서 당선되었다" The English version is: In the Constituent Assembly election on 10 May 1948 five candidates from the Korean Democratic Party were running, but only Yi Yun-yong was elected in Jongno District in Seoul. Number  5  7  19:57, 4 April 2016 (UTC)

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Unsourced electoral results
what is the source for the electoral results you added? – Finnusertop (talk ⋅ contribs) 15:52, 8 September 2019 (UTC)
 * They appear to be largely taken from the individual election article's results tables, which are sourced. However, the 1948 South Korean parliamentary election result (1 seat) is not in that article. Number   5  7  16:24, 8 September 2019 (UTC)
 * On a separate note, Korean Wikipedia has separate articles on the North and South Korean parties (North Korean, South Korean). I wonder whether they are worth splitting here too. Number   5  7  16:34, 8 September 2019 (UTC)

Social democracy, or socialism?
The KSDP has put out a commentary on their website which reads (in part): "Under the socialist system, state sovereignty and the means of production are in the hands of the working masses. Therefore, all policies are implemented in accordance with the interests of the people. The material and cultural wealth created will be distributed to the people. [...] Our country's socialist system is the most superior social system in the world. [...] All party members must retain the pride and self-esteem that our socialist system is the best and must further promote the superiority and power of our style of socialism." This... Doesn't really sound anything like social democracy, no matter how you spin it. Update ideology section maybe? Azurescapegoat (talk) 23:49, 28 September 2023 (UTC)

 * I don't think it's surprising that the KSDP, whose existence is at the whim of the WPK, is praising the political and economic system put in place by the WPK. The commentary is not about their own beliefs, which is intentionally kept vague in both Korean and English publications. Regardless, the claim of "nominal social democracy" is unsourced in this article, so I am removing it. Yue 🌙 03:26, 29 September 2023 (UTC)

title: Talk:Korean Social Democratic Party


text:
My Philosophical Development

My Philosophical Development is a 1959 book by the philosopher Bertrand Russell, in which the author summarizes his philosophical beliefs and explains how they changed during his life.

Summary
Russell gives an account of his philosophical development. He describes his Hegelian period and includes hitherto unpublished notes for a Hegelian philosophy of science. He deals next with the two-fold revolution involved with his abandonment of idealism and adoption of a mathematical logic founded upon that of Giuseppe Peano. After two chapters on Principia Mathematica (1910-1913), he passes to the problems of perception as dealt with in Our Knowledge of the External World (1914). In a chapter on ‘The Impact of Wittgenstein’, Russell examines what he now thinks must be accepted and what rejected in that philosopher's work. He notes the changes from earlier theories required by the adoption of William James's view that sensation is not essentially relational and is not per se a form of knowledge. In an explanatory chapter, he endeavors to remove misconceptions of and objections to his theories as to the relation of perception to scientific knowledge. Russell concludes with a reprint of some articles on modern Oxford philosophy.

title: My Philosophical Development


text:
1913 in rail transport

January events

 * January 13 - Julius Kruttschnitt leaves Union Pacific Railway and succeeds Robert S. Lovett as Chairman of the Executive Committee for the Southern Pacific Railroad.

February events

 * February 1 - New York City's Grand Central Terminal opens as the world's largest train station to date.

May events

 * May 7 - Tracklaying begins on the Graysonia, Nashville and Ashdown Railroad (a predecessor of Kansas City Southern Railway) between Murfreesboro and Shawmut, Arkansas.

June events

 * June 28/29 - Bever–Scuol-Tarasp railway opens in Switzerland.

July events

 * July 2 - General Electric produces a gas-electric locomotive which is sold to the Electric Line of Minnesota as its #100 Dan Patch.
 * July 15 - Opening of the Bern–Lötschberg–Simplon railway's Lötschberg railway line in Switzerland, including the 14.6 km Lötschberg Tunnel.

August events

 * August 1 - The Alton and Southern Railroad is formed through the merger of the Alton and Southern Railroad Company, the Denverside Connecting Railroad and the Alton and Southern Railway.
 * August 13 - Stainless steel (which will soon be used to construct passenger car bodies) is invented by Harry Brearley in Sheffield.
 * August 21 - Construction begins on the Morrisburg and Ottawa Electric Railway just south of Billings Bridge, Ottawa.

September events

 * September 1 – Howard Elliott succeeds Charles Sanger Mellen as president of New York, New Haven and Hartford Railroad.
 * September 2 – Traveling at 40 mph in heavy fog north of New Haven, Connecticut, the White Mountain Express crashes through two cars of the Bar Harbor Express and overturns a third coach, killing 21 and injuring 50.

October events

 * October 20 - The Chicago, Burlington and Quincy Railroad's tracks reach Casper, Wyoming, making Casper the busiest rail junction in Wyoming.

December events

 * December 1 - First section of Buenos Aires Metro opened, the earliest metro system in the Southern Hemisphere or the Hispanophone world, and the southernmost.
 * December 18 - Korekimi Nakamura steps down as president of South Manchuria Railway.
 * December 19 - Ryutaro Nomura succeeds Korekimi Nakamura as president of South Manchuria Railway.
 * December 26 - A major fire at its predecessor forces the new Michigan Central Station in Detroit to open early.

Unknown date events

 * The Nickel Plate Road completes its grade separation project in Cleveland, Ohio.
 * The Supreme Court of the United States orders the Union Pacific Railroad to sell all of its stock in the Southern Pacific Railroad.
 * ALCO ceases new steam locomotive production at the former Rogers Locomotive Works plant in Paterson, New Jersey; ALCO continues producing new locomotives at its other plants.
 * First examples of Class 140 C steam locomotives delivered to Chemins de Fer de l'État in France; 340 will eventually be built.
 * The world’s first rail vehicle with diesel-electric transmission, and the first diesel of any type in regular revenue main line service, a 75 bhp railcar built by Atlas-Deva/Asea, enters service on the Södermanland Mellersta Railway in Sweden. It will remain in use until 1939.
 * The Butte, Anaconda and Pacific Railway, a copper ore-hauling short line in Montana, electrifies using a 2,400 Volts DC system engineered by General Electric, the first primarily freight railroad in North America to electrify.
 * Hejaz Railway Station opened in Damascus.
 * First on-train cinema set up, on the Trans-Siberian Railway.
 * William Finley is succeeded by Fairfax Harrison as president of the Southern Railway.
 * Mary Averell Harriman, wife of the late Edward H. Harriman, creates the E. H. Harriman Award to recognize outstanding achievements in railway safety.

April births

 * April 21 - Richard Beeching, chairman of the British Railways Board 1961–1965 (died 1985).

December births

 * December 27 - Ian David Sinclair, president of Canadian Pacific Railway 1969-1981, is born (died 2006).

March deaths

 * March 31 - J. P. Morgan, American financier who helped to finance United States Steel Corporation (born 1837).

April deaths

 * April 22 - John Saxby, English railway signalling engineer (born 1821).

May deaths

 * May 20 - Henry Morrison Flagler, visionary and builder of the Florida East Coast Railway (born 1830).

September deaths

 * September 25 - Herbert William Garratt, English steam locomotive builder and inventor of the Garratt locomotive (born 1864).

title: 1913 in rail transport


text:
Minnesota Kicks

The Minnesota Kicks was a professional soccer team that played at Metropolitan Stadium in the Minneapolis suburb of Bloomington, Minnesota, from 1976 to 1981. The team was a member of the now defunct North American Soccer League (NASL). Initially known as the Denver Dynamos, the team relocated and became the Minnesota Kicks in 1976. The Kicks quickly became one of the league's more popular teams, with an average attendance of 23,120 fans per game in 1976. The Kicks won their division four years in a row from 1976 to 1979. The Kicks drew over 23,000 fans in each season from 1976 to 1979, with attendance peaking at 32,775 in 1977.

History
The team had relocated to Minnesota after having been based in Denver, Colorado, as the Denver Dynamos. A group of ten investors from Minnesota, led by Jack Crocker, bought the Denver team on November 25, 1975, and relocated to Minnesota. The name "Kicks" was selected by a name-the-team contest, and announced on January 28, 1976. Freddie Goodwin, who had previously coached the New York Generals, was named the first coach on February 19, 1976. Goodwin served also as team president starting in August 1976.

The team began the 1976 season slowly, however by the end of its first season the team had won the Western Division. During the season, the Kicks boosted their roster by signing Ade Coker from Boston. The Kicks also played Glasgow Rangers to a 2–2 draw in a friendly. Minnesota was a success with fans, averaging 23,117 per game, including 42,065 for its regular season finale, But it was a game with the New York Cosmos on June 9 that convinced that The Kicks have arrived. With Pelé playing for the Cosmos, the Cosmos beat the Kicks 2–1, but the Kicks set a new NASL record of 46,164 fans. The team was led by leading scorer Alan Willey with 16 goals. The 1976 playoffs included a 3–0 win over Seattle, followed by a 3–1 win over San Jose in front of a Kicks record of 49,576 fans, and finished with a 3–0 loss to the Toronto Metros-Croatia in the 1976 Soccer Bowl at Seattle's Kingdome in front of 25,000, with the winning goal scored by Portuguese legend Eusébio.

In 1977, the Kicks won the Western Division again, and averaged 32,775 fans, second only to the New York Cosmos. The Kicks were again led by Alan Willey with 14 goals, while midfielder Alan West was named to the All-Star team. The Kicks lost in the playoffs to Seattle.

In 1978 the Kicks won the Central Division, averaging 30,928 fans. The team's leading scorer was Alan Willey, with 21 goals. In the playoffs, the Kicks defeated Tulsa before losing to the New York Cosmos. After the 1978 season, Goodwin stepped down as coach.

Roy McCrohan was named coach December 1978, and he coached the team for the 1979 season. In 1979, the Kicks signed a major international star in defender Björn Nordqvist, Sweden's all-time caps leader. The Kicks won the Central Division again in 1979, but fell to Tulsa in the playoffs. Once again, Alan Willey led the team's scoring with 21 goals, and Ace Ntsoelengoe was named to the All-Star Team.

After nine games into 1980 season, McCrohan was removed, and Goodwin again became coach. The Kicks finished the regular season second behind the Dallas Tornado in the Central Division, and lost in the playoffs to Dallas. Ace Ntsoelengoe was the team's leading scorer with 13 goals and 17 assists.

Stars for the Kicks included US Soccer Hall of Famers Patrick (Ace) Ntsoelengoe and Alan Willey, the league's fifth and third league all-time leading scorers respectively. Ron Futcher, who along with Willey played all six Kicks seasons, went on to become the league's fourth all-time leading scorer.

The Kicks were the first team in the NASL to win 4 straight division titles (1976–79). The team reached the playoffs each of its six seasons, but usually lost in the early rounds. The Minnesota Kicks are remembered for the tailgating in the Metropolitan Stadium parking lot. It became a cultural phenomenon in the late 1970s, with thousands of fans arriving early to socialize and consume beverages.

Demise
The original ownership group sold the team on November 12, 1980, to a group led by Englishman Ralph Sweet, who replaced Goodwin as coach early in the 1981 season. Goodwin remained president of the team until June 1981. The Kicks finished the 1981 season second in the Central Division. Ron Futcher was the team's leading scorer with 14 goals. The Kicks defeated Tulsa in the playoffs, but lost to Ft. Lauderdale in the quarterfinals.

The Kicks' last season was 1981. The team's last regular-season game was August 19, 1981, a 2–1 home win at Met Stadium over the Dallas Tornado. The team's last game at the Met was August 26, 1981, a 1–0 shootout playoff victory against the Tulsa Roughnecks. The team's last game was played on September 6, 1981, a 3–0 home playoff loss to the Fort Lauderdale Strikers played at the University of Minnesota's Memorial Stadium due to a schedule conflict with the Minnesota Twins in front of only 10,722 fans. The team had planned to move to the Hubert H. Humphrey Metrodome for the 1982 season.

The Kicks lost $2.5 million during the 1981 season. By the end of the 1981 season, the Kicks were up for sale, the team missed a payment for its players and office staff, NASL Commissioner Phil Woosnam was trying to find a buyer for the club, and the NASL announced it would play the 1981–82 indoor season without Minnesota. The Kicks folded in December 1981. The NASL conducted a dispersal draft on December 7, 1981, in which five Kicks players were selected: Ace Ntsoelengoe by Toronto, Ron Futcher by Portland, Tino Lettieri by Vancouver, David Stride by Fort Lauderdale, Randy Phillips by Tulsa, and Tim Twellman by Tulsa.

NASL seasons
1976  Alan Willey, Ace Ntsoelengoe, Peter Brine, Alan Merrick (Captain), Ron Webster, Mike Flater, Chaka Ngcobo, Geoff Barnett, Sam Bick, Ron Futcher, Alan West, Doug Brooks, Smith Eggleston, Nick Owcharuk, Ade Coker, Tom Howe, Jeff Solem, Steve Litt, Frank Spraggon, Peter Short. Freddie Goodwin (Coach), Gary Smith (Trainer), Dave Nowicki (Ass't Trainer), Dr. James Priest (Team Physician).

1979  Willie Morgan, Gary Vogel, Tony Want, Alan Merrick, Ace Ntsoelengoe, Alan West, Chico Hamilton, Volkmar Gross, Mark Moran, Geoff Barnett, Bjorn Nordqvist (Captain), Alan Willey, Tino Lettieri, Ricardo Alonso, Steve Litt, Greg Villa, Brian Zins, Ron Futcher, Mike McLenaghan, Tim Twellman. Roy McCrohan (Head Coach), Gary Smith (Head Trainer), Jim Mulcahy (Ass't Trainer), Dr. James Priest (Team Physician), Freddie Goodwin (President).

NASL indoor
Minnesota participated in and finished as runners-up in the 1978 NASL Skelly Indoor Invitational. They played one other match that year against Tampa Bay. The NASL began playing a full schedule of indoor soccer in the fall of 1979. The Kicks played their home games at Met Center and participated for 2 seasons, before folding in November 1981, just a month before the start of the 1981–82 indoor season.

Honors
NASL championships
 * 1976 runner-up
 * 1978 indoor runner-up

Conference Titles
 * 1976 Pacific Conference

Division titles
 * 1976 Western Division, Pacific Conference
 * 1977 Western Division, Pacific Conference
 * 1978 Central Division, National Conference
 * 1979 Central Division, National Conference

U.S. Soccer Hall of Fame
 * 2003 Ace Ntsoelengoe & Alan Willey

Canadian Soccer Hall of Fame
 * 2001 Tino Lettieri
 * 2008 Bruce Twamley

All-Star first team selections
 * 1977 Alan West
 * 1979 Ace Ntsoelengoe
 * 1980 Ace Ntsoelengoe

All-Star second team selections
 * 1976 Ron Webster & Alan West
 * 1978 Alan Merrick

All-Star honorable mentions
 * 1976 Frank Spraggon
 * 1977 Steve Litt, Ace Ntsoelengoe & Alan Merrick
 * 1978 Mike Renshaw
 * 1979 Steve Litt

Indoor All-Stars
 * 1980–81 Tino Lettieri, Björn Nordqvist

Radio
Frank Buetel was the original play-by-play announcer (1976–79), followed by Al Shaver in 1980 and Doug McLeod in 1981.
 * 1976 WWTC-AM 1280
 * 1977 KSTP AM 1500
 * 1978–79 WWTC-AM 1280
 * 1980 KSTP-AM 1500
 * 1981 WAYL AM 980

Television
KSTP's original announcers were Kicks' public address announcer Rod Trongard and Tom Ryther. When Ryther left KSTP in March 1978, Bob Bruce replaced him. Ralph Jon Fritz called Kicks' games on WCCO.
 * 1976–80 KSTP-TV
 * 1981 WCCO-TV

Records
Records of the Minnesota Kicks are available for research use. They include manager's subject files (1976–1980), staff and player files, payrolls, marketing and promotional materials, financial files, and miscellaneous records. The bulk of the records are the files of team coach and manager Freddie Goodwin, and concern the general management of the franchise.

title: Minnesota Kicks


text:
Guinea-Bissau national football team

The Guinea-Bissau national football team (Portuguese: Seleção nacional de futebol da Guiné-Bissau) represents Guinea-Bissau in men's international association football and it is controlled by the Football Federation of Guinea-Bissau, The team has never qualified for the FIFA World Cups but qualified for the Africa Cup of Nations four times, making their debut in 2017. The team is a member of both FIFA and Confederation of African Football (CAF).

World Cup qualifying
Guinea-Bissau entered their first FIFA World Cup qualification with the aim of reaching the 1998 World Cup in France. The first round of African qualification required for them to play Guinea in a two-legged match. The first leg was held at home in the Estadio 24 de Setembro in Bissau on 1 June 1996 with an attendance of 15,000. Guinea-Bissau went 2–0 up at half-time after strikes from Pereira Tavares in 11th and 36th minutes. Guinea's Titi Camara equalised with his own brace in the 53rd and 54th minutes. Guinea-Bissau's Co Cipriano won the game with a 60th-minute penalty to make it 3–2. The away leg was held at the Stade du 28 Septembre in Conakry. Momo Soumah of Guinea scored to level the tie at half-time before Nando Có scored a bicycle kick for Guinea-Bissau to put his side 4–3 up on aggregate, however another goal from Momo Soumah and a winner from Tibou Bangoura won the match for Guinea, giving them a 5–4 lead on aggregate.

Guinea-Bissau had never progressed beyond the first round of qualification until the 2022 qualifiers where they defeated São Tomé and Príncipe 3–1 over two legs, thanks to three goals from Joseph Mendes.

Africa Cup of Nations
Guinea-Bissau first participated in AFCON qualification in 1994 where they defeated Cape Verde over three legs, but failed to register a single point in the second round as their draw against Togo was annulled after Togo withdrew from the competition. In 1996 Guinea-Bissau withdrew from qualification after a draw and two losses to begin the campaign, leading to their ban for 1998 AFCON.

Guinea-Bissau next entered qualification in 2006 where they lost 4–1 to Mali national football team and were again banned in 2008 for unpaid debts to CAF. In 2012 they secured a single win (1–0 against Kenya) and five losses to finish last in Group J. The following year they were eliminated 2–0 by Cameroon. In 2015, after beating Central African Republic 3–1, they lost to Botswana by the same scoreline.

For the 2017 qualifiers, Guinea-Bissau was drawn from Pot 4 into Group E and, despite being the lowest ranked nation in their group, achieved ten points and qualified for the 2017 tournament ahead of Congo, Zambia and Kenya. In their African Cup of Nations debut, Guinea-Bissau drew 1–1 with Gabon with a 91st-minute equaliser by Juary Soares. This was the only point they collected at the tournament and they were eliminated in the group stage.

Guinea-Bissau then also won their Group in the 2019 qualifiers to reach a second straight Finals. They again managed one draw (0–0 against Benin) and two losses and failed to progress to the knock-out stages.

On March 30, 2021, Guinea-Bissau went into their final qualifying match against Congo, needing a victory to qualify. They ended comfortable winners with goals from Piqueti, Frédéric Mendy and Jorginho to secure their third successive AFCON appearance.

Results and fixtures
The following is a list of match results in the last 12 months, as well as any future matches that have been scheduled.

Coaching history

 * Guilherme Farinha (1990–1994)
 * 🇬🇼 Armando Antonio Miranda (2000)
 * 🇬🇼 Baciro Candé (2001–2009)
 * Luís Norton de Matos (2010–2012)
 * Carlos Manuel (2012–2014)
 * Paulo Torres (2014–2016)
 * 🇬🇼 Baciro Candé (2016–2024)
 * Luís Boa Morte (2024–present)

Current squad
The following players were called up for the 2026 FIFA World Cup qualification against Ethiopia and Egypt on 3 and 10 June 2024 respectively.

Caps and goals correct as of 10 June 2024, after the match against Egypt

Recent call-ups
The following players have been called up for Guinea-Bissau in the last 12 months.

DEC Player refused to join the team after the call-up. INJ Player withdrew from the squad due to an injury. PRE Preliminary squad. RET Player has retired from international football. SUS Suspended from the national team. WD Withdrew from squad.

Records

 * Players in bold are still active with Guinea Bissau.

Honours

 * Amilcar Cabral Cup
 * Runners-up (1): 1983

title: Guinea-Bissau national football team


text:
1916 in rail transport

January events

 * January 15 - First through Berlin-Istanbul train.

February events

 * February 4 - The Manila Railway Company (1906), Limited of London and the Manila Railroad Company corporation of New Jersey are merged by the Insular Government of the Philippine Islands to become the state-owned Manila Railroad Company.

April events

 * April
 * Murman Railway in Russia completed from Petrograd to the city that becomes Murmansk (central section not completed until November). The intermediate station at Kola lies at 68° 52′ 58″ N, the world's most northerly station at this date.
 * Motor Rail deliver the first of over 900 petrol engined 60 cm narrow gauge railway locomotives for the British War Department Light Railways on the Western Front (World War I); substantially the same design is in production until the 1980s.
 * April 13 - Oris Paxton Van Sweringen and his younger brother Mantis James Van Sweringen purchase a 75% controlling interest in the Nickel Plate Road from William Kissam Vanderbilt for $8.5 million.

May events

 * May 6 - Rome and Fiuggi Rail Road opens for service.

July events

 * July 16 - Much of the Southern Railway's mainline in North and South Carolina is damaged or destroyed by flooding.

August events

 * August 24 - After a bankruptcy, the St. Louis and San Francisco Railroad is reorganized as the St. Louis - San Francisco Railway (often called the "Frisco").
 * August 24 - Due to several serious accidents caused by broken red lenses in its signals, the New York Central Railroad discontinues white lights as indications to proceed. The new color is green.

September events

 * September 11 - The almost-completed Quebec Bridge collapses for the second time.
 * September 30 - Construction is completed on the Hell Gate Bridge in New York City.

October events

 * October 5 - Opening of Amur River line completes through rail communication on Trans-Siberian Railway.

November events

 * November 16 - The two-storey station opened by the California Southern Railroad in San Bernardino, California, is destroyed by fire.
 * November 24 - German sleeping and dining car operator Mitropa is founded.

December events

 * December 1 - In the Herceghalom rail crash in Hungary, a side collision occurs between an express train and a shunting passenger train, killing 69.

Unknown date events

 * Early Summer - The Fairbourne Railway, in Wales, is converted from a horse-drawn tramway into a gauge steam railway.
 * The Pennsylvania Railroad adopts the motto "the Standard Railroad of the World".
 * The Pennsylvania Railroad's first I1s 2-10-0 "Decapod" locomotive is completed and first A5s 0-4-0 and B6sb switching locomotives enter service.
 * Joel Coffin purchases Lima Locomotive Corporation; the company is renamed Lima Locomotive Works.
 * The first all-steel fish car is built for use on American railroads.
 * Underground Electric Railways Company of London, operator of the London Underground, adopts Johnston (typeface) as part of its corporate identity.
 * In the USA all-railroad mileage peaks at 254,251 miles (409,177 km) with the most of lines located in the east part of country.

April births

 * April 15 - Benjamin Biaggini, president of the Southern Pacific Company (U.S.) 1964–1976 (died 2005).

September births

 * September 10 - Michael Cobb, British railway historian (died 2010).

March deaths

 * March 18 - Karl Gölsdorf, Austrian steam locomotive designer (born 1861).

April deaths

 * April 19 - Ephraim Shay, American inventor of the Shay locomotive (born 1839).

May deaths

 * May 12 - Fred T. Perris, Chief Engineer of the California Southern Railroad (born 1836).
 * May 29 - James J. Hill, American financier who gained control of the Great Northern Railway and the Northern Pacific Railway (born 1838).

title: 1916 in rail transport


text:
Lanterman–Petris–Short Act

The Lanterman–Petris–Short (LPS) Act (Chapter 1667 of the 1967 California Statutes, codified as Cal. Welf & Inst. Code, sec. 5000 et seq.) regulates involuntary civil commitment to a mental health institution in the state of California. The act set the precedent for modern mental health commitment procedures in the United States. The bipartisan bill was co-authored by California State Assemblyman Frank D. Lanterman (R) and California State Senators Nicholas C. Petris (D) and Alan Short (D), and signed into law in 1967 by Governor Ronald Reagan. The Act went into full effect on July 1, 1972. It cited seven articles of intent:
 * To end the inappropriate, indefinite, and involuntary commitment of mentally disordered persons, people with developmental disabilities, and persons impaired by chronic alcoholism, and to eliminate legal disabilities;
 * To provide prompt evaluation and treatment of persons with serious mental disorders or impaired by chronic alcoholism;
 * To guarantee and protect public safety;
 * To safeguard individual rights through judicial review;
 * To provide individualized treatment, supervision, and placement services by a conservatorship program for gravely disabled persons;
 * To encourage the full use of all existing agencies, professional personnel and public funds to accomplish these objectives and to prevent duplication of services and unnecessary expenditures;
 * To protect mentally disordered persons and developmentally disabled persons from criminal acts.

The Act in effect ended all hospital commitments by the judiciary system, except in the case of criminal sentencing, e.g., convicted sexual offenders, and those who were "gravely disabled", defined as unable to obtain food, clothing, or housing. It did not, however, impede the right of voluntary commitments. It expanded the evaluative reach of psychiatrists and created provisions and criteria for holds.

Prior to 1987 it was assumed that the Act allowed involuntary treatment for those who were detained under an initial three-day hold (for evaluation and treatment) and a subsequent fourteen-day hospitalization (for those people declared after the three-day hold to be dangerous to themselves or others or gravely disabled). However, in the 1987 case of Riese v. St. Mary’s Hospital and Medical Center, the California Court of Appeal declared that these people had the right to exercise informed consent regarding the use of antipsychotic drugs, except in an emergency, and if they rejected medication "a judicial determination of their incapacity to make treatment decisions" was required before they could be involuntarily treated. This case was a class action suit brought in the name of person Eleanor Riese by the California ACLU. Eleanor Riese's story is depicted in the movie 55 Steps.

LPS evaluation, detention, and conservatorship process
Under the LPS Act, individuals can be detained into a locked psychiatric facility in the following process:

5150 hold
Under California Welfare and Institutions Code (WIC) 5150, an individual can be involuntarily placed in a locked psychiatric facility for an evaluation for up to 72 hours. Any peace officer or specific individuals authorized by a county government may place the hold. Three criteria apply – the individual is assessed to be a danger to themselves, a danger to others, or "gravely disabled". Per WIC 5008, grave disability is defined as an individual's lack of ability, due to their mental illness, to provide for their food, clothing, or shelter. In the case of children, it is the inability to use food, clothing, or shelter even if it is supplied.

It is not uncommon for police to be the party who places them on the 5150 hold and then takes the individual to the hospital for further assessment. Over the next 72 hours, the hospital or psychiatrist must determine the individual's need for further locked psychiatric detainment. If the individual's condition clears up and they are no longer a danger to others or themselves or gravely disabled, they are released from the hospital. If, however, they remain a danger to others or themselves or continue to be gravely disabled, the hospital/psychiatrist may then request a 5250 hold to thereby keep the individual in the hospital beyond the 72-hour limit of the 5150 hold.

In popular culture
Largely because many American movies and television programs are primarily produced in California, usage of the term 5150 has spread beyond its original location and user population. An album of the same name by the California hard rock band Van Halen was named directly for the code section, and several derivative uses followed.

5250 hold
If, after a 72-hour hold, an individual is deemed to still be a danger to others or themselves, or is gravely disabled, WIC 5250 permits an individual to be involuntarily held (in a locked psychiatric hospital) for an additional 14 days.

Unlike a 5150 hold a 5250 hold requires that the individual served receive a court hearing within 4 days of being served to ascertain the validity of the hold. Court hearings are often held in the hospital. Individuals are provided an attorney and a county court officer reviews the evidence for the hold presented by the hospital, hears the argument of the client and their attorney, and decides whether or not to uphold the 5250.

Just as with the 5150 hold, during the 5250 hold, the individual is continually being assessed by psychiatric staff. Again, if the individual is (at any time) deemed to be no longer a danger or gravely disabled, they are then released from the hospital.

According to section 5257 of the act, the individual must be released after 14 days, unless: they agree to further treatment on a voluntary basis, they are certified for an additional 14 days of intensive treatment, they are certified for an additional 30 days of intensive treatment, they are the subject of a conservatorship (commonly known as a Temporary LPS Conservatorship) petition, or they are the subject of a petition for post-certification treatment of a dangerous person.

5350 hold (temporary LPS conservatorship)
A 5350 hold, otherwise known as a temporary LPS conservatorship (under W&I Code § 5352.1), is initiated at the end of a 14-day hold. Such is initiated by the individual's treating psychiatrist and co-signed by the medical director of the psychiatric facility to the Public Guardian Office in the individual's county of residence. The basis for the LPS temporary conservatorship is that the individual (due to their mental illness, even after ~17 days of involuntary psychiatric detention) remains "gravely disabled."

There are 58 counties in California, each with its own independent Public Guardian Office. Unlike other conservatorship processes in California (probate/older adult or limited/developmentally disabled) - a LPS conservatorship cannot be initiated by the public at large. Codified in the WIC - the individual must go through the 5150 - 5250 process and from there the county Public Guardian is the only authorized party to be able to request for a LPS conservatorship. The legislative intent for such was that prior to the LPS Act, it was felt individuals were often psychiatrically committed for subjective (if not outright punitive) reasons. To combat such potential abuses, the county Public Guardian, seen as an impartial third party, was designated as sole party.

Once the individual is on a LPS temporary conservatorship, they are no longer legally on a "hold," but now, legal consent to treat and continue to detain the individual (now known as the "conservatee") lies with the Public Guardian office.

A temporary LPS conservatorship can last a maximum of 180 days. As the county superior court has direct oversight of LPS conservatorship matters, typically the conservatee is afforded court hearings (for status) every 30 days. Unlike other conservatorship hearing, LPS conservatorship matters/records are not open to the public.

With 58 counties, the Public Guardian Offices and Superior Courts may interpret and practice differing methods of legal administration of LPS conservatorship. In general, all conservatees are appointed legal counsel (typically from the public defender's office), and during the course of their LPS conservatorship, they can ask for a series of writs and hearings or even a full jury trial to contest their detention and overall LPS conservatorship. It is not uncommon for a psychiatrist to conversely declare the conservatee is no longer gravely disabled. During the course of the LPS conservatorship, if the conservatee stabilizes and can thereby be discharged to the community, a psychiatrist can request that the LPS conservatorship be dismissed (for lack of legal support).

During a temporary LPS conservatorship, it is the general duty of the Public Guardian Office to ensure the conservatee is properly cared for and that the conservatee continues to require locked psychiatric care.

During the LPS temporary conservatorship, it is indeed the Public Guardian, not the conservatee, who consents to treatment and placement. A common way to understand this is to think of the relationship as that of a parent to a child - in that a minor child cannot consent to medical care. The same goes for the conservatee - in that the Public Guardian consents to his or her psychiatric treatment and placement.

If during the LPS temporary conservatorship, the Public Guardian feels the conservatee will (for the foreseeable future) need to remain in locked psychiatric care - the Public Guardian can then seek to have the LPS conservatorship changed from temporary to general (also referred to as "Permanent" but this can be a misnomer as it is neither permanent nor indefinite). With the appointment of a permanent LPS conservatorship (approved by the court) - the conservatee is now under the care / authority of the LPS conservator for exactly 1 year. It is with a permanent LPS conservatorship that then the public (family / friends) can now become involved. Upon request, pending court approval, family and/or friends (unlike the temporary LPS conservatorship) can be appointed general / permanent LPS conservator for the conservatee.

The 1-year duration for a general / permanent LPS conservatorship was again codified into the LPS Act to combat past abuses. This ensures that no individual is indefinitely detained in locked psychiatric care and that every year justification to continue the LPS conservatorship is brought before the court. This is another difference between LPS conservatorship and probate or limited conservatorship - both of which have no explicit expiration date. Indeed, if the LPS conservator does not submit a request to the court to renew the LPS conservatorship, by default it expires. Renewal of the LPS conservatorship requires that two mental health professionals formally declare that the LPS conservatorship still remains appropriate.

During a general / permanent LPS conservatorship, the conservatee is most likely held in long-term, locked psychiatric care. Although California state hospitals still exist and are in use, most LPS conservatees are placed at local (county level) psychiatric hospitals. Nothing in the LPS Act precludes a conservatee being under a LPS conservatorship and living in the community. No time frame is quantified in the LPS Act (as matters vary from conservatee to conservatee), but, in general, amongst the 58 county Public Guardian Offices, if a conservatee has been living in the community for an extended period of time, the legal justification to continue the LPS conservatorship diminishes and the conservatorship is likely to be dismissed. As such there is no common duration for a LPS conservatorship. It can indeed vary from a single LPS conservatorship lasting 30 years to multiple temporary LPS conservatorships being implemented over the course of a single year.

Some family of mentally ill individuals believe that the LPS act favors the individual's civil rights too much when weighed against their self-evident need for treatment. It can be very difficult for their family member to be placed on a 5150 hold or on a LPS conservatorship. The LPS Act requires a "grave disability" to provide oneself with food, clothing, or shelter. Some argued that revisions should be made to make it easier for individuals to be detained, lessening the restrictions required under the LPS Act.

In 2018, SB 1045 was signed into California law, establishing a pilot program in San Francisco, Los Angeles, and San Diego counties, if the counties approve. It would allow for the creation of a conservatorship for a person who is unable to care for his or her own health and well-being due to serious mental illness and substance use disorder. SB 1045 provides the least restrictive and most clinically appropriate alternative needed for the protection of persons incapable of caring for their own health.

title: Lanterman–Petris–Short Act


text:
User talk:WD-40

Welcome!

Hello,, and welcome to Wikipedia! Thank you for your contributions. I hope you like the place and decide to stay. Here are some pages that you might find helpful: I hope you enjoy editing here and being a Wikipedian! Please sign your messages on discussion pages using four tildes ( ~ ); this will automatically insert your username and the date. If you need help, check out Questions, ask me on, or ask your question on this page and then place  before the question. Again, welcome! Basketball 110  01:00, 23 January 2008 (UTC)
 * The five pillars of Wikipedia
 * Tutorial
 * How to edit a page
 * How to write a great article
 * Manual of Style

title: User talk:WD-40


text:
Erg (disambiguation)

An erg is a unit of energy.

Erg, Ergs or ERG may also refer to:

Arts and entertainment

 * Mikey Erg (born 1980), American musician
 * Erg (comics), a fictional character in the Marvel Comics Universe
 * Erg (Hyperion), a creature in the Hyperion Cantos series by Dan Simmons

Organisations

 * Education Reference Group, in Connecticut, US
 * Erg (company), an Italian energy company
 * Efficiency and Reform Group (May 2010-October 2014), former part of the Cabinet Office of the UK
 * Eurasian Resources Group, a Luxembourgish mining and smelting company
 * European Research Group, anti-EU group of British Conservative MPs
 * Videlli, an Australian smart card ticketing system manufacturer formerly known as ERG Group

Places

 * English Riviera Geopark, in Torbay, England
 * Erbogachen Airport (IATA code), Russia

Science and technology

 * Electron-releasing group
 * Electroretinography, or electroretinogram
 * Erg (landform), sand dune field
 * ERG (gene)
 * ERG theory, in psychology
 * Exploration of Energization and Radiation in Geospace, now Arase, a Japanese scientific satellite

Other uses

 * Employee resource group, groups of employees who join together in their workplace
 * Emergency Response Guidebook, a hazardous-materials reference book
 * Erg (indoor rower)
 * Erg (tug), a Canadian tug, sunk in Halifax Harbour in 1943
 * Ergative case

title: Erg (disambiguation)


text:
User:Xinoph/Private

Private stuff here

title: User:Xinoph/Private


text:
Rotator cuff tear

Rotator cuff tendinopathy is a process of senescence. The pathophysiology is mucoid degeneration. Most people develop rotator cuff tendinopathy within their lifetime.

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. 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.

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 up or back. 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.

Signs and symptoms

Rotator cuff tendinopathy is often asymptomatic even when there is thinning or a full thickness defect. Rotator cuff defects are common on post mortem and MRI studies in those without any history of shoulder pain or symptoms. Rotator cuff tendinopathy is associated with pain over the front and side (anterolateral) of the shoulder pain that radiates towards the elbow. The pain may occur with shoulder movement above the horizontal position, shoulder flexion and abduction. Pain is often described as weakness. Actual muscle weakness does not correlate with symptoms of weakness. Symptom severity does not correlate with rotator cuff defect size and associated muscle quality.

Risk factors

Epidemiological studies strongly support a relationship between age and cuff tear prevalence, with the most common cause being age-related degeneration and, less frequently, sports injuries or trauma.

Those most prone to failed rotator cuff syndrome are people 65 years of age or older; and those with large, sustained tears. Smokers, people with diabetes, individuals with muscle atrophy or fatty infiltration, and those who do not follow postoperative-care recommendations also are at greater risk. In a 2008 study the frequency of such tears increased from 13% in the youngest group (aged 50–59 y) to 20% (aged 60–69 y), 31% (aged 70–79 y), and 51% in the oldest group (aged 80–89 y).

Some risk factors, such as increased age and height, cannot be changed. Increased body mass index is also associated with tearing. Recurrent lifting and overhead motions are at risk for rotator cuff injury as well. This includes jobs that involve repetitive overhead work, such as carpenters, painters, custodians, and servers. People who play sports that involve overhead motions, such as swimming, water polo, volleyball, baseball, and tennis, and American football quarterbacks are at a greater risk of experiencing a rotator cuff tear. Striking-based combat sports, such as boxing, also account for severe rotator cuff injuries in competitors, typically when their punches miss the target, or overusing the shoulder by throwing an excessively large number of punches. Certain track-and-field activities, such as shot put and javelin throw are also of considerable risk, especially when athletes perform outdoors under cold weather conditions or neglect warming-up procedures; proper warm-up of the throwing and/or swinging arm can help reduce the stress on the musculature of the shoulder girdle. Corticosteroid injections around the tendons increase the risk of tendon tear and delay tendon healing.

Mechanisms of injury

The shoulder is a complex mechanism involving bones, ligaments, joints, muscles, and tendons.

The two main causes are acute injury or chronic and cumulative degeneration of the shoulder joint. Mechanisms can be extrinsic, intrinsic or a combination of both.

The cuff is responsible for stabilizing the glenohumeral joint to allow abduction and rotation of the humerus. When trauma occurs, these functions can be compromised. Because individuals are dependent on the shoulder for many activities, overuse can lead to tears, with the vast majority being in the supraspinatus tendon.

The role of the supraspinatus is to resist downward motion, both while the shoulder is relaxed and carrying weight. Supraspinatus tears usually occurs at its insertion on the humeral head at the greater tubercle. Though the supraspinatus is the most commonly injured tendon in the rotator cuff, the other three can also be injured at the same time.

Acute tears
The amount of stress needed to acutely tear a rotator cuff tendon will depend on the underlying condition of the tendon. If healthy, the stress needed will be high, such as with a fall on the outstretched arm. This stress may occur coincidentally with other injuries such as a dislocation of the shoulder or separation of the acromioclavicular joint. In the case of a tendon with pre-existing degeneration, the force may be more modest, such as with a sudden lift, particularly with the arm above the horizontal position. The type of loading involved with injury is usually eccentric, such as when two people are carrying a load and one lets go, forcing the other to maintain force while the muscle elongates.

Chronic tears
Chronic tears are indicative of extended use in conjunction with other factors such as poor biomechanics or muscular imbalance. Ultimately, most are the result of wear that occurs slowly over time as a natural part of aging. They are more common in the dominant arm, but a tear in one shoulder signals an increased risk of a tear in the opposing shoulder.

Several factors contribute to degenerative, or chronic, rotator cuff tears of which repetitive stress is the most significant. This stress consists of repeating the same shoulder motions frequently, such as overhead throwing, rowing, and weightlifting. Many jobs that require frequent shoulder movement such as lifting and overhead movements also contribute. In older populations impairment of blood supply can also be an issue. With age, circulation to the rotator cuff tendons decreases, impairing natural ability to repair, increasing risk for tear. Another potential contributing cause is impingement syndrome, the most common non-sports related injury and which occurs when the tendons of the rotator cuff muscles become irritated and inflamed while passing through the subacromial space beneath the acromion. This relatively small space becomes even smaller when the arm is raised in a forward or upward position. Repetitive impingement can inflame the tendons and bursa, resulting in the syndrome.

Extrinsic factors
Well-documented anatomic factors include the morphologic characteristics of the acromion, a bony projection from the scapula that curves over the shoulder joint. Hooked, curved, and laterally sloping acromia are strongly associated with cuff tears and may cause damage through direct traction on the tendon. Conversely, flat acromia may have an insignificant involvement in cuff disease and consequently may be best treated conservatively. The development of these different acromial shapes is likely both genetic and acquired. In the latter case, there can be a progression from flat to curved or hooked with increasing age. Repetitive mechanical activities such as sports and exercise may contribute to flattening and hooking of the acromion. Cricket bowling, swimming, tennis, baseball, and kayaking are often implicated. Progression to a hooked acromion could be an adaptation to an already damaged, poorly balanced rotator cuff with resultant stress on the coracoacromial arch. Other anatomical factors include an os acromiale and acromial spurs. Environmental factors include age, shoulder overuse, smoking, and medical conditions that affect circulation or impair the inflammatory and healing response, such as diabetes mellitus.

Intrinsic factors
Intrinsic factors refer to injury mechanisms that occur within the rotator cuff itself. The principal is a degenerative-microtrauma model, which supposes that age-related tendon damage compounded by chronic microtrauma results in partial tendon tears that then develop into full rotator cuff tears. As a result of repetitive microtrauma in the setting of a degenerative rotator cuff tendon, inflammatory mediators alter the local environment and oxidative stress induces tenocyte apoptosis, causing further rotator cuff tendon degeneration. A neural theory also exists that suggests neural overstimulation leads to the recruitment of inflammatory cells and may also contribute to tendon degeneration.

Surgical considerations
Depending upon the diagnosis, several treatment alternatives are available. They include revision repair, non-anatomic repair, tendon transfer, and arthroplasty. When possible, surgeons make tension-free repairs in which they use grafted tissues rather than stitching to reconnect tendon segments. This can result in a complete repair. Other options are a partial repair, and reconstruction involving a bridge of biologic or synthetic substances. Partial repairs are typically performed on retracted cuff tears.

Tendon transfers are prescribed for young, active cuff-tear individuals who experience weakness and decreased range of motion, but little pain. The technique is not considered appropriate for older people or those with pre-operative stiffness or nerve injuries. People diagnosed with glenohumeral arthritis and rotator cuff anthropathy have the alternative of total shoulder arthroplasty, if the cuff is largely intact or repairable. If the cuff is incompetent, a reverse shoulder arthroplasty is available and, although not as robust a prosthesis, does not require an intact cuff to maintain a stable joint.

Diagnosis
Diagnosis is based upon physical assessment and history, including description of previous activities and acute or chronic symptoms. A systematic physical examination of the shoulder comprises inspection, palpation, range of motion, provocative tests to reproduce the symptoms, neurological examination, and strength testing. The shoulder should also be examined for tenderness and deformity. Since pain arising from the neck is frequently 'referred' to the shoulder, the examination should include an assessment of the cervical spine looking for evidence suggestive of a pinched nerve, osteoarthritis, or rheumatoid arthritis.

Neer promoted the concept of three stages of rotator cuff disease. Stage I, according to Neer, occurred in those younger than 25 years and involved edema and hemorrhage of the tendon and bursa. Stage II involved tendinitis and fibrosis of the rotator cuff in 25- to 40-year-olds. Stage III involved tearing of the rotator cuff (partial or full thickness) and occurred in those older than 40 years. For surgical purposes, tears are also described by location, size or area, and depth. Further subclasses include the acromiohumeral distance, acromial shape, fatty infiltration or degeneration of muscles, muscle atrophy, tendon retraction, vascular proliferation, chondroid metaplasia, and calcification. Again, in surgical planning, age-related degeneration of thinning and disorientation of the collagen fibers, myxoid degeneration, and hyaline degeneration are considered.

Diagnostic modalities, dependent on circumstances, include X-ray, MRI, MR arthrography, double-contrast arthrography, and ultrasound. Although MR arthrography is currently considered the gold standard, ultrasound may be most cost-effective. Usually, a tear will be undetected by X-ray, although bone spurs, which can impinge upon the rotator cuff tendons, may be visible. Such spurs suggest chronic severe rotator cuff disease. Double-contrast arthrography involves injecting contrast dye into the shoulder joint to detect leakage out of the injured rotator cuff, and its value is influenced by the experience of the operator. The most common diagnostic tool is magnetic resonance imaging (MRI), which can sometimes indicate the size of the tear, as well as its location within the tendon. Furthermore, MRI enables the detection or exclusion of complete rotator cuff tears with reasonable accuracy and is also suitable for diagnosing other pathologies of the shoulder joint.

The logical use of diagnostic tests is an important component of effective clinical practice.

Clinical judgement, rather than over-reliance on MRI or any other modality, is strongly advised in determining the cause of shoulder pain, or planning its treatment, since rotator cuff tears are also found in some without pain or symptoms. The role of X-ray, MRI, and ultrasound is adjunctive to clinical assessment and serves to confirm a diagnosis provisionally made by a thorough history and physical examination. Over-reliance on imaging may lead to overtreatment or distract from the true dysfunction causing symptoms.

Symptoms
Symptoms may occur immediately after trauma (acute) or develop over time (chronic).

Acute injury is less frequent than chronic disease, but may follow bouts of forcefully raising the arm against resistance, as occurs in weightlifting, for example. In addition, falling forcefully on the shoulder can cause acute symptoms. These traumatic tears predominantly affect the supraspinatus tendon or the rotator interval and symptoms include severe pain that radiates through the arm, and limited range of motion, specifically during abduction of the shoulder. Chronic tears occur among individuals who constantly participate in overhead activities, such as pitching or swimming, but can also develop from shoulder tendinitis or rotator cuff disease. Symptoms arising from chronic tears include sporadic worsening of pain, debilitation, and atrophy of the muscles; noticeable pain during rest; crackling sensations (crepitus) when moving the shoulder; and inability to move or lift the arm sufficiently, especially during abduction and flexion motions.

Pain in the anterolateral aspect of the shoulder is not specific to the shoulder, and may arise from, and be referred from, the neck, heart, or gut.

Symptoms will often include pain or ache over the front and outer aspect of the shoulder, pain aggravated by leaning on the elbow and pushing upward on the shoulder (such as leaning on the armrest of a reclining chair), intolerance of overhead activity, pain at night when lying directly on the affected shoulder, and pain when reaching forward (e.g., unable to lift a gallon of milk from the refrigerator). Weakness may be reported, but is often masked by pain and is usually found only through examination. With longer-standing pain, the shoulder is favored and gradually loss of motion and weakness may develop, which, due to pain and guarding, are often unrecognized and only brought to attention during the physical exam.

Primary shoulder problems may cause pain over the deltoid muscle intensified by abduction against resistance – the impingement sign. This signifies pain arising from the rotator cuff, but cannot distinguish among inflammation, strain, or tear. Individuals may report that they are unable to reach upward to brush their hair or to lift a can of food from an overhead shelf.

Signs
No single physical examination test distinguishes reliably between bursitis, partial-thickness, and full-thickness tears. The most useful single test for infraspinatous tendon tears is the drop sign (the examiner lifts the arm straight out from the body with the palm up, the person then needs to hold it there for 10 seconds) and the external rotation lag sign (with the arm by the side and the elbow bent to 90 degrees the person tries to rotate outwards against resistance).

A combination of tests seems to provide the most accurate diagnosis. For impingement, these tests include the Hawkins-Kennedy impingement sign, in which an examiner medially rotates the injured individual's flexed arm, forcing the supraspinatus tendon against the coracoacromial ligament and so producing pain if the test is positive, a positive painful arc sign, and weakness in external rotation with the arm at the side. Another common impingement test is the neer test. The neer test is performed by the examiner maximally forward flexing the patient's arm with the scapula in a depressed position. Localized pain on the anterior shoulder suggests subacromial impingement, whereas posterior shoulder pain suggests internal impingement. For the diagnosis of full-thickness rotator cuff tear, the best combination appears to include once more the painful arc and weakness in external rotation, and in addition, the drop arm sign. This test is also known as Codman's test. The arm is raised to the side to 90° by the examiner. The injured individual then attempts to lower the arm back to neutral with palm down. If the arm drops suddenly or pain is experienced, the test is considered positive.

MRI
Magnetic resonance imaging (MRI) and ultrasound are comparable in efficacy and helpful in diagnosis, although both have a false positive rate of 15–20%. MRI can reliably detect most full-thickness tears, although very small pinpoint tears may be missed. In such situations, an MRI combined with an injection of contrast material, an MR-arthrogram, may help to confirm the diagnosis. It should be realized that a normal MRI cannot fully rule out a small tear (a false negative) while partial-thickness tears are not as reliably detected. While MRI is sensitive in identifying tendon degeneration (tendinopathy), it may not reliably distinguish between a degenerative tendon and a partially torn tendon. Again, magnetic resonance arthrography can improve the differentiation. An overall sensitivity of 91% (9% false negative rate) has been reported, indicating that magnetic resonance arthrography is reliable in the detection of partial-thickness rotator cuff tears. However, its routine use is not advised, since it involves entering the joint with a needle, with the potential risk of infection. Consequently, the test is reserved for cases in which the diagnosis remains unclear.

Ultrasound
Musculoskeletal ultrasound has been advocated by experienced practitioners, avoiding the radiation of X-ray and the expense of MRI while demonstrating comparable accuracy to MRI for identifying and measuring the size of full-thickness and partial-thickness rotator cuff tears. This modality can also reveal the presence of other conditions that may mimic rotator cuff tear at clinical examination, including tendinosis, calcific tendinitis, subacromial subdeltoid bursitis, greater tuberosity fracture, and adhesive capsulitis. However, MRI provides more information about adjacent structures in the shoulder, such as the capsule, glenoid labrum muscles, and bone, and these factors should be considered in each case when selecting the appropriate study.

Xray
X-ray projectional radiography cannot directly reveal tears of the rotator cuff, a 'soft tissue', and consequently, normal X-rays cannot exclude a damaged cuff. However, indirect evidence of pathology may be seen in instances where one or more of the tendons has undergone degenerative calcification (calcific tendinitis). The humeral head may migrate upward (high-riding humeral head) secondary to tears of the infraspinatus, or combined tears of the supraspinatus and infraspinatus. The migration can be measured by the distance between: Normally, the former is positioned inferiorly to the latter, and a reversal therefore indicates a rotator cuff tear. Prolonged contact between a high-riding humeral head and the acromion above it may lead to X-ray findings of wear on the humeral head and acromion; secondary degenerative arthritis of the glenohumeral joint (the ball and socket joint of the shoulder), called cuff arthropathy, may follow. Incidental X-ray findings of bone spurs at the adjacent acromioclavicular joint may show a bone spur growing from the outer edge of the clavicle downward toward the rotator cuff. Spurs may also be seen on the underside of the acromion, once thought to cause direct fraying of the rotator cuff from contact friction, a concept currently regarded as controversial.
 * A line crossing the center of a line between the superior and inferior rims of the glenoid articular surface (blue in image).
 * The center of a "best-fit" circle positioned over the humeral articular surface (green in image)

In-office testing
As part of clinical decision-making, a simple, minimally invasive, in-office procedure, the rotator cuff impingement test, may be performed. A small amount of a local anesthetic and an injectable corticosteroid are injected into the subacromial space to block pain and provide anti-inflammatory relief. If pain disappears and shoulder function remains good, no further testing is pursued. The test helps to confirm that the pain arises primarily from the shoulder, rather than being referred from the neck, heart, or gut.

If pain is relieved, the test is considered positive for rotator-cuff impingement, of which tendinitis and bursitis are major causes. However, partial rotator-cuff tears may also demonstrate good pain relief, so a positive response cannot rule out a partial rotator-cuff tear. However, with demonstration of good, pain-free function, the treatment will not change, so the test is useful in helping to avoid overtesting or performing unnecessary surgery.

Classification
Tears of the rotator cuff tendon are described as partial or full thickness, and full thickness with complete detachment of the tendons from bone.
 * Partial-thickness tears often appear as fraying of an intact tendon.
 * Full-thickness tears are "through-and-through". These tears can be small pinpoint or larger buttonhole, or involve the majority of the tendon where it still remains substantially attached to the humeral head and thus maintains function.
 * Full-thickness tears may also involve complete detachment of the tendon(s) from the humeral head and may result in significantly impaired shoulder motion and function.

Shoulder pain is variable and may not be proportional to the size of the tear.

Tears are also sometimes classified based on the trauma that caused the injury:
 * Acute, as a result of a sudden, powerful movement which might include falling onto an outstretched hand at speed, making a sudden thrust with a paddle in kayaking, or following a powerful pitch/throw
 * Subacute, arising in similar situations but occurring in one of the five layers of the shoulder anatomy
 * Chronic, developing over time, and usually occurring at or near the tendon (as a result of the tendon rubbing against the overlying bone), and usually associated with an impingement syndrome.

Prevention
Long-term overuse/abuse of the shoulder joint is generally thought to limit range of motion and productivity due to daily wear and tear of the muscles, and many public web sites offer preventive advice. (See external links) The recommendations usually include:
 * regular shoulder exercises to maintain strength and flexibility
 * using proper form when lifting or moving heavy weights
 * resting the shoulder when experiencing pain
 * application of cold packs and heat pads to a painful, inflamed shoulder
 * strengthening program to include the back and shoulder girdle muscles as well as the chest, shoulder and upper arm
 * adequate rest periods in occupations that require repetitive lifting and reaching

Size
According to a study which measured tendon length against the size of the injured rotator cuff, researchers learned that as rotator cuff tendons decrease in length, the average rotator cuff tear severity is proportionally decreased, as well. This shows that larger individuals are more likely to develop a severe rotator cuff tear if they do not "tighten the shoulder muscles around the joint".

Position
Another study observed 12 different positions of movements and their relative correlation with injuries occurred during those movements. The evidence shows that putting the arm in a neutral position relieves tension on all ligaments and tendons.

Stretching
One article observed the influence of stretching techniques on preventive methods of shoulder injuries. Increased velocity of exercise increases injury, but beginning a fast-movement exercise with a slow stretch may cause muscle/tendon attachment to become more resistant to tearing.

Muscle groups
When exercising, exercising the shoulder as a whole and not one or two muscle groups is also found to be imperative. When the shoulder muscle is exercised in all directions, such as external rotation, flexion, and extension, or vertical abduction, it is less likely to develop a tear of the tendon.

Treatment
A rotator cuff tear can be treated operatively or non-operatively. No benefit is seen from early rather than delayed surgery, and many with partial tears and some with complete tears will respond to nonoperative management. Consequently, an individual may begin with nonsurgical management. However, early surgical treatment may be considered in significant (>1 cm – 1.5 cm) acute tears, in young individuals with full-thickness tears who have a significant risk for the development of irreparable rotator cuff damage, or the patient is very active and/or uses their arms for overhead work or sports.

Rotator-cuff surgery appears to result in similar benefits as nonoperative management. As a conservative approach has less complications and is less expensive it is recommended as initial treatment.

Non-operative treatment
Those with pain but reasonably maintained function are suitable for nonoperative management. This includes medications that provide pain relief such as anti-inflammatory agents, topical pain relievers such as cold packs, and if warranted, subacromial corticosteroid or local anesthetic injection. Topical glyceryl trinitrate appears effective at relieving acute symptoms however, headaches were reported as a side effect. A sling may be offered for short-term comfort, with the understanding that undesirable shoulder stiffness can develop with prolonged immobilization. Early physical therapy may afford pain relief with modalities (e.g. iontophoresis) and help to maintain motion. Ultrasound treatment is not efficacious. As pain decreases, strength deficiencies and biomechanical errors can be corrected.

Shock wave therapy has seen widespread use since the 1990s to treat various musculoskeletal disorders including rotator cuff disease, but evidence of its efficacy remains dubious. In a review of 2020, the benefits and harms of shock wave therapy for rotator cuff disease, with or without calcificationcurrently, were investigated. They found low to moderate certainty evidence, that there were very few clinically important benefits of shock wave therapy, and uncertainty regarding its safety.

A conservative physical therapy program begins with preliminary rest and restriction from engaging in activities which gave rise to symptoms. Normally, inflammation can usually be controlled within one to two weeks, using a nonsteroidal anti-inflammatory drug and subacromial steroid injections to decrease inflammation, to the point that pain has been significantly decreased to make stretching tolerable. After this short period, rapid stiffening and an increase in pain can result if sufficient stretching has not been implemented.

A gentle, passive range-of-motion program should be started to help prevent stiffness and maintain range of motion during this resting period. Stiffness negatively affects the tendon-bone healing process, a critical part of recovery. Stiffness during rehabilitation is related to worse clinical outcomes, so it is important for the patient to understand the importance of a proactive regimen. Strain induced tendon remodeling, which is part of an accelerated rehabilitation protocol, has been shown to speed up the time to return to daily activities. Exercises, for the anterior, inferior, and posterior shoulder, should be part of this program. Codman exercises (giant, pudding-stirring), to "permit the patient to abduct the arm by gravity, the supraspinatus remains relaxed, and no fulcrum is required" are widely used. The use of NSAIDs, hot and cold packs, and physical therapy modalities, such as ultrasound, phonophoresis, or iontophoresis, can be instituted during this stretching period, if effective. Corticosteroid injections are recommended two to three months apart with a maximum of three injections. Multiple injections (four or more) have been shown to compromise the results of rotator cuff surgery which result in weakening of the tendon. Kinesio taping was compared to sham taping and other conservative treatment for the approach of the rotator cuff disease and has uncertain effects in terms of self‐reported pain, function, pain on motion and active range of motion.

Rockwood coined the term orthotherapy to describe the program which is aimed at creating an exercise regimen that initially gently improves motion, then gradually improves strength in the shoulder girdle. This program involves a home therapy kit which includes elastic bands of six different colors and strengths, a pulley set, and a three-piece, one-meter-long stick. The program is individually customized. Participants are asked to use their exercise program whether at home, work, or traveling.

Surgery
Benefits of surgery are unclear as of 2019. Several instances when surgery may be recommended include:
 * 20 to 30-year-old active person with an acute tear and severe functional deficit from a specific event
 * 30 to 50-year-old person with an acute rotator cuff tear secondary to a specific event
 * a highly competitive athlete who is primarily involved in overhead or throwing sports

These individuals more often benefit from operative treatment because they are willing to tolerate the risks of surgery to return to their preoperative level of function, and have higher likelihood of a successful outcome. Those who do not respond to, or are unsatisfied with, conservative treatment can seek a surgical opinion.

The three general surgical approaches are arthroscopic, mini open, and open-surgical repair. In the past, small tears were treated arthroscopically, while larger tears would usually require an open procedure. Advances in arthroscopy now allow arthroscopic repair of even the largest tears, and arthroscopic techniques are now required to mobilize many retracted tears. The results match open surgical techniques, while permitting a more thorough evaluation of the shoulder at time of surgery, increasing the diagnostic value of the procedure, as other conditions may simultaneously cause shoulder pain. Arthroscopic surgery also allows for shorter recovery time although differences in postoperative pain or pain medication use are not seen between arthroscopic- and open-surgery. A 2019 review found that the evidence does not support decompression surgery in those with more than 3 months of shoulder pain without a history of trauma.

Even for full-thickness rotator cuff tears, conservative care (i.e., nonsurgical treatment) outcomes are usually reasonably good.

If a significant bone spur is present, any of the approaches may include an acromioplasty, a subacromial decompression, as part of the procedure. Subacromial decompression, removal of a small portion of the acromion that overlies the rotator cuff, aims to relieve pressure on the rotator cuff in certain conditions and promote healing and recovery. Although subacromial decompression may be beneficial in the management of partial and full-thickness tear repair, it does not repair the tear itself and arthroscopic decompression has more recently been combined with "mini-open" repair of the rotator cuff, allowing for the repair of the cuff without disruption of the deltoid origin. The results of decompression alone tend to degrade with time, but the combination of repair and decompression appears to be more enduring. Subacromial decompression may not improve pain, function, or quality of life.

Repair of a complete, full-thickness tear involves tissue suture. The method currently in favor is to place an anchor in the bone at the natural attachment site, with resuture of torn tendon to the anchor. If tissue quality is poor, mesh (collagen, Artelon, or other degradable material) may be used to reinforce the repair. Repair can be performed through an open incision, again requiring detachment of a portion of the deltoid, while a mini-open technique approaches the tear through a deltoid-splitting approach. The latter may cause less injury to muscle and produce better results. Contemporary techniques now use an all arthroscopic approach. Recovery can take as long as three–six months, with a sling being worn for the first one–six weeks. In the case of partial thickness tears, if surgery is undertaken, tear completion (converting the partial tear to a full tear) and then repair, is associated with better early outcomes than transtendinous repairs (where the intact fibres are preserved) and no difference in failure rates.

Biceps tenotomy and tenodesis are often performed concomitantly with rotator cuff repair or as separate procedures, and can also cause shoulder pain. Tenodesis, which may be performed as an arthroscopic or open procedure, generally restores pain free motion it the biceps tendon, or attached portion of the labrum, but can cause pain. Tenotomy is a shorter surgery requiring less rehabilitation, that is more often performed in older patients, though after surgery there can be a cosmetic 'popeye sign' visible in thin arms.

In a small minority of cases where extensive arthritis has developed, an option is shoulder joint replacement (arthroplasty). Specifically, this is a reverse shoulder replacement, a more constrained form of shoulder arthroplasty that allows the shoulder to function well even in the presence of large full thickness rotator cuff tears.

Shoulder Replacement
The latest systematic reviews suggests (with low quality evidence) that total shoulder arthroplasty does not provide important benefits over hemiarthroplasty for glenohumeral osteoarthritis and rotator cuff tears. It highlighted the current lack of high-quality evidence and need for randomized controlled trials.

Biologics
The main goal in biological augmentation is to enhance healing. There are a number of potential options. These include injecting an individual's own stem cells, growth factors or platelet rich plasma (PRP) into the repair site, and installing scaffolds as biological or synthetic supports to maintain tissue contour. A 2014 Cochrane review evaluated PRP and found insufficient evidence to make recommendations. Mesenchymal stem cells have no convincing evidence for their use overall, with quality human trials lacking. The greater tuberosity can also be microfractured to create a small blood clot just lateral to the repair site.

Rehabilitation
Rehabilitation after surgery consists of three stages. First, the arm is immobilized so that the muscle can heal. Second, when appropriate, a therapist assists with passive exercises to regain range of motion. Third, the arm is gradually exercised actively, with a goal of regaining and enhancing strength. The empty can and full can exercises are amongst the most effective at isolating and strengthening the supraspinatus.

Following arthroscopic rotator-cuff repair surgery, individuals need rehabilitation and physical therapy. Exercise decreases shoulder pain, strengthens the joint, and improves range of motion. Therapists, in conjunction with the surgeon, design exercise regimens specific to the individual and their injury.

Traditionally, after injury the shoulder is immobilized for six weeks before rehabilitation. However, the appropriate timing and intensity of therapy are subject to debate. Most surgeons advocate using the sling for at least six weeks, though others advocate early, aggressive rehabilitation. The latter group favors the use of passive motion, which allows an individual to move the shoulder without physical effort. Alternatively, some authorities argue that therapy should be started later and carried out more cautiously. Theoretically, that gives tissues time to heal; though there is conflicting data regarding the benefits of early immobilization. A study of rats suggested that it improved the strength of surgical repairs, while research on rabbits produced contrary evidence. Individuals with a history of rotator cuff injury, particularly those recovering from tears, are prone to re-injury. Rehabbing too soon or too strenuously might increase the risk of retear or failure to heal. However, no research has proven a link between early therapy and the incidence of re-tears. In some studies, those who received earlier and more aggressive therapy reported reduced shoulder pain, less stiffness and better range of motion. Other research has shown that accelerated rehab results in better shoulder function.

There is consensus amongst orthopedic surgeons and physical therapists regarding rotator cuff repair rehabilitation protocols. The timing and duration of treatments and exercises are based on biologic and biomedical factors involving the rotator cuff. For approximately two to three weeks following surgery, an individual experiences shoulder pain and swelling; no major therapeutic measures are instituted in this window other than oral pain medicine and ice. Those at risk of failure should usually be more conservative with rehabilitations.

That is followed by the "proliferative" and "maturation and remodeling" phases of healing, which ensues for the following six to ten weeks. The effect of active or passive motion during any of the phases is unclear, due to conflicting information and a shortage of clinical evidence. Gentle physical therapy guided motion is instituted at this phase, only to prevent stiffness of the shoulder; the rotator cuff remains fragile. At three months after surgery, physical therapy intervention changes substantially to focus on scapular mobilization and stretching of the glenohumeral joint. Once full passive motion is regained (at usually about four to four and a half months after surgery) strengthening exercises are the focus. The strengthening focuses on the rotator cuff and the upper back/scapular stabilizers. Typically at about six months after surgery, most have made a majority of their expected gains.

The objective in repairing a rotator cuff is to enable an individual to regain full function. Surgeons and therapists analyze outcomes in several ways. Based on examinations, they compile scores on tests; some examples are those created by the University of California at Los Angeles and the American Shoulder and Elbow Surgeons. Other outcome measures include the Constant score; the Simple Shoulder Test; and the Disabilities of the Arm, Shoulder and Hand score. The tests assess range of motion and the degree of shoulder function.

Due to the conflicting information about the relative benefits of rehab conducted early or later, an individualized approach is necessary. The timing and nature of therapeutic activities are adjusted according to age and tissue integrity of the repair. Management is more complex in those who have had multiple tears.

Prognosis
While people with rotator cuff tears may not have any noticeable symptoms, studies have shown that, those with age related tears, over time 40% will have enlargement of the tear over a five-year period. Of those whose tears enlarge, 20% have no symptoms while 80% eventually develop symptoms.

Most usually regain function and experience less pain following surgery. For some, however, the joint continues to hurt. Weakness and a limited range of motion also may persist. Those who report such symptoms frequently are diagnosed with failed rotator cuff syndrome. There is no irrefutable evidence that rotator cuff surgery benefits more than non-surgical management and a percentage of individuals never regain full range of motion after surgery.

Arthroscopic procedures produce "satisfactory results" more than 90 percent of the time. However, 6-8 percent of patients have "incompetent" rotator cuffs because their repaired tendons either fail to heal or develop additional tears. In some cases, persistent rotator cuff type pain after surgery can be due to disease elsewhere. For example, cervical spine disease and can involve neck pain radiating into the shoulder. Suprascapular neuropathy, shoulder impingement, superior labral anterior-posterior (SLAP) tears and arthritis can all mimic rotator cuff disease and cause persistent pain that does not respond to rotator cuff surgery.

One possible long-term consequence result of a rotator cuff tear is called proximal humeral head migration, this is where the "ball" of the shoulder joint rests higher in the shoulder joint "socket" disrupting normal shoulder mechanics. Only tear size is an independent predictor of humeral migration. Tears extending into the infraspinatus tendon are associated with greater humeral migration than is seen with isolated supraspinatus tears.

Epidemiology
Rotator cuff tears are among the most common conditions affecting the shoulder.

A rotator cuff tear can be caused by the weakening of the rotator cuff tendons. This weakening can be caused by age or how often the rotator cuff is used. Adults over the age of 60 are more susceptible to a rotator cuff tear, with the overall frequency of tears increasing with age. By the age of 50 10% of people with normal shoulders have a rotator cuff tear.

In an autopsy study of rotator cuff tears, the incidence of partial tears was 28%, and of complete rupture 30%. Frequently, tears occurred on both sides and occurred more often with females and with increasing age. Other cadaver studies have noted intratendinous tears to be more frequent (7.2%) than bursal-sided (2.4%) or articular-sided tears (3.6%). However, clinically, articular-sided tears are found to be 2 to 3 times more common than bursal-sided tears and among a population of young athletes, articular-sided tears constituted 91% of all partial-thickness tears. Rotator cuff tears may be more common in men between the ages of 50–60, though between 70 and 80 there is minimal difference across genders.

In terms of the size of tears, a study compared the ages of patient to the size of tears. It was emphasized the older you are, the more massive of a tear you will have. It was found that mean age increased with larger tear sizes (small tears 59 years, medium tears 62 years, large tears 64 years, and massive tears 66 years).

title: Rotator cuff tear