Rotator cuff injuries represent a significant source of shoulder pain and disability, affecting millions of individuals worldwide. The rotator cuff is a group of four muscles and tendons that stabilize the shoulder joint and enable a wide range of arm movements. Injuries to this crucial structure can range from tendinitis and bursitis to partial or complete tears of the tendons. These injuries are often associated with repetitive overhead activities, heavy lifting, or traumatic events such as falls or sports injuries. As a result, rotator cuff injuries are particularly prevalent among athletes, laborers and the elderly, although they can affect individuals of any age or occupation [1-5].     

Globally, the incidence of rotator cuff injuries is on the rise, driven by an aging population, increased participation in sports and occupational hazards. In India, particularly in rural and semi-urban regions like District Kangra in Himachal Pradesh, awareness and understanding of rotator cuff injuries remain limited. The population in this area is engaged in a variety of physically demanding occupations, such as agriculture, construction and manual labor, which can increase the risk of shoulder injuries. Additionally, limited access to healthcare and specialized orthopedic services may contribute to delayed diagnosis and inadequate management of these injuries, leading to chronic pain and disability [6-9].

Despite the significant impact that rotator cuff injuries can have on individuals' quality of life, public awareness and knowledge of these injuries are often lacking. Early recognition of symptoms, such as shoulder pain, weakness and limited range of motion, is crucial for prompt treatment and rehabilitation. Without proper understanding, individuals may delay seeking medical attention, exacerbating the injury and leading to more complex treatment needs. Moreover, preventive measures, including proper lifting techniques, strengthening exercises and ergonomic adjustments, are often underutilized due to a lack of awareness [10-12].

In District Kangra, where traditional lifestyles and physically demanding jobs are common, understanding the public's knowledge of rotator cuff injuries is essential for developing effective health strategies. This study aims to assess the awareness and knowledge of rotator cuff injuries among adults in District Kangra, Himachal Pradesh. By identifying gaps in understanding, this research seeks to inform public health interventions that can enhance injury prevention, promote early diagnosis and improve treatment outcomes.

Objectives of the Study

The primary objective is to gauge awareness and knowledge about Rotator Cuff Injuries among general public of District Kangra, Himachal Pradesh.

• Research Approach: Descriptive

• Research Design: Cross-sectional survey design

• Study Area: District Kangra, Himachal Pradesh

• Study Duration: Between January 2024 to May 2024

• Study Population: The study's target population encompassed all adults aged 18 and above who had been residents of District Kangra Himachal Pradesh for a minimum of 12 months

• Sample Size: A robust sample size of 400 adults was determined using a 95% confidence level, an estimated knowledge level of 50% regarding Rotator Cuff Injuries, a precise 5% absolute error margin and a conservative 5% non-response rate

• Study Tool: A google form questionnaire consisting of questions regarding socio-demography and knowledge regarding Rotator Cuff Injuries was created. The questionnaire was initially pre-tested on a small number of participants to identify any difficulty in understanding by the respondents

Description of Tool

• Demographic Data Survey Instrument: The demographic form elicited information on participants’ background: age, gender, marital status, religion, employment, education and many more

• Questionnaire: The questionnaire contains 20 structured knowledge related questions regarding Rotator Cuff Injuries. One mark was given for each correct answer and zero for incorrect answer. The maximum score was 20 and minimum score was zero. Scoring was done on the basis of marks as >80% (16-20) = very good, 60-79% (12-15) = Good, 41-59% (8-11) = Fair, <40% (<8) = poor

• Validity of Tool: by the experts in this field

• Data Collection: Data was collected under the guidance of supervisors. The google form questionnaire was circulated among the residents of District Kangra Himachal Pradesh for responses using online modes like e-mail and social media platforms like Whatsapp groups, Facebook, Instagram and Linkedin till the 400 responses were collected

• Data Analysis: Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analyzed with Epi Info V7 Software with appropriate statistical test in terms of frequencies and percentage. 

• Ethical Considerations: Participants confidentiality and anonymity was maintained

The study conducted on 400 participants from District Kangra, Himachal Pradesh, provides valuable insights into the socio-demographic characteristics and knowledge levels regarding rotator cuff injuries. The socio-demographic data, as presented in Table 1, reveals a fairly balanced distribution of participants across different age groups, with 30.0% aged between 18-30 years, 25.8% aged 31-40 years, 22.8% aged 41-50 years and 21.5% aged above 50 years. Gender distribution was slightly tilted towards females, with 51.8% of participants being female and 48.3% being male. Regarding marital status, the majority of the participants were married (57.0%), while 39.8% were single and 3.3% fell into the "others" category. 

In terms of religion, the majority of the participants were Hindu (83.0%), followed by Sikhs (7.8%), Muslims (6.8%) and others (2.5%). The employment status of the participants indicated that 49.5% were employed, 26.5% were unemployed and 24.0% were students. Educational attainment varied, with 34.8% of participants being graduates, 26.8% having completed high school, 25.3% holding postgraduate or higher degrees and 13.3% having education below high school.

Table 1: Socio-Demographic Characteristics of Study Participants (N = 400)

Table 2 explores participants' knowledge regarding the symptoms of rotator cuff injuries. A notable 79.3% of participants had heard of rotator cuff injuries, demonstrating a reasonable level of general awareness. Specifically, 72.0% knew that rotator cuff injuries could cause shoulder pain and 69.0% were aware that these injuries could result in arm weakness. Additionally, 66.3% of participants recognized that rotator cuff injuries could limit shoulder movement and 64.5% knew that they could cause difficulty in lifting the arm. These findings suggest that while there is a general awareness of rotator cuff injuries, the understanding of specific symptoms could be improved.

Table 2: Knowledge Regarding Symptoms of Rotator Cuff Injuries (N = 400)

Table 3 focuses on participants' knowledge of the causes and risk factors associated with rotator cuff injuries. The results indicate moderate awareness, with 60.5% of participants understanding that repetitive overhead movements could lead to these injuries. Additionally, 58.8% recognized that aging increases the risk and 57.5% were aware that previous shoulder injuries could contribute to rotator cuff injuries. Furthermore, 55.3% of participants knew that heavy lifting could be a contributing factor and 53.5% acknowledged that certain sports are associated with a higher risk of rotator cuff injuries. These findings highlight the need for increased public education on the various risk factors associated with these injuries.

Table 3: Knowledge Regarding Causes and Risk Factors of Rotator Cuff Injuries (N = 400)

Table 4 presents participants' knowledge regarding the prevention of rotator cuff injuries. Awareness of preventive measures was relatively low, with only 53.0% of participants knowing that proper warm-up exercises could help prevent these injuries. Similarly, 51.8% recognized that strengthening shoulder muscles could serve as a preventive measure, while 50.8% understood that avoiding repetitive overhead movements could also help. Awareness of proper lifting techniques was noted by 48.8% of participants and only 45.5% knew that regular stretching could maintain shoulder flexibility. These results suggest that there is a significant need for public health initiatives focused on educating the population about effective prevention strategies for rotator cuff injuries.

Table 4: Knowledge Regarding Prevention of Rotator Cuff Injuries (N = 400)

Table 5 delves into participants' knowledge regarding the treatment and management of rotator cuff injuries. Less than half of the participants (47.3%) were aware that rest and ice could help manage the condition. Similarly, 45.0% knew that physical therapy could aid in recovery and 43.0% understood that specific exercises could strengthen the shoulder and manage symptoms. Awareness of over-the-counter pain relievers as a treatment option was noted by 40.5% of participants, while only 38.0% recognized that surgical intervention might be necessary in severe cases. These findings highlight a gap in knowledge regarding the various treatment options available for managing rotator cuff injuries.

Table 5: Knowledge Regarding Treatment and Management of Rotator Cuff Injuries (N = 400)

Finally, Table 6 categorizes participants' overall knowledge scores regarding rotator cuff injuries. The results show that 25.3% of participants demonstrated very good knowledge, scoring between 16-20 points. A slightly larger proportion (29.5%) had good knowledge, scoring between 12-15 points. However, a significant portion of the population had fair knowledge (27.0%, scoring between 8-11 points) and 18.3% of participants fell into the poor knowledge category, scoring below 8 points. This distribution underscores the variability in knowledge levels among the population and highlights the need for targeted educational interventions to bridge the knowledge gaps regarding rotator cuff injuries.

Table 6: Overall Knowledge Score Categories for Rotator Cuff Injuries (N = 400)

This study provides a comprehensive assessment of the public's awareness and knowledge regarding rotator cuff injuries among residents of District Kangra, Himachal Pradesh. The findings highlight both the strengths and gaps in understanding that exist within this population, offering important insights for public health interventions aimed at improving prevention, diagnosis and management of rotator cuff injuries.

The socio-demographic profile of the study participants reveals a balanced representation across various age groups, genders and educational levels, ensuring that the findings are reflective of the broader population in District Kangra. The slight female majority (51.8%) and the distribution across age groups, particularly with 30.0% of participants aged 18-30 and 25.8% aged 31-40, underscore the relevance of these findings across different life stages. The significant proportion of participants who are employed (49.5%) or students (24.0%) further emphasizes the importance of addressing rotator cuff injuries, as these groups are likely to be engaged in physically demanding activities that could increase their risk of injury. Educational attainment varied, with a notable 34.8% of participants being graduates, which suggests a reasonable baseline for health literacy. However, despite this educational background, gaps in specific knowledge areas about rotator cuff injuries remain evident, indicating that targeted educational interventions are necessary [3-5].

The study reveals a relatively high level of general awareness regarding rotator cuff injuries, with 79.3% of participants having heard of the condition. This suggests that rotator cuff injuries are recognized as a significant health issue within the community. However, when delving into specific symptoms, the knowledge appears more variable. While 72.0% of participants were aware that rotator cuff injuries could cause shoulder pain, fewer participants recognized other key symptoms, such as arm weakness (69.0%) and limited shoulder movement (66.3%). The fact that only 64.5% of participants were aware that rotator cuff injuries could cause difficulty in lifting the arm is concerning, as this is one of the most common and debilitating symptoms. These findings highlight the need for public health campaigns to emphasize the full range of symptoms associated with rotator cuff injuries, as early recognition of these symptoms is crucial for prompt treatment and rehabilitation [6-9].

The study also explores participants' knowledge of the causes and risk factors associated with rotator cuff injuries. The findings reveal a moderate level of awareness, with 60.5% of participants understanding that repetitive overhead movements could lead to these injuries. However, knowledge of other significant risk factors, such as aging (58.8%), previous shoulder injuries (57.5%) and heavy lifting (55.3%), was slightly lower. Notably, only 53.5% of participants were aware that certain sports are associated with a higher risk of rotator cuff injuries. This gap in understanding is concerning, particularly in a region like District Kangra, where many individuals are engaged in physically demanding occupations that could contribute to these risk factors. These results suggest a need for targeted education that highlights the role of both modifiable and non-modifiable risk factors in the development of rotator cuff injuries. By improving awareness of these risk factors, individuals may be more likely to adopt preventive measures and seek early intervention if symptoms arise [10-12].

One of the most significant findings of this study is the relatively low level of knowledge regarding the prevention of rotator cuff injuries. While just over half of the participants (53.0%) recognized that proper warm-up exercises could help prevent these injuries, awareness of other preventive measures was notably lower. For example, only 51.8% of participants were aware that strengthening shoulder muscles could be beneficial and even fewer participants knew about the importance of avoiding repetitive overhead movements (50.8%) or using proper lifting techniques (48.8%). The lowest awareness was related to regular stretching, known by only 45.5% of participants. These findings underscore the need for public health initiatives to focus on educating the population about practical strategies for preventing rotator cuff injuries. This could include promoting regular physical activity, ergonomic practices and proper body mechanics in both occupational and recreational settings [7-10].

The study also highlights significant gaps in knowledge regarding the treatment and management of rotator cuff injuries. Less than half of the participants were aware that rest and ice (47.3%) and physical therapy (45.0%) could help manage symptoms. Even fewer participants knew about the benefits of specific exercises targeting the shoulder (43.0%) or the use of over-the-counter pain relievers (40.5%) to alleviate symptoms. The lowest awareness was related to surgical intervention, with only 38.0% of participants recognizing that it might be necessary in severe cases. This lack of knowledge about available treatment options could lead to inadequate self-management and delayed care, resulting in worse outcomes for individuals with rotator cuff injuries. These findings highlight the need for improved communication between healthcare providers and patients, ensuring that individuals are fully informed about their treatment options and the importance of early and ongoing management of the condition [9-12].

The overall knowledge scores of participants demonstrate a wide distribution, with 25.3% of participants exhibiting very good knowledge and 29.5% showing good knowledge. However, a significant portion of the population still falls into the fair (27.0%) and poor (18.3%) knowledge categories. This variability indicates that while some individuals have a strong understanding of rotator cuff injuries, a considerable percentage of the population still lacks adequate knowledge. This disparity underscores the importance of targeted educational interventions that address specific gaps in knowledge, particularly among those with lower overall awareness. Ensuring that all segments of the population are well-informed is crucial for preventing and managing rotator cuff injuries effectively [7-12].

The findings of this study have important implications for public health strategies in District Kangra and similar rural regions. There is a clear need for comprehensive educational campaigns that address both general awareness and specific knowledge gaps related to rotator cuff injuries. Public health initiatives should prioritize the dissemination of information on modifiable risk factors, prevention strategies and treatment options, with a focus on practical, actionable advice that can be easily implemented by the general public. Additionally, healthcare providers in the region should be equipped with the tools and resources to educate their patients about rotator cuff injuries, emphasizing early diagnosis and effective management. Community-based interventions, such as workshops, health camps and workplace ergonomic assessments, could be effective in raising awareness and promoting healthy practices that prevent and manage rotator cuff injuries.

In conclusion, this study highlights the existing gaps in public awareness and knowledge regarding rotator cuff injuries among the residents of District Kangra, Himachal Pradesh. While there is a foundational awareness of the condition, particularly concerning its general symptoms, significant deficiencies remain in understanding the specific risk factors, preventive measures and treatment options. These gaps underscore the urgent need for targeted educational interventions to enhance public knowledge and promote early diagnosis and effective management of rotator cuff injuries. By addressing these knowledge deficits through comprehensive public health campaigns and better healthcare communication, we can improve the overall quality of life for individuals at risk of or suffering from rotator cuff injuries.

Such efforts are essential not only for preventing chronic pain and disability but also for empowering individuals to take proactive steps in maintaining their shoulder health, thereby reducing the long-term burden on healthcare systems.

1. Gowda, C.S. et al. “Rotator cuff tears: Correlation between clinical examination, magnetic resonance imaging and arthroscopy.” Cureus, vol. 16, no. 3, March 2024, article e56065.

2. Alqasim, A.K.A. et al. “Awareness and knowledge of rotator cuff injury and its risk factor among the general population in Saudi Arabia.” International Journal of Medicine in Developing Countries, vol. 7, no. 9, 2023, pp. 1240–1246.

3. Bangalore Shoulder Institute. “Types of rotator cuff tears.” Bangalore Shoulder Institute, https://bangaloreshoulderinstitute.com/types-rotator-cuff-tears/. Accessed 2024.

4. Ortho Bangalore. “Rotator cuff tear.” Ortho Bangalore, https://www.orthobangalore.com/rotator-cuff-tear. Accessed 2024.

5. Max Healthcare. “Rotator cuff tear: Conditions & treatments.” Max Healthcare, https://www.maxhealthcare.in/our-specialities/orthopaedics/conditions-treatments/rotator-cuff-tear. Accessed 2024.

6. Salibi, G. “Addressing the burden of rotator cuff tears in India: Current practices, challenges and opportunities for improved diagnosis and management in healthcare and service.” Special Journal of the Medical Academy and Other Life Sciences, vol. 2, no. 6, July 2024.

7. Jain, N.B. et al. “Does my patient with shoulder pain have a rotator cuff tear? A predictive model from the ROW cohort.” Orthopaedic Journal of Sports Medicine, vol. 6, no. 7, 2018.

8. Fares, A.B. et al. “Arthroscopic repair of traumatic rotator cuff tears in patients 70 years and older.” Orthopaedic Journal of Sports Medicine, vol. 10, no. 11, November 2022.

9. Devarasetty, V.V.N.M. et al. “Public Perceptions of Rotator Cuff Tears.” Clinics and Practice, vol. 14, no. 3, April 2024, pp. 729–738.

10. Maravi, P. et al. “Role of high-frequency USG in rotator cuff injury and its comparison with MRI.” International Journal of Medical Research Review, vol. 8, no. 6, December 2020, pp. 440–445.

11. Zhang, X. et al. “Clinical perspectives for repairing rotator cuff injuries with multi-tissue regenerative approaches.” Journal of Orthopaedic Translation, vol. 36, August 2022, pp. 91–108.

12. Prabhakar, A. et al. “Current concepts on management of cuff tear.” Journal of Clinical Orthopaedics and Trauma, vol. 28, February 2022, article 101808.