Saturday, December 6, 2014

Many rotator cuff tears are a function of aging - how do you treat that?

A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age

These authors reviewed the published literature to establish the prevalence of abnormalities of the rotator cuff and to determine if the prevalence of abnormalities increases with advancing age.  Their search terms included cuff degeneration, tear, disruption, perforation, pathologic change, defect, lesion, or abnormality. They assessed the prevalence of cuff tear abilities in 4 groups: (1) asymptomatic patients, (2) general population (including cadavers), (3) symptomatic patients, and (4) patients after shoulder dislocation.Thirty studies including 6112 shoulders met their criteria.

The prevalence of abnormalities increased with age for each of the groups.

Comment:  A key comment in this article is that "Atraumatic rotator cuff defects are commonly referred to as tears, but if rotator cuff thinning is part of the normal aging process, the word tear which implies damage in need of repair may be inappropriate." We have previously posted on  cuff tear versus cuff wear.

The authors conclude that the prevalence of rotator cuff abnormalities in asymptomatic people is high enough for rotator cuff tendon failure to be considered a common aspect of normal human aging and not necessarily an indication for surgery. These results also point to the increasing frailty of the cuff with age, a characteristic that is not changed by rotator cuff repair surgery.

Against this background, it is important to consider the relative advantages and disadvantages of  non-opeartive, non-repair surgery and surgical repair attempt for each patient found to have a cuff tendon defect.

Our approach to the rotator cuff is summarized here


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