Friday, August 7, 2015

Rotator cuff tears in young patients are different from those in elderly patients.

Rotator cuff tears in young patients: a different disease than rotator cuff tears in elderly patients.

These authors conducted a systematic search for clinical studies evaluating rotator cuff tears in patients younger than 40 years. 12 Level IV studies (336 patients) were included. The mean age of the patients was 28 years (range, 16-40 years), with a mean follow-up of 39 months. There were 2 distinct subgroups. The majority of studies (7 of 10) showed that patients typically had a full-thickness tear with an acute traumatic etiology. However, within the subgroup of elite throwers, 5 of 6 studies demonstrated a majority of tears that were partial thickness stemming from chronic overuse. Rotator cuff repair improved pain and strength in almost all studies reporting on these parameters. Eighty-seven percent of patients reported they were satisfied. However, all studies examining elite throwers showed significant difficulty in returning to play (25%-97%).

Comment: The results of this study can be anticipated from a few basic observations. 
*The incidence of cuff tears increases with age. 
*Young shoulders are used more vigorously than older shoulders. 
*These two observations indicated that the rotator cuff tendon attachments to bone are stronger in younger individuals. 
*Stronger attachments require more force (trauma) or extraordinary repetitive use to disrupt them.

Rather than being a 'different disease', it is more likely that there is a continuum from acute traumatic tears in the healthy cuffs of young shoulders to chronic degenerative tears in the age-weakened cuffs older shoulders. 

What we would have liked to learn from this study is the healing rate of repairs of cuff tears in younger individuals, but this information is not included. Our current 'wisdom' is that acute traumatic tears in otherwise healthy shoulders respond well to acute repairs. Hopefully we can garner evidence to support this wisdom.

Of course all older rotator cuffs are not weak. See here.


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