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

Teunis, Teun; Lubberts, Bart; Reilly, Brian; Ring, David

doi:10.1016/j.jse.2014.08.001

Cited by 389 publications

(238 citation statements)

References 45 publications

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“…MRI of asymptomatic wrists has shown rates of TFCC changes varying from 38 % (n=39/103) [6] to 50 % (n=35/70) [20]. This rate is similar to that shown in a cadaveric dissection study showing a TFCC defect rate of 36 % (n = 141/393) [21]. The supraspinatus has a somewhat higher rate of changes: one study showed changes in 89 % (n=49/55) of asymptomatic patients [1].…”

Section: Discussionsupporting

confidence: 69%

Incidental Signal Changes in the Extensor Carpi Ulnaris on MRI

Kuntz

Janssen

Ring

2015

Hand (New York, N,Y.)

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Background Magnetic resonance imaging (MRI) commonly finds musculoskeletal abnormalities incidental to the reason for ordering the test. The purpose of this study was to determine if the prevalence of extensor carpi ulnaris (ECU) signal changes on MRI varies between patients undergoing upper extremity MRI for assessment of clinically suspected ECU tendinopathy and those undergoing upper extremity MRI for other indications. Our secondary null hypotheses were that the prevalence of ECU signal changes on MRI does not vary based on patient age or sex and that the prevalence of ECU signal changes on MRI does not vary among other indications for MRI. Methods We searched MRI reports of all patients undergoing MRI of the hand, wrist, or arm at our institution between 2001 and 2014 for signal changes in the ECU. The medical record was reviewed to determine the indication for the MRI and the presence of clinically suspected ECU tendinopathy. Results ECU signal changes (overall prevalence of 13 %) were more common in patients undergoing MRI for a working clinical diagnosis of ECU tendinopathy or ulnar-sided wrist pain compared to patients evaluated for nonspecific pain and other indications. Age was independently associated with ECU signal changes on MRI. MRI signal changes are uncommonly associated with symptomatic tendinopathy (low positive predictive value). Conclusions ECU signal changes on MRI are common and often asymptomatic.

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Section: Discussionsupporting

confidence: 69%

Incidental Signal Changes in the Extensor Carpi Ulnaris on MRI

Kuntz

Janssen

Ring

2015

Hand (New York, N,Y.)

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“…Prevalence of rotator cuff abnormalities increases with age making assigning cause to new symptoms problematic [27]. Interpreting diagnostic test results given age related degeneration is also problematic in determining whether an abnormality is new or even the direct cause of patient symptoms.…”

Section: Rotator Cuff Tears Resulting From Degenerationmentioning

confidence: 99%

“…The high prevalence of asymptomatic abnormalities makes interpretation of diagnostic tests and radiologic findings difficult and therefore the clinical assignment of direct cause as either due to an acute trauma event or simply RC attrition can be challenging. However, the conclusions of the Review are only weakly related to individuals with FTRCTs that result from a recent acute shoulder trauma, the focus of this article [27]. Table 3 lists the prevalence findings of the Review limited to asymptomatic RCTs [27].…”

Section: Asymptomatic Ftrcts Increase With Agementioning

confidence: 99%

Determining Work-Relatedness of Acute Shoulder Trauma. Review 2017

Rhode¹,

Rhode²

2017

MOJOR

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The chronicity of rotator cuff tears and their cause with increasing age has been extensively studied resulting in widely varying prevalence estimates. Focusing on a reported prevalence rate that increases with age to as high as 80% for 70 year olds can result in denial of reimbursement for work-related rotator cuff tears based on the presumed existence of underlying tendon pathology. The age at which inherent degeneration of the rotator cuff becomes a consideration in worker's comp judgments is vague at best. There are instances of acute shoulder trauma that occur in individuals as young as 20 years and even younger in athletes before significant tendon degeneration occurs. Multiple studies report low prevalence rates of asymptomatic rotator cuff tears in individuals less than 50 years. Acute shoulder trauma occurring at work in young workers provides strong evidence that the exposure event underlies any resulting shoulder disorder rather than tendon degeneration and as such is compensable. It can be questioned whether work-related acute shoulder trauma occurring at any age should be attributed to inherent tendon degeneration. IntroductionRotator cuff disease is the most common upper extremity disability [1]. Tendons are connective tissues primarily made up of aligned type I collagen fibrils. The primary cells in tendons are fibroblasts which produce the extra cellular matrix components. As a tendon ages, there is a drop in both cell numbers and cell synthetic activity which could affect mechanical function as tendon structure and composition are altered. These changes likely underlie the increase in tendon injuries with aging [2]. The principal focus of this review is the determination between acute traumatic and chronic degenerative rotator cuff tears (RCTs) which has huge implications for compensation of workrelated injuries. Determining the underlying cause of an RCT is complicated by an increasing incidence of asymptomatic rotator cuff disease with increasing age due to ongoing degeneration of the shoulder tendons. As the age of patient's increases and along with possible RC degeneration, it becomes increasingly difficult to exclusively attribute shoulder injuries to work-related trauma. However, ethically and given the original intent of worker compensation legislation, work-related trauma to the shoulder should be compensable [3].Determining the chronicity of tendon tears remains an issue that is still being pursued. Codman in 1931 stated four prescient hypotheses for RC supraspinatus tendon lesions: (1) trauma, (2) calcification, (3) necrosis or osteoarthritis, or (4) direct result of attrition [4]. Extrinsic and intrinsic factors are recognized to affect rotator cuff tears. Neer identified extrinsic factors based on impingement of the cuff against the coracoacromial arch when the arm is elevated in a forward direction leading to tendonitis and tears [5]. Variable morphology of the acromion includes spurs [6][7][8] and a hook-shaped acromion [9,10] that influence the degree of impingement and li...

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“…These studies, often relying on abnormalities in the asymptomatic shoulder, suggest that atraumatic rotator cuff tears are part of the normal aging process in many individuals [1]. In a systematic review investigating the prevalence of rotator cuff disease with increasing age, Teunis et al showed that abnormalities ranged from 9.7% in patients aged 20 years and younger and increased to 62% in patients of 80 years and older [2]. This increase persisted regardless of the presence of symptoms.…”

Section: Introductionmentioning

confidence: 99%

Natural History of Degenerative Rotator Cuff Tears

Codding

Keener

2018

Curr Rev Musculoskelet Med

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Purpose of Review In the past several years, there have been significant advances in our understanding of the natural history of rotator cuff disease. Studies have continued to provide valuable insight into the clinical, radiographic, and anatomic features of these atraumatic tears. Our purpose is to summarize the findings and contributions from these recent high-quality studies. Recent Findings Current research has continued to describe and provide understanding into the natural history of atraumatic rotator cuff disease, including symptom progression, tear enlargement, and the development of arthritis. This knowledge has allowed identification of tears with higher risk of disease progression. Additionally, studies have investigated, with long-term healing data, whether the natural history of degenerative rotator cuff tears can be altered with surgical intervention. Summary Recent studies have shown encouraging mid to long-term healing data and clinical outcome scores for smaller tears in younger patients with minimal fatty infiltration. Future research should focus on obtaining long-term healing data, functional outcome data, and refining surgical indications for rotator cuff repair. Identifying patients with specific tear characteristics amendable to healing will allow us to provide a long-term, durable repair, thus interrupting the natural history of degenerative rotator cuff disease.

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

Cited by 389 publications

References 45 publications

Incidental Signal Changes in the Extensor Carpi Ulnaris on MRI

Incidental Signal Changes in the Extensor Carpi Ulnaris on MRI

Determining Work-Relatedness of Acute Shoulder Trauma. Review 2017

Natural History of Degenerative Rotator Cuff Tears

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