Advertisement

High prevalence of rotator cuff tears in a population who never sought for shoulder problems: a clinical, ultrasonographic and radiographic screening study

  • Shwan Khoschnau
  • Jugoslav Milosavjevic
  • Bo Sahlstedt
  • Rebecca Rylance
  • Hans Rahme
  • Bakir KadumEmail author
Original Article • SHOULDER - ARTHROSCOPY
  • 37 Downloads

Abstract

Background

This study was designed to investigate the prevalence of rotator cuff tears in a population who had never sought for symptoms from their shoulders. The aim was to see whether there is a correlation between dysfunction and the presence of cuff tears seen with ultrasonography or radiology.

Materials and methods

Clinical assessment with constant score, ultrasound and radiographic examination was done on 106 voluntary subjects (212 shoulders). There were 52 men and 54 women with a median age of 66 years. The correlations between complaints, cuff tears, constant score, ultrasound and radiological findings were calculated.

Results

Of 106 subjects, 64 (60%) had shoulder problems. The prevalence of full-thickness cuff tears was 30% (21% of all the 212 shoulders). 61% of the shoulders with full-thickness tears had symptoms compared to 33% of the shoulders without tears. The constant score was lower in shoulders with full-thickness tears. Partial tears or acromioclavicular degeneration had no impact on shoulder complaints or constant score. The subacromial index was lower for shoulders with full-thickness tears. Patients with primary osteoarthritis had a lower acromion index than patients with full-thickness tears.

Conclusion

The prevalence of shoulder complaints and/or cuff tears was high in this population, which had never sought medical care for shoulder problems. Only full-thickness tears had an impact on shoulder function and constant score. Partial-thickness tears and degenerative changes in the acromioclavicular joint may be considered as age-related changes. The subacromial index can be used as a predictor for full-thickness cuff tears.

Level of evidence

Level III, cross-sectional study, prevalence study.

Keywords

Rotator cuff Rotator cuff tear Rotator cuff surgery Shoulder radiography Shoulder ultrasound Prevalence of rotator cuff tear 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest related to this study.

References

  1. 1.
    Smith JG (2010) The classic: pathological appearances of seven cases of injury of the shoulder-joint: with remarks. Clin Orthop Relat Res 468(6):1471–1475.  https://doi.org/10.1007/s11999-010-1231-x CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Meyer AW (1924) Further evidences of attrition in the human body. Am J Anat 34(1):241–267.  https://doi.org/10.1002/aja.1000340108 CrossRefGoogle Scholar
  3. 3.
    Neer CS 2nd (1983) Impingement lesions. Clin Orthop Relat Res 173:70–77Google Scholar
  4. 4.
    Bigliani L, Morrison D, April E (1986) The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans 10:228Google Scholar
  5. 5.
    Keyes EL (1933) Observations on rupture of the supraspinatus tendon based upon a study of seventy-three cadavers. Ann Surg 97(6):849–856CrossRefGoogle Scholar
  6. 6.
    Ozaki J, Fujimoto S, Nakagawa Y, Masuhara K, Tamai S (1988) Tears of the rotator cuff of the shoulder associated with pathological changes in the acromion. A study in cadaver. J Bone Joint Surg Am 70(8):1224–1230CrossRefGoogle Scholar
  7. 7.
    Moosmayer S, Smith HJ, Tariq R, Larmo A (2009) Prevalence and characteristics of asymptomatic tears of the rotator cuff: an ultrasonographic and clinical study. J Bone Joint Surg Br 91(2):196–200.  https://doi.org/10.1302/0301-620X.91B2.21069 CrossRefPubMedGoogle Scholar
  8. 8.
    Constant CR, Murley AH (1987) A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 214:160–164Google Scholar
  9. 9.
    Mack LA, Gannon MK, Kilcoyne RF, Matsen RA III (1988) Sonographic evaluation of the rotator cuff. Accuracy in patients without prior surgery. Clin Orthop Relat Res 234:21–27Google Scholar
  10. 10.
    Middleton WD, Reinus WR, Totty WG, Melson CL, Murphy WA (1986) Ultrasonographic evaluation of the rotator cuff and biceps tendon. J Bone Joint Surg Am 68(3):440–450CrossRefGoogle Scholar
  11. 11.
    Milosavljevic J, Elvin A, Rahme H (2005) Ultrasonography of the rotator cuff: a comparison with arthroscopy in one-hundred-and-ninety consecutive cases. Acta Radiol 46(8):858–865.  https://doi.org/10.1080/02841850500270506 CrossRefPubMedGoogle Scholar
  12. 12.
    Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C (2006) Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am 88(4):800–805.  https://doi.org/10.2106/jbjs.d.03042 CrossRefPubMedGoogle Scholar
  13. 13.
    Crass JR, Craig EV, Thompson RC, Feinberg SB (1984) Ultrasonography of the rotator cuff: surgical correlation. J Clin Ultrasound 12(8):487–491CrossRefGoogle Scholar
  14. 14.
    Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M (1995) Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br 77(2):296–298CrossRefGoogle Scholar
  15. 15.
    Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB (1995) Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am 77(1):10–15CrossRefGoogle Scholar
  16. 16.
    Yamamoto A, Takagishi K, Kobayashi T, Shitara H, Osawa T (2011) Factors involved in the presence of symptoms associated with rotator cuff tears: a comparison of asymptomatic and symptomatic rotator cuff tears in the general population. J Shoulder Elbow Surg 20(7):1133–1137.  https://doi.org/10.1016/j.jse.2011.01.011 CrossRefPubMedGoogle Scholar
  17. 17.
    Okoroha KR, Fidai MS, Tramer JS, Davis KD, Kolowich PA (2019) Diagnostic accuracy of ultrasound for rotator cuff tears. Ultrasonography 38(3):215–220.  https://doi.org/10.14366/usg.18058(Epub 2018 Nov 17) CrossRefPubMedGoogle Scholar
  18. 18.
    Pearsall AW 4th, Bonsell S, Heitman RJ, Helms CA, Osbahr D, Speer KP (2003) Radiographic findings associated with symptomatic rotator cuff tears. J Shoulder Elbow Surg 12(2):122–127.  https://doi.org/10.1067/mse.2003.19 CrossRefPubMedGoogle Scholar
  19. 19.
    Teefey SA, Hasan SA, Middleton WD, Patel M, Wright RW, Yamaguchi K (2000) Ultrasonography of the rotator cuff. A comparison of ultrasosnographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am 82(4):498–504CrossRefGoogle Scholar
  20. 20.
    Ziegler DW (2004) The use of in-office, orthopaedist-performed ultrasound of the shoulder to evaluate and manage rotator cuff disorders. J Shoulder Elbow Surg 13(3):291–297CrossRefGoogle Scholar
  21. 21.
    Watson S, Allen B, Robbins C, Bedi A, Gagnier JJ, Miller B (2018) Does the rotator cuff tear pattern influence clinical outcomes after surgical repair? Orthop J Sports Med 6(3):2325967118763107CrossRefGoogle Scholar
  22. 22.
    Tahal DS, Katthagen JC, Millett PJ (2016) Rotator cuff repair in the elderly: Is it worthwhile? Curr Orthop Pract 27(3):281–290CrossRefGoogle Scholar
  23. 23.
    Lambers Heerspink FO, van Raay JJ, Koorevaar RC, van Eerden PJ, Westerbeek RE, van’t Riet E, van den Akker-Scheek I, Diercks RL (2015) Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial. J Shoulder Elbow Surg 24(8):1274–1281CrossRefGoogle Scholar
  24. 24.
    Tashjian RZ (2012) Epidemiology, natural history, and indications for treatment of rotator cuff tears. Clin Sports Med 31(4):589–604 (Epub 2012 Aug 30)CrossRefGoogle Scholar
  25. 25.
    Ramme AJ, Robbins CB, Patel KA, Carpenter JE, Bedi A, Gagnier JJ, Miller BS (2019) Surgical versus nonsurgical management of rotator cuff tears: a matched-pair analysis. J Bone Joint Surg Am 101(19):1775–1782.  https://doi.org/10.2106/JBJS.18.01473 CrossRefPubMedGoogle Scholar
  26. 26.
    Kukkonen J, Joukainen A, Lehtinen J, Mattila KT, Tuominen EK, Kauko T, Äärimaa V (2015) Treatment of nontraumatic rotator cuff tears: a randomized controlled trial with two years of clinical and imaging follow-up. J Bone Joint Surg Am 97(21):1729–1737CrossRefGoogle Scholar
  27. 27.
    Sobhy MH, Khater AH, Hassan MR, El Shazly O (2018) Do functional outcomes and cuff integrity correlate after single- versus double-row rotator cuff repair? A systematic review and meta-analysis study. Eur J Orthop Surg Traumatol 28(4):593–605.  https://doi.org/10.1007/s00590-018-2145-7(Epub 2018 Feb 13) CrossRefPubMedGoogle Scholar
  28. 28.
    Bedeir YH, Schumaier AP, Abu-Sheasha G, Grawe BM (2019) Type 2 retear after arthroscopic single-row, double-row and suture bridge rotator cuff repair: a systematic review. Eur J Orthop Surg Traumatol 29(2):373–382.  https://doi.org/10.1007/s00590-018-2306-8(Epub 2018 Sep 18) CrossRefPubMedGoogle Scholar
  29. 29.
    Fehringer EV, Sun J, VanOeveren LS, Keller BK, Matsen FA III (2008) Full-thickness rotator cuff tear prevalence and correlation with function and co-morbidities in patients sixty-five years and older. J Shoulder Elbow Surg 17(6):881–885.  https://doi.org/10.1016/j.jse.2008.05.039 CrossRefPubMedGoogle Scholar
  30. 30.
    Vosloo M, Keough N, De Beer MA (2017) The clinical anatomy of the insertion of the rotator cuff tendons. Eur J Orthop Surg Traumatol 27(3):359–366.  https://doi.org/10.1007/s00590-017-1922-z(Epub 2017 Feb 16) CrossRefPubMedGoogle Scholar
  31. 31.
    Geary MB, Elfar JC (2015) Rotator cuff tears in the elderly patients. Geriatr Orthop Surg Rehabil 6(3):220–224.  https://doi.org/10.1177/2151458515583895 CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Tempehof S, Rupp S, Seil R (1999) Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg 8(4):296–299.  https://doi.org/10.1016/S1058-2746(99)90148-9 CrossRefGoogle Scholar
  33. 33.
    Schibany N, Zehetgruber H, Kainberger F, Wurnig C, Ba-Ssalamah A, Herneth AM, Lang T, Gruber D, Breitenseher MJ (2004) Rotator cuff tears in asymptomatic individuals: a clinical and ultrasonographic screening study. Eur J Radiol 51(3):263–268.  https://doi.org/10.1016/S0720-048X(03)00159-1 CrossRefPubMedGoogle Scholar
  34. 34.
    Miyazaki AN, Itoi E, Sano H, Fregoneze M, Santos PD, da Silva LA, SellaGdo V, Martel EM, Debom LG, Andrade ML, Checchia SL (2011) Comparison between the acromion index and rotator cuff tears in the Brazilian and Japanese populations. J Shoulder Elbow Surg 20(7):1082–1086.  https://doi.org/10.1016/j.jse.2011.04.028 CrossRefPubMedGoogle Scholar
  35. 35.
    Wang JC, Shapiro MS (1997) Changes in acromial morphology with age. J Shoulder Elbow Surg 6(1):55–59.  https://doi.org/10.1016/S1058-2746(97)90071-9 CrossRefPubMedGoogle Scholar
  36. 36.
    Ellman H, Hanker G, Bayer M (1986) Repair of the rotator cuff. End-result study of factors influencing reconstruction. J Bone Joint Surg Am 68(8):1136–1144CrossRefGoogle Scholar
  37. 37.
    Weiner DS, Macnab I (1970) Superior migration of the humeral head. A radiological aid in the diagnosis of tears of the rotator cuff. J Bone Joint Surg Br 52(3):524–527CrossRefGoogle Scholar
  38. 38.
    Bonsell S, Pearsall AW 4th, Heitman RJ, Helms CA, Major NM, Speer KP (2000) The relationship of age, gender, and degenerative changes observed on radiographs of the shoulder in asymptomatic individuals. J Bone Joint Surg Br 82(8):1135–1139CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.ElisabethsjukhusetUppsalaSweden
  2. 2.Radiology DepartmentVästerås Central HospitalVästeråsSweden
  3. 3.Department of Orthopedics, The Southern Sweden Musculoskeletal Research Center (MORSE)University HospitalLundSweden
  4. 4.Department of Clinical and Experimental MedicineLinköping UniversityLinköpingSweden

Personalised recommendations