News For the Over 40 Crowd with Rotator Cuff TearsWine may improve with age but research shows the shoulder doesn't. In fact, there's a direct relationship between increasing age and the number of rotator cuff tears. At age 50, just slightly more than one in 10 adults has a rotator cuff tear seen on MRIs. By age 80, this has increased to five out of 10 (or half of all adults).
That seems high, but many of those people are asymptomatic (i.e., have no pain or other symptoms). They don't complain of any pain and don't report any problems. The damage is found when MRIs are done for something else, or as in the case of this report, the MRIs show these types of injuries when imaging is done for research purposes.
For those adults over the age of 66, shoulder pain on one side is actually a sign of rotator cuff tears in both shoulders. And that's not all. Studies show that where there's a rotator cuff tear, there's likely a tear of the biceps tendon where it attaches to the labrum.
The labrum is a dense ring of fibrous cartilage around the rim of the acetabulum (shoulder socket). It helps deepen the socket and increases shoulder stability. If the labrum is torn from front to back, it's called a superior labral anterior posterior (SLAP) lesion. Rotator cuff tears with SLAP lesions are usually treated surgically.
That's where this study comes in. The authors are surgeons from a sports medicine clinic. They compared the results of surgery for rotator cuff tears and SLAP lesions when treated with rotator cuff repair and debridement of the SLAP lesion (group one) versus rotator cuff and SLAP repair (group two). All patients were 45 years old or older. They all had arthroscopic surgery. And they all had a tear of the supraspinatus tendon (one of the four tendons that makes up the rotator cuff).
Two other characteristics of the patients in this study included 1) the SLAP lesion was considered repairable and 2) the torn tendons weren't retracted (pulled back) very far. The surgeon could grab the tendon and stitch it back in place.
To measure the results of treatment, range of motion was recorded before and after surgery. And each participant filled out the Tegner and UCLA self-reported tests of activity level and function, patient satisfaction, range-of-motion, and strength. Before surgery, the groups were evenly matched with similar results on all test scores.
After surgery, the debridement group had better results than the repair group. Everyone in both groups did improve, but patients in the debridement group got better faster. The got faster and better pain relief, which translated in to improved function as well. And two years later, they were still showing improved shoulder rotation compared with the repair group.
The authors concluded that in older adults minimal intervention might be best. With combined shoulder lesions (rotator cuff and labral tears), functional outcome is better when the SLAP lesion is shaved smooth rather than anchored back in place. The reason for this might be because (as has been shown in other studies), the labrum in older adults loses blood supply and has fewer new chondrocytes (cartilage cells) to replace the damaged ones.
Amy E. Abbot, MD, et al. Arthroscopic Treatment of Concomitant Superior Labral Anterior Posterior (SLAP) Lesions and Rotator Cuff Tears in Patients Over the Age of 45 Years. In The American Journal of Sports Medicine. July 2009. Vol. 37. No. 7. Pp. 1358-1362.
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