The Shoulder

Incidence of rotator cuff defects

Partial thickness and even full thickness cuff tears exist without bothering the patient.

The incidence of rotator cuff defects has been described both in autopsy dissections and in asymptomatic patients.

Incidence of rotator cuff tears in cadaver dissections
Authors	Incidence	Remarks
Keyes EL. (1933) Anatomical observations of rupture of the supraspinatus tendon. Based upon a cadaveric study of 73 cadavers; Ann Surg 97:849-856,1933	19%
Wilson CL (1943) Lesions of the supraspinatus tendon. Degeneration, rupture and calcification/ Arch Surg 46:307, 1943	20% to 26.5%
Cotton RE, Rideaout D (1963) Tears of the humeral rotator cuff : A radiological and and pathological necropsy survey; J Bone Joint Surg 46 (B):214-328, 1964	8%
Uhtoff et al.(1986) The pathogenesis of rotator cuff tears. In: Proceedings of the third international Conference on Surgery of the Shoulder, Fukuora Japan 1986	20%
Kummer FJ, Zuckerman JD (1995) The incidence of full thickness rotator cuff tears in a large cadaveric population. Bull Hosp Jt Dis 54:30-31, 1995	17%	6% in cadavers younger than 60 years / 30% in cadavers older than 60 years
Jerosch J, Muller T, Castro WH (1991) The incidence of rotator cuff rupture. An anatomic study. Acta Orthop Belg 57(2):124-129	partial: 28.3% complete: 31%	more common in women
Fukada H et al (1987) Incomplete rotator cuff tears diagnosed by subacromial bursography. Clin Orthop 223:51-58, 1987	13% partial rupture	30% in patients older than 40 / no tears seen in those younger than 40
Sakurai et al (1998) Incomplete tears of the subscapularis tendon associated with tears of the supraspinatus tendon: cadaveric and clinical studies . J Shoulder Elbow Surg 1992;J:4-14	61.5% rotator cuff ruptures in 52 shoulders - main age 76.3y

Incidence of rotator cuff tears in asymptomatic patients
Authors	Incidence	Remarks
Petterson G: (1942) Rupture of the tendon aponeurosis of the shoulder joint in antero-inferior dislocation Acta Chirur Scand (suppl) 77:1-187, 1942	20% partial or full	50% in subjects between 55 and 85
Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. (1995) Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. JJ Bone Joint Surg Br 1995 Mar;77(2):296-298	50% tears after age 50	rotator cuff lesions are a normal correlate with age they often present with no clinical symptoms
Sher JS, Uribe JW, Posada A et al. (1995) Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg 77:933-936	15% full 20% partial	1° significantly increase of tears with age defects are compatible with normal, painless, functional activity
Connor PM, Banks DM, et al (2003) Magnetic resonance imaging of the asymptomatic shoulder of overhead athletes: a 5-year follow-up study. Am J Sports Med. 2003 Sep-Oct;31(5):724-7.	40% of dominant shoulders had findings consistent with partial- or full-thickness tears of the rotator cuff as compared with none (0%) of the nondominant shoulders	CONCLUSIONS: Magnetic resonance imaging alone should not be used as a basis for operative intervention in this patient population.
Miniaci A, Dowdy PA, Willits KR, Vellet AD.(1995) Magnetic resonance imaging evaluation of the rotator cuff tendons in the asymptomatic shoulder. Am J Sports Med. 1995 Mar-Apr;23(2):142-5.	23% of supraspinatus and infraspinatus tendons had grade 1 changes (partial thickness ruptures) through the tendons	Nonenhanced magnetic resonance imaging may be of limited value in defining rotator cuff injury in a patient with shoulder pain unless a full-thickness rotator cuff tear is suspected clinically.

It must be concluded from these studies that cuff defects become increasingly common after the age of 40 and that many of these occur without substantial clinical manifestations.

This realisation poses substantial questions regarding the treatment and in particular the indications for cuff surgery.