Rotator Cuff Failure.

Figure 1 - Cuff strength changes with age

Figure 2 - Age at presentation of patients with full thickness rotator cuff tears

Figure 3 - Avulsion of bone from the tuberosity

Introduction

About rotator cuff failure

The young healthy cuff is highly resistant to disruption or degeneration. Because of the change in cuff strength with age (see figures 1 and 2), full thickness cuff lesions are most unusual under the age of 40. When cuff lesions occur in the younger age group, they may be only partial thickness or they may include the avulsion of bone from the tuberosity (see figure 3). Disuse and scarring of the partial thickness lesion may lead to stiffness limiting the range of elevation, cross-body adduction, and internal rotation.

With increasing age and disuse, less force is required to tear the cuff. Often, the acute symptoms from progression of the cuff defect are dismissed as "tendinitis" or "bursitis." Once these transient symptoms resolve, the shoulder becomes asymptomatic, except for a relatively imperceptible increment in weakness. Thus we often encounter patients with large cuff defects and minimal symptoms. If these shoulders remain stable with the humeral head centered in the glenoid, they can demonstrate an astounding degree of function. Bilateral degenerative cuff defects are common. In one of our studies we found that 55 percent of patients presenting with a symptomatic cuff tear on one side also had a tear on the opposite side.

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