Rotator Cuff Tears in the Elderly Patients

Michael B Geary, John C Elfar, Michael B Geary, John C Elfar

Abstract

Rotator cuff tears (RCT) are a common clinical problem in the geriatric population, and debate exists over how to best provide pain relief and restore shoulder function. Treatment options can be broadly divided into nonsurgical and surgical, with the majority of patients initially placed on a trial of conservative therapy. For those with irreparable RCT, low functional demand, or interest in nonoperative management, there are a number of nonsurgical treatments to consider, including rehabilitation and injections of corticosteroids, hyaluronate, and platelet-rich plasma. Surgical treatment is increasingly common, as geriatric patients remain active with high functional demands. Studies in elderly populations have demonstrated satisfactory healing and clinical results following surgical repair. Predictors of poor outcome after repair are large tear size as well as higher stages of fatty infiltration. Decompression is a less invasive surgical option that has been shown to provide short-term pain relief, though the lasting effects may deteriorate over time. A number of factors must be weighed when considering which patients are likely to benefit from surgical intervention.

Keywords: conservative management; corticosteroids; debridement; decompression; hyaluronate; platelet-rich plasma; rehabilitation; rotator cuff repair; rotator cuff tear.

Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br. 1995;77(2):296–298.
    1. Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77(1):10–15.
    1. Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am. 2006;88(8):1699–1704.
    1. Gumina S, Carbone S, Campagna V, Candela V, Sacchetti FM, Giannicola G. The impact of aging on rotator cuff tear size. Musculoskelet Surg. 2013;97(suppl 1):69–72.
    1. Matthews TJ, Hand GC, Rees JL, Athanasou NA, Carr AJ. Pathology of the torn rotator cuff tendon. Reduction in potential for repair as tear size increases. J Bone Joint Surg Br. 2006;88(4):489–495.
    1. Matthews TJ, Smith SR, Peach CA, Rees JL, Urban JP, Carr AJ. In vivo measurement of tissue metabolism in tendons of the rotator cuff: implications for surgical management. J Bone Joint Surg Br. 2007;89(5):633–638.
    1. Funakoshi T, Iwasaki N, Kamishima T, et al. In vivo visualization of vascular patterns of rotator cuff tears using contrast-enhanced ultrasound. Am J Sports Med. 2010;38(12):2464–2471.
    1. Rudzki JR, Adler RS, Warren RF, et al. Contrast-enhanced ultrasound characterization of the vascularity of the rotator cuff tendon: age- and activity-related changes in the intact asymptomatic rotator cuff. J Shoulder Elbow Surg. 2008;17(1 suppl):96S–100S.
    1. Nho SJ, Brown BS, Lyman S, Adler RS, Altchek DW, MacGillivray JD. Prospective analysis of arthroscopic rotator cuff repair: prognostic factors affecting clinical and ultrasound outcome. J Shoulder Elbow Surg. 2009;18(1):13–20.
    1. Tashjian RZ, Hollins AM, Kim HM, et al. Factors affecting healing rates after arthroscopic double-row rotator cuff repair. Am J Sports Med. 2010;38(12):2435–2442.
    1. Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005;87(6):1229–1240.
    1. Cho NS, Rhee YG. The factors affecting the clinical outcome and integrity of arthroscopically repaired rotator cuff tears of the shoulder. Clin Orthop Surg. 2009;1(2):96–104.
    1. Maman E, Harris C, White L, Tomlinson G, Shashank M, Boynton E. Outcome of nonoperative treatment of symptomatic rotator cuff tears monitored by magnetic resonance imaging. J Bone Joint Surg Am. 2009;91(8):1898–1906.
    1. Zingg PO, Jost B, Sukthankar A, Buhler M, Pfirrmann CW, Gerber C. Clinical and structural outcomes of nonoperative management of massive rotator cuff tears. J Bone Joint Surg Am. 2007;89(9):1928–1934.
    1. Kuhn JE, Dunn WR, Sanders R, et al. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. J Shoulder Elbow Surg. 2013;22(10):1371–1379.
    1. Merolla G, Paladini P, Saporito M, Porcellini G. Conservative management of rotator cuff tears: literature review and proposal for a prognostic. Prediction Score. Muscles Ligaments Tendons J. 2011;1(1):12–19.
    1. Moosmayer S, Lund G, Seljom U, et al. Comparison between surgery and physiotherapy in the treatment of small and medium-sized tears of the rotator cuff: a randomised controlled study of 103 patients with one-year follow-up. J Bone Joint Surg Br. 2010;92(1):83–91.
    1. Kocher MS, Horan MP, Briggs KK, Richardson TR, O’Holleran J, Hawkins RJ. Reliability, validity, and responsiveness of the American Shoulder and Elbow Surgeons subjective shoulder scale in patients with shoulder instability, rotator cuff disease, and glenohumeral arthritis. J Bone Joint Surg Am. 2005;87(9):2006–2011.
    1. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res. 1987;(214):160–164.
    1. Paavola M, Kannus P, Jarvinen TA, et al. Treatment of tendon disorders. Is there a role for corticosteroid injection? Foot Ankle Clin. 2002;7(3):501–513.
    1. Weiss JJ. Intra-articular steroids in the treatment of rotator cuff tear: reappraisal by arthrography. Arch Phys Med Rehabil. 1981;62(11):555–557.
    1. Bokor DJ, Hawkins RJ, Huckell GH, et al. Results of nonoperative management of full-thickness tears of the rotator cuff. Clin Orthop Relat Res. 1993;(294):103–110.
    1. Dean BJ, Franklin SL, Murphy RJ, Javaid MK, Carr AJ. Glucocorticoids induce specific ion-channel-mediated toxicity in human rotator cuff tendon: a mechanism underpinning the ultimately deleterious effect of steroid injection in tendinopathy? Br J Sports Med. 2014;48(22):1620–1626.
    1. Poulsen RC, Watts AC, Murphy RJ, Snelling SJ, Carr AJ, Hulley PA. Glucocorticoids induce senescence in primary human tenocytes by inhibition of sirtuin 1 and activation of the p53/p21 pathway: in vivo and in vitro evidence. Ann Rheum Dis. 2014;73(7):1405–1413.
    1. Koester MC, Dunn WR, Kuhn JE, Spindler KP. The efficacy of subacromial corticosteroid injection in the treatment of rotator cuff disease: a systematic review. J Am Acad Orthop Surg. 2007;15(1):3–11.
    1. Shibata Y, Midorikawa K, Emoto G, Naito M. Clinical evaluation of sodium hyaluronate for the treatment of patients with rotator cuff tear. J Shoulder Elbow Surg. 2001;10(3):209–216.
    1. Marshall KW. Intra-articular hyaluronan therapy. Curr Opin Rheumatol. 2000;12(5):468–474.
    1. Chou WY, Ko JY, Wang FS, et al. Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears: a randomized, double-blind, placebo-controlled study. J Shoulder Elbow Surg. 2010;19(4):557–563.
    1. Kukkonen J, Kauko T, Vahlberg T, Joukainen A, Aärimaa V. Investigating minimal clinically important difference for Constant score in patients undergoing rotator cuff surgery. J Shoulder Elbow Surg. 2013;22(12):1650–1655.
    1. Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10(4):225–228.
    1. Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg. 2004;114(6):1502–1508.
    1. Peerbooms JC, Sluimer J, Bruijn DJ, et al. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010;38(2):255–262.
    1. Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med. 2011;39(10):2130–2134.
    1. Hoppe S, Alini M, Benneker LM, Milz S, Boileau P, Zumstein MA. Tenocytes of chronic rotator cuff tendon tears can be stimulated by platelet-released growth factors. J Shoulder Elbow Surg. 2013;22(3):340–349.
    1. Jo CH, Kim JE, Yoon KS, Shin S. Platelet-rich plasma stimulates cell proliferation and enhances matrix gene expression and synthesis in tenocytes from human rotator cuff tendons with degenerative tears. Am J Sports Med. 2012;40(5):1035–1045.
    1. Rodeo SA, Delos D, Williams RJ, Adler RS, Pearle A, Warren RF. The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: a prospective, randomized clinical study. Am J Sports Med. 2012;40(6):1234–1241.
    1. Weber SC, Kauffman JI, Parise C, Weber SJ, Katz SD. Platelet-rich fibrin matrix in the management of arthroscopic repair of the rotator cuff: a prospective, randomized, double-blinded study. Am J Sports Med. 2013;41(2):263–270.
    1. Kesikburun S, Tan AK, Yilmaz B, Yaşar E, Yazicioğlu K. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med. 2013;41(11):2609–2616.
    1. Rha DW, Park GY, Kim YK, Kim MT, Lee SC. Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil. 2013;27(2):113–122.
    1. Flurin PH, Hardy P, Abadie P, et al. Rotator cuff tears after 70 years of age: a prospective, randomized, comparative study between decompression and arthroscopic repair in 154 patients. Orthop Traumatol Surg Res. 2013;99(8 suppl):S371–378.
    1. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994;(304):78–83.
    1. Flurin PH, Hardy P, Abadie P, et al. Arthroscopic repair of the rotator cuff: prospective study of tendon healing after 70 years of age in 145 patients. Orthop Traumatol Surg Res. 2013;99(8 suppl):S379–384.
    1. Djahangiri A, Cozzolino A, Zanetti M, et al. Outcome of single-tendon rotator cuff repair in patients aged older than 65 years. J Shoulder Elbow Surg. 2013;22(1):45–51.
    1. Robinson PM, Wilson J, Dalal S, Parker RA, Norburn P, Roy BR. Rotator cuff repair in patients over 70 years of age: early outcomes and risk factors associated with re-tear. Bone Joint J. 2013;95-B(2):199–205.
    1. Fehringer EV, Sun J, Cotton J, Carlson MJ, Burns EM. Healed cuff repairs impart normal shoulder scores in those 65 years of age and older. Clin Orthop Relat Res. 2010;468(6):1521–1525.
    1. Dezaly C, Sirveaux F, Philippe R, et al. Arthroscopic treatment of rotator cuff tear in the over-60s: repair is preferable to isolated acromioplasty-tenotomy in the short term. Orthop Traumatol Surg Res. 2011;97(6):S125–130.
    1. Charousset C, Bellaiche L, Kalra K, Petrover D. Arthroscopic repair of full-thickness rotator cuff tears: is there tendon healing in patients aged 65 years or older? Arthroscopy. 2010;26(3):302–309.
    1. Verma NN, Bhatia S, Baker CL, III, et al. Outcomes of arthroscopic rotator cuff repair in patients aged 70 years or older. Arthroscopy. 2010;26(10):1273–1280.
    1. Grondel RJ, Savoie FH, III, Field LD. Rotator cuff repairs in patients 62 years of age or older. J Shoulder Elbow Surg. 2001;10(2):97–99.
    1. Rebuzzi E, Coletti N, Schiavetti S, et al. Arthroscopic rotator cuff repair in patients older than 60 years. Arthroscopy. 2005;21(1):48–54.
    1. Romeo AA, Bach BR, Jr, O’Halloran KL. Scoring systems for shoulder conditions. Am J Sports Med. 1996;24(4):472–476.
    1. Worland RL, Arredondo J, Angles F, Lopez-Jimenez F. Repair of massive rotator cuff tears in patients older than 70 years. J Shoulder Elbow Surg. 1999;8(1):26–30.
    1. Kempf JF, Gleyze P, Bonnomet F, et al. A multicenter study of 210 rotator cuff tears treated by arthroscopic acromioplasty. Arthroscopy. 1999;15(1):56–66.
    1. Jaffe M, Frank A, Beaufils P. Endoscopic acromioplasty in total rupture of the rotator cuff [in French]. Rev Chir Orthop Reparatrice Appar Mot. 1994;80:369–378.
    1. Levy HJ, Gardner RD, Lemak LJ. Arthroscopic subacromial decompression in the treatment of full-thickness rotator cuff tears. Arthroscopy. 1991;7(1):8–13.
    1. Gartsman GM. Massive, irreparable tears of the rotator cuff. Results of operative debridement and subacromial decompression. J Bone Joint Surg Am. 1997;79(5):715–721.
    1. Rockwood CA, Jr, Williams GR, Jr, Burkhead WZ., Jr Debridement of degenerative, irreparable lesions of the rotator cuff. J Bone Joint Surg Am. 1995;77(6):857–866.
    1. Melillo AS, Savoie FH, III, Field LD. Massive rotator cuff tears: debridement versus repair. Orthop Clin North Am. 1997;28(1):117–124.
    1. Zvijac JE, Levy HJ, Lemak LJ. Arthroscopic subacromial decompression in the treatment of full thickness rotator cuff tears: a 3- to 6-year follow-up. Arthroscopy. 1994;10(5):518–523.

Source: PubMed

Спонсоры и соавторы

Заболевания

Медикаментозные вмешательства

Подписаться