Understanding Rotator Cuff Tears: Prevalence, Risk Factors, and Treatment Strategies

Rotator cuff tears are quite common, especially among older adults. In the U.S., it is stimated that around 2 million people are affected by rotator cuff injuries or tears each yea his includes both full-thickness tears (where the tendon is completely torn) and partia thickness tears (where the tendon is partially torn). It is possible to have a torn rotator cuff tendon without having a specific injury. However, falls on an outstretched arm are notorious for causing rotator cuff tears.

The incidence increases with age, with tears becoming more common after the age of 40.

Studies suggest that by the time people reach 60, nearly 30-50% of individuals may have some form of rotator cuff tear. Shoulder pain that is persistent and lasts for more than a few weeks despite relative rest should be evaluated. Partial thickness tears (less than 50%) can often be managed conservatively but do need monitoring to make sure they are not progressing. In our experience, PRP injection directly into the tear can be very helpful in patients with partial tears, especially when coupled with a very specific rehabilitation program.

For symptomatic tears that are not successfully treated non-surgically, arthroscopic surgery to repair the torn/damaged tendon has proven to be very reliable in our hands. The surgical results are primarily related to three factors:

• the size of the tear
• the degree of tendon tear retraction/tissue loss
• the quality of the tendon tissue (ie, degree of degeneration)

These three factors tend to become less favorable with passage of time. When treatment decisions are delayed, many untreated tears will expand in size and will be associated with tendon retraction. This will additionally lead to degradation in the quality of the tissue, thereby making repair probability less likely, leading to poor outcomes and dissatisfaction with care.

Therefore, timely evaluation and proper treatment decision making on the proper treatment pathway is critical to achieve the best outcome.