Made up of four muscles whose tendons come together to cover the humerus and top of the shoulder, the rotator cuff is what allows shoulders to rotate and arms to lift.
In young people, rotator cuff tendons are generally healthy and robust unless subjected to repetitive overhead activities, such as throwing a baseball or swimming. These overhand sports may cause partial tears of the rotator cuff tendons, which results in thinning of the tendon. The good news is that these injuries can often be treated conservatively with physical therapy. Occasionally, young patients do suffer complete tears of the rotator cuff, often as the result of a traumatic injury. In these cases, when the tendon is torn completely away from the bone, surgery is required. In such cases, the healing rates and outcomes are excellent.
At the other end of the spectrum, rotator cuff tears in older patients are typically more degenerative in nature, as 30-50% of people over the age of 60 likely have some degree of rotator cuff tearing, often asymptomatic. A trial of conservative treatment, including rehabilitation and potentially an injection, can often help. Older patients with full-thickness tears who are very active and/or those that fail conservative treatment, may benefit from surgery. Because the underlying biology in elderly patients isn’t as good as in young patients, healing rates tend to be lower. Yet despite this, successful clinical outcomes are achieved in more than 90% of cases.
Taking these considerations into account, treatment protocols should be varied depending on the age and physical demand of the patient.
Dr. Joshua Dines is an orthopedic surgeon and a member of the HSS Sports Medicine Institute. He currently serves as an assistant team physician for the New York Mets.