Prevalence, Natural History, and Nonoperative Treatment of Rotator Cuff Disease

Abstract

Rotator cuff disease is extremely common, affecting between 6.8% and 22.4% of the population over age 40. Tear prevalence, size, likelihood of progression, and retear rates after surgical repair are all related to increasing age. These data suggest that asymptomatic rotator cuff tears are a process related to aging, and the description of this as a “tear” may be inaccurate. In addition to age, other nonmodifiable variables related to the presence and progression of rotator cuff tears include male sex, family history, and hand dominance. Smoking and certain disease states (diabetes, hypertension, serum lipid disorders) are potentially modifiable influences on rotator cuff disease. The relationship between symptoms and the presence of a rotator cuff tear and the progression of a rotator cuff tear are not robust. As fewer than 95% of people with rotator cuff tears come to surgery, the majority of rotator cuff tears are either asymptomatic or mildly symptomatic. Approximately half of existing rotator cuff tears progress over time. Those that progress more rapidly are more likely to have symptoms as the ability to compensate through teres minor hypertrophy and other adaptive mechanisms are exceeded. Both surgery and nonoperative treatments are effective at treating symptoms in patients with rotator cuff disease, but at this time it is not known which treatment is better for which patients. While some authors recommend repair for younger patients with smaller tears, the data on whether this approach can modify the natural history of rotator cuff disease is lacking.