Rotator cuff injuries in medico-legal practice

Abstract

Rotator cuff tears are a common cause of shoulder weakness and pain.1 Rotator cuff tears have been found in 36%2 of people with shoulder pain. One of the major difficulties from a medico-legal perspective is how to differentiate reliably between constitutional (degenerative) tears and work-related injuries or traumatic tears. Rotator cuff tears may be caused by extrinsic or intrinsic factors. Tears may be a result of exclusively extrinsic, exclusively intrinsic or a mixture of both factors. A tear resulting from extrinsic factors may be a result of a single traumatic event or degeneration and cuff failure due to a repetitive act, a ‘cumulative trauma disorder’. A tear due to exclusively intrinsic factors is a result of tendon degeneration as part of the ageing process with no associated mechanical cause. The crucial question when considering the issue of causation for a painful tendon tear is whether the pathology has a mechanical cause or is due to the normal ageing process. There still remains considerable range and difference of opinion among orthopaedic surgeons about surgical indications for cuff tears3 and there is much ongoing work looking at the clinical and cost effectiveness of rotator cuff repair.4 Young adults typically have normal rotator cuff tendons. A single traumatic event causing a rotator cuff tear in an individual with normal tendons may include mechanisms such as a sporting injury, a significant fall or a road traffic collision. Acute rotator cuff tears generally occur in previously asymptomatic patients, who identify a significant traumatic incident leading to a sudden onset of symptoms including severe pain, immediate loss of strength and functional impairment of the shoulder. Acute rotator cuff tears only account for 8% of patients who present with symptomatic rotator cuffs.5 Correct and early clinical diagnosis is often difficult.6 Tears …