Prevalence of structural damage of the rotator cuff due to shoulder trauma

Status:

completed 06/2025

Aims:

The majority of rotator cuff lesions (RCLs) develop on the basis of degenerative processes. Distinguishing an acute traumatic RCL in individual cases is difficult and is frequently critically questioned. The aim of this research project was to improve the early detection of structural shoulder damage – particularly RCLs – following an accident, in order to draw conclusions about the genesis of RCLs.

Activities/Methods:

All patients aged between 18 and 65 years who presented to the emergency department after an acute shoulder injury were examined clinically immediately (time point 1, T1) and underwent MRI diagnostics (3 Tesla) within one week. Exclusion criteria included, among others, fractures or shoulder dislocations. Data were collected on the trauma mechanism (e.g., fall on an outstretched arm, lateral impact on the shoulder), occupational activity, and shoulder complaints prior to the accident. In addition, several scores were assessed (Oxford Shoulder Score, Disabilities of the Arm, Shoulder and Hand [DASH] score, Constant & Murley Score [CMS], Visual Analog Scale for pain [VAS], and Hospital Anxiety and Depression Scale [HADS]).

After 6 weeks (time point 2, T2), patients received a second questionnaire by mail assessing interim treatment, duration of any work incapacity, clinical function, and pain over time (Oxford, DASH, VAS). In addition to descriptive analyses, group comparisons were performed using ANOVA, and influencing factors on the development of full-thickness RCLs (t-RCLs) were analyzed using logistic regression.

Results:

A total of n = 324 patients were included. In 31 cases (9.6%), full-thickness rotator cuff lesions (t-RCLs) were identified (75% men, 25% women); in n = 102 cases (31.5%), partial tears (p-RCLs) were present; and in n = 191 cases (59%), no RCL was detected. In n = 24 cases of t-RCL, only one tendon was torn; in n = 6 cases, two tendons; and in one case, three tendons.

For lesions of the supraspinatus tendon, age emerged as the most important predictor of RCL (mean age 55 years in t-RCL vs. mean age 43 years in p-RCL and 34 years in patients without RCL; p < 0.001). Range of motion was significantly reduced in the presence of a t-RCL. Moreover, the drop-arm test was the only rotator cuff test that was significantly positive in t-RCLs at time point 1. Comparison of clinical scores between the two examination time points showed a significant difference among the three groups (no RCL, p-RCL, t-RCL), indicating less improvement in DASH and CMS scores in patients with p-RCL and t-RCL compared with those without RCL. Within the logistic regression model, age and a previously injured shoulder were identified as the most important predictors for the occurrence of a t-RCL of the supraspinatus tendon (OR = 1.13; p < 0.001 and OR = 3.6; p = 0.021, respectively). No significant difference in the frequency of RCLs was found between different trauma mechanisms.

The data demonstrate that age and pre-existing shoulder damage are significantly associated with full-thickness and partial supraspinatus tendon RCLs. The trauma mechanism alone has no significant influence on rotator cuff injury. These results support the hypothesis of degenerative influences on supraspinatus tendon ruptures in the context of acute traumatic events.

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