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Rotator Cuff Degeneration

As the rotator cuff ages, it becomes susceptible to degenerative changes, which can lead to shoulder dysfunction. As the tendon degenerates it may detach from the humerus and form a defect in the rotator cuff. This is known as a 'degenerative rotator cuff tear'. It is not truly a 'tear' since there often is no injury. However, there is a defect in the rotator cuff tendons due to this degeneration. Your shoulder can often compensate for a degenerative cuff defect (tear), as it's onset is gradual over many years and often undetectable. Many people can function normally with a degenerative tear and approximately 20-40% of people in their 60's have these tears with no pain or noticeable weakness {Milgrom:1995; Seitz:2011; Hashimoto:2003; Milgrom:1995}
 
However, this weakness in the tendons of the rotator cuff does make it more susceptible to tear further with minor injuries, such as a fall or wrenching injury of the arm.A minor injury can suddenly convert a functionally compensated cuff tear into a dysfunctional situation. This leads to pain and inability to lift your arm overhead. These 'acute-on-chronic' tears are often massive, since there has been a pre-existing defect in the rotator cuff, which has been made larger.



References:
  1. Milgrom C, Schaffler M, Gilbert S. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. Journal of Bone and …. 1995;
  2. Seitz AL, McClure PW, Finucane S, Boardman ND, Michener LA. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clin Biomech (Bristol, Avon). 2011 Jan.;26(1):1–12. 
  3. Hashimoto T, Nobuhara K. Pathologic evidence of degeneration as a primary cause of rotator cuff tear. Clinical orthopaedics and …. 2003.

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