McMahon Patrick J, Prasad Amitesh, Francis Kimberly A
McMahon Orthopedics & Rehabilitation, 2100 Jane Street, Pittsburgh, PA, 15203, USA,
Clin Orthop Relat Res. 2014 Aug;472(8):2427-32. doi: 10.1007/s11999-014-3560-7.
Older individuals with rotator cuff injuries may have difficulties not only with activities of daily living, but also with sports activities.
QUESTIONS/PURPOSES: (1) How frequent and severe are rotator cuff abnormalities, as identified by ultrasound, in senior athletes? (2) To what degree does the severity of ultrasound-identified rotator cuff pathology correlate with pain and shoulder dysfunction?
We assessed pain and shoulder function in 141 elite athletes older than 60 years of age (median age, 70 years; range 60-84) at the Senior Olympics who volunteered to participate. An ultrasound evaluation of the rotator cuff of the dominant shoulder was performed by an experienced musculoskeletal radiologist in all of these elite athletes. We then determined the relationship between ultrasound findings and shoulder pain and shoulder function as assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) and American Shoulder and Elbow Surgeons (ASES) scores.
There were 20 shoulders with a normal cuff (14.2% [20 of 141], of which 5% [one of 20] were painful), 23 with tendinosis (16.3% [23 of 141], of which 30% [six of 20] were painful), 68 with a partial-thickness rotator cuff tear (48.2% [68 of 141], of which 32% [20 of 63] were painful), and 30 with a full-thickness rotator cuff tear (21.3% [30 of 141], of which 25% [seven of 28] were painful). Only 5% of athletes (one of 20) with a normal cuff on ultrasound evaluation reported shoulder pain, whereas 30% of athletes (33 of 111) with any degree of rotator cuff damage on ultrasound evaluation reported shoulder pain, This resulted in an odds ratio of 8.0 (95% confidence interval, 1.0-62.5). The proportion of patients who had pain was not different in those with different severities of rotator cuff pathology. Neither the ASES nor the DASH was different in those with different severities.
The frequency of full-thickness rotator cuff tears in senior athletes was 21.3% (30 of 141). Pain was a predictor of rotator cuff injury but not of its severity. The odds of having shoulder pain was eight times greater in those athletes with any rotator cuff damage as compared with those without any rotator cuff damage. Those with pain had poorer shoulder function but the ASES and DASH were poor predictors of the severity of rotator cuff pathology. Rotator cuff tears in older individuals are often not painful and may not need to be repaired for successful participation in athletics.
Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
患有肩袖损伤的老年人不仅在日常生活活动中会遇到困难，在体育活动中也会如此。
问题/目的：（1）经超声检查，老年运动员肩袖异常的频率和严重程度如何？（2）超声检查确定的肩袖病变严重程度与疼痛和肩部功能障碍在何种程度上相关？
我们评估了141名年龄超过60岁（中位年龄70岁；范围60 - 84岁）自愿参加高级奥林匹克运动会的精英运动员的疼痛和肩部功能。由一位经验丰富的肌肉骨骼放射科医生对所有这些精英运动员的优势肩进行肩袖超声评估。然后我们确定超声检查结果与通过手臂、肩部和手部功能障碍（DASH）评分及美国肩肘外科医生（ASES）评分评估的肩部疼痛和肩部功能之间的关系。
有20个肩部肩袖正常（14.2%[141例中的20例]，其中5%[20例中的1例]疼痛），23个肩部有肌腱病（16.3%[141例中的23例]，其中30%[23例中的6例]疼痛），68个肩部有部分厚度肩袖撕裂（48.2%[141例中的68例]，其中32%[68例中的20例]疼痛），30个肩部有全层肩袖撕裂（21.3%[141例中的30例]，其中25%[30例中的7例]疼痛）。超声评估肩袖正常的运动员中只有5%（20例中的1例）报告有肩部疼痛，而超声评估有任何程度肩袖损伤的运动员中有30%（111例中的33例）报告有肩部疼痛，这导致比值比为8.0（95%置信区间，1.0 - 62.5）。不同严重程度肩袖病变患者的疼痛比例没有差异。不同严重程度患者的ASES评分和DASH评分也没有差异。
老年运动员中全层肩袖撕裂的频率为21.3%（141例中的30例）。疼痛是肩袖损伤的一个预测因素，但不是损伤严重程度的预测因素。与没有任何肩袖损伤的运动员相比，有任何肩袖损伤的运动员出现肩部疼痛的几率高8倍。有疼痛的患者肩部功能较差，但ASES评分和DASH评分并不能很好地预测肩袖病变的严重程度。老年人的肩袖撕裂通常不疼痛，可能无需修复就能成功参与体育活动。
II级，预后研究。有关证据水平的完整描述，请参阅作者指南。
