Etiology of rotator cuff tears in paraplegic patients: a case-control study

The purpose of this study was to investigate the etiology and the demographic and functional characteristics of rotator cuff tears (RCTs) in 100 paraplegic patients as compared with 100 able-bodied volunteers.

The magnetic resonance imaging examination results of 200 shoulders in each group were analyzed. Clinical examination included the Constant score and a visual analog scale for pain intensity.

The prevalence of RCTs was 63% in paraplegic patients versus 15% in able-bodied volunteers (P < .0001). All RCTs in the paraplegic group were associated with symptoms. Among the patients with RCTs, full-thickness tears were detected in 78% of cases in the paraplegic patient group versus 73% of cases in the volunteer group. The rate of partial-thickness tears was 22% in the paraplegic group versus 27% in the volunteer group. Paraplegic patients had a lower Constant score; Disabilities of the Arm, Shoulder and Hand score; and range of motion and a higher pain intensity than the volunteer cohort. The mean tear width in paraplegic patients was 14.4 mm (range, 8-28 mm) versus 9.9 mm (range, 8-14 mm) in the volunteers (P < .01).

The etiology of RCTs in paraplegic patients seems to be based on wear-and-tear mechanisms rather than aging. These results are important for our understanding of shoulder pathology in long-term paraplegic patients and show the impact of this problem.