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Impingement is not impingement: the case for calling it "Rotator Cuff Disease"
Edward G McFarland1, Nicola Maffulli2, Angelo Del Buono3
1Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore MD, USA.
Muscles, Ligaments and Tendons Journal
|December 25, 2013
Summary
Rotator cuff disease may not be caused by impingement. Aging-related tendinopathy is a more likely factor, suggesting a new approach to patient care.
Area of Science:
- Orthopedics
- Sports Medicine
- Musculoskeletal Research
Background:
- The prevailing theory for rotator cuff conditions involves impingement of the supraspinatus tendon against the acromion and coracoacromial ligament.
- This impingement theory has been increasingly challenged as it fails to adequately explain age-related changes in rotator cuff tendons.
- Consequently, the efficacy of surgical interventions like acromioplasty and coracoacromial ligament release is being re-evaluated.
Purpose of the Study:
- To challenge the traditional impingement theory of rotator cuff disease.
- To highlight the significant role of age-related tendinopathy in rotator cuff degeneration.
- To advocate for a paradigm shift in understanding rotator cuff pathology for improved patient management.
Main Methods:
- Review and synthesis of existing scientific literature on rotator cuff pathology.
- Critical analysis of the evidence supporting and refuting the impingement hypothesis.
- Evaluation of the role of aging and tendinopathy in rotator cuff disease development.
Main Results:
- Evidence suggests that age-related tendinopathy is a more significant factor in rotator cuff degeneration than previously thought.
- The traditional impingement mechanism does not fully account for the observed pathological changes, particularly those associated with aging.
- The effectiveness of surgical treatments targeting impingement is being questioned.
Conclusions:
- A paradigm shift is needed, moving away from the sole focus on impingement.
- Age-related tendinopathy should be recognized as a primary driver of rotator cuff disease.
- A comprehensive understanding of rotator cuff pathology, incorporating aging factors, is crucial for effective patient care.
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