Short communicationThe effects of a rotator cuff tear on activities of daily living in older adults: A kinematic analysis
Introduction
Sarcopenia and reduced strength are well-known sequelae of aging contributing to functional declines older adults experience (Clark and Manini, 2010). Presence of a shoulder injury, like a rotator cuff tear (RCT), can further reduce an individual׳s ability to perform functional tasks (Lin et al., 2008, van Schaardenburg et al., 1994). RCT is a common musculoskeletal injury for older adults, with prevalence increasing from 25.6% to 50.0% for adults in their sixties and eighties, respectively (Yamamoto et al., 2010). Shoulder injury may result in adaptive movements caused by muscle weakness or force imbalance (Lippitt and Matsen, 1993, Lippitt et al., 1993, Magarey and Jones, 2003, Phadke et al., 2009), or used as a pain avoidance strategy (Hall et al., 2011, Mell et al., 2005). In addition to limiting functionality, altered kinematics may expose the glenohumeral joint to new contact force scenarios, which could lead to further joint damage (Hsu et al., 2003, Vidt, 2014).
The upper limb is critical for daily functional tasks, including eating and personal hygiene (Katz et al., 1963). Studies evaluating upper limb functional task performance have primarily focused on younger or uninjured individuals (Magermans et al., 2005, Safaee-Rad et al., 1990, van Andel et al., 2008). Little work has focused on older adults (Hall et al., 2011) or investigated functional task performance in those with RCT. Therefore, our objective was to quantify thoracohumeral kinematics for a group of older adults with and without RCT during performance of functional tasks spanning the upper limb workspace. Kinematics for three thoracohumeral degrees of freedom were compared between groups. The null hypothesis was that task kinematics for RCT and control groups would not be different.
Section snippets
Participants
Eighteen older individuals (mean age=63.3±2.2) participated (Table 1); 9 participants (4F/5M) had RCT of the supraspinatus tendon; 9 were age- and sex-matched controls. RCT participants had an MRI-confirmed supraspinatus tendon tear (≥50% tendon thickness) and were recruited from our institution׳s orthopedic clinic, where they sought treatment for RCT symptoms. Controls were recruited from the local community, had no history of shoulder pain or injury, and were screened for shoulder pain and
Results
Six RCT participants had full-thickness supraspinatus tear. Tears extended into infraspinatus in 7 participants and subscapularis in 5 participants. Three RCT participants did not complete all tasks due to pain: one could not complete perineal care and hair comb; one could not complete hair comb; one could not complete upward reach 105°. RCT participants completed several tasks with different kinematics than controls (Fig. 2; Appendix A Supplementary material, Appendix A Supplementary material
Discussion
We found older individuals with RCT completed functional reach, functional pull, hair comb, and upward reach 105° with more internal rotation than controls. The RCT group completed functional pull most differently, with differences identified in all three degrees of freedom. Kinematic differences identified for RCT participants across tasks may precipitate glenohumeral joint damage and increase functional impairment.
Three RCT participants could not complete all tasks due to pain because of
Conflict of interest statement
Michael Freehill serves as a consultant for Smith and Nephew. No financial remuneration was received related to information from this study and it does not represent a conflict of interest. Christopher Tuohy declares an ownership interest in a medical device with research applications that measures rotator cuff tendon repair tension; all participation in device development and testing is beyond the scope of this manuscript and does not represent a conflict of interest. No other authors have any
Acknowledgments
This study was funded by the National Institute on Aging of the National Institutes of Health (#F31AG040921 (Vidt)), the Wake Forest University Claude D. Pepper Older Americans Independence Center (#P30AG021332), the National Science Foundation (#1405246 (Saul)), the Wake Forest Center for Biomolecular Imaging and the Wake Forest School of Medicine Translational Science Institute Clinical Research Unit. The sponsors of this study had no involvement in study design, collection, analysis, or
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