Does the presence of a full-thickness rotator cuff tear influence outcome after proximal humeral fractures?

Background: Prevalence of rotator cuff tears increases with advancing age. Despite proximal humeral fractures being common in the elderly, the influence of a coexistent rotator cuff tear on outcome has, to our knowledge, not been previously investigated. This study prospectively assessed whether the presence of a rotator cuff tear in association with a proximal humeral fracture influences functional prognosis.

Methods: Eighty-five patients treated conservatively for proximal humeral fractures were evaluated prospectively with ultrasonography to determine the status of the rotator cuff. Every patient was managed by immobilization in an arm sling for 2 weeks followed by physiotherapy. Functional outcome was measured using the Constant and the Oxford shoulder score, at 3 and 12 months postinjury.

Results: There were 43 patients with full-thickness cuff tears and 42 patients with no cuff tear or a partial-thickness tear. Full thickness cuff tears were more frequent in patients more than 60 years old. The outcome scores at 3 and 12 months showed no statistically significant difference for either the Constant or the Oxford shoulder score with regard to cuff integrity. Analysis of these scores showed no correlation between presence or absence of a full-thickness cuff tear and shoulder function.

Conclusion: The results indicate that rotator cuff integrity is not a predictor of shoulder function at 12 months after proximal humeral fracture, as measured by outcome scores and therefore there is no clinical indication for routine imaging of the rotator cuff in patients for whom conservative management is the preferred treatment option.