Matthew Maeder MD, Presenter: Nothing to Disclose

Andrew Michael Zbojniewicz MD, Abstract Co-Author: Author, Amirsys, Inc

Kathleen Helme Emery MD, Abstract Co-Author: Nothing to Disclose

Shelia Salisbury PhD, Abstract Co-Author: Stockholder, Angiodynamics, Inc Stockholder, Apricus Biosciences, Inc Stockholder, BioClinica, Inc Stockholder, Optic Circuits Ltd Stockholder, Computerized Thermal Imaging, Inc Stockholder, CytRx Corporation Stockholder, General Electric Company Stockholder, Orchid Cellmark, Inc Stockholder, Poniard Pharmaceuticals, Inc Stockholder, RXI Pharmaceuticals Corporation Stockholder, Retractable Technologies, Inc Stockholder, Targeted Genetics Corporation Stockholder, Women First Healthcare, Inc Stockholder, YM Bioscience Inc Stockholder, OSI Pharmaceuticals, Inc

Rotator cuff tears are considered rare in the pediatric age group with few case reports in the literature. Anecdotally we have noticed rotator cuff tears with a broad spectrum in appearance not infrequently at our hospital. We set out to evaluate the incidence and spectrum of tears in pediatric patients at a large tertiary care pediatric hospital.

MRI studies of the shoulder performed over the course of one year including both arthrograms and standard examinations were obtained. Studies performed for neoplasm, infection, brachial plexopathy, and in patients with connective tissue disease or prior surgery were excluded yielding 100 examinations. There were 56 boys and 42 girls. The mean age for females was 16 years-old and for males was 15 years-old. Presence of rotator cuff tear was determined by presence of a discrete measurable fluid signal defect within the rotator cuff on at least two planes for non-arthrographic studies. For arthrograms, presence of fluid/contrast within the tendon substance on two imaging planes was used. Surgical confirmation was noted when present.

Review of the 100 shoulder examinations showed 16 rotator cuff tears. Two of these tears were excluded from final analysis due to presence of greater tuberosity avulsions for a total of 14 tears in 98 children. Twelve of 14 tears were partial thickness. Both full thickness tears were partial width. Eleven of 14 tears were at the cuff insertion, two were at the so-called critical zone and one involved both bursal and articular surface. Seven tears were of supraspinatus (SST), 5 of infraspinatus (IST), 1 involved both SST and IST, and one of subscapularis. Seven tears were in patients with closed growth plates, 5 with closing growth plates, and 2 with open growth plates.

Rotator cuff tears are more common in pediatric patients than previously reported. There was a significant trend toward presence of tears and closing of the growth plate. The location and distribution of tears is similar to that seen in adults. We reviewed all cases of patients presenting for MRI examination with shoulder pain, used strict guidelines to define a tear and did not only include patients with surgical confirmation in hopes of reducing verification bias.

Rotator cuff tears are more common in pediatric patients than previously reported and should be considered in young patients with appropriate clinical symptoms.

Maeder, M, Zbojniewicz, A, Emery, K, Salisbury, S, Spectrum and Incidence of Rotator Cuff Tears in Pediatric Patients at a Large Tertiary Care Hospital.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11013009.html