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Four Cases of Rare Rotator Cuff Tear in Adolescents

Rotator cuff tears of the shoulder aren't common in children. When they occur, it's usually because of chronic overuse. Overhead-throwing athletes are at greatest risk. In this report, surgeons present four cases of adolescent rotator cuff tears. All four were athletes between the ages of 12 and 14.

Case 1: A 12-year old boy hurt his shoulder at least twice during different activities. He was involved in many sports such as swimming, football, hockey, weight lifting, and golf. His injuries occurred during skateboarding and baseball. The case was unusual because he had very few positive signs of a rotator cuff tear. CT scan, MRI, and surgery all confirmed a complete tear of the subscapularis tendon.

Case 2: A 14-year old boy injured his shoulder during a wrestling match. Pain and weakness didn't go away with conservative care. An MRI showed a tear in the subscapularis tendon but the family didn't want surgery. After a year he finally had surgery because of continued symptoms. The patient was able to return to sports six months after the operation.

Case 3: A 12-year old boy felt something tear in his shoulder after throwing a baseball. Despite normal motion and normal strength in that arm, he couldn't throw without pain. The MRI was negative so they tried nonoperative therapy. None months later he had arthroscopic surgery. They found a partial tear of the supraspinatus tendon. The bones were still growing in that area so they couldn't repair the tendon. His sports activities were limited after that.

Case 4: A 14-year old boy tore his supraspinatus tendon during a hockey injury. He had pain and decreased range of motion. He was unable to regain his strength even after two months of physical therapy. At the time of surgery to repair the tear the surgeon saw bone fragments around the edges of the torn tendon. After the operation, his strength came back and he returned to playing hockey.

Rotator cuff tears are uncommon in teenagers. Delays in diagnosis occur because the case doesn't look like a typical rotator cuff tear. Doctors must look at clues from the history, exam, and imaging studies to make the correct diagnosis. MRIs seem to give the best results over other imaging studies for this problem.

References: Ivan S. Tarkin, MD, et al. Rotator Cuff Tears in Adolescent Athletes. In The American Journal of Sports Medicine. April 2005. Vol. 33. No. 4. Pp. 596-601.

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