MOJ Header

Current Issue - March 2026, Volume 20, Issue No. 1

Official Journal of Malaysian Orthopaedic Association and ASEAN Orthopaedic Association

Asymptomatic Rotator Cuff Tendinopathy in Elderly Diabetics: Is Routine Magnetic Resonance Imaging Evaluation of the Shoulder Warranted?

References

  1. Milgrom C, Schaffler M, Gilbert S, van Holsbeeck M. Rotator-cuff changes in asymptomatic adults. The effect of age, hand dominance and gender. J Bone Joint Surg Br. 1995; 77(2): 296-8.
  2. Needell SD, Zlatkin MB, Sher JS, Murphy BJ, Uribe JW. MR imaging of the rotator cuff: peritendinous and bone abnormalities in an asymptomatic population. AJR Am J Roentgenol. 1996; 166(4): 863-7. doi: 10.2214/ajr.166.4.8610564
  3. Iorgoveanu VC, Bojinca V, Malitchi R, Gheorghe M, Ionescu C, Ionescu R. AB1069 Shoulder ultrasonography in diabetic patients – is there damage with no clinical sign?. Ann. Rheum. Dis. 2017: 76 (Suppl 2): 1429. doi: 10.1136/annrheumdis-2017-eular.5482
  4. Abate M, Schiavone C, Salini V. Sonographic evaluation of the shoulder in asymptomatic elderly subjects with diabetes. BMC Musculoskelet Disord. 2010; 11: 278. doi: 10.1186/1471-2474-11-278
  5. Itoi E, Minagawa H, Yamamoto N, Seki N, Abe H. Are pain location and physical examinations useful in locating a tear site of the rotator cuff? Am J Sports Med. 2006; 34(2): 256-64. doi: 10.1177/0363546505280430
  6. Schibany N, Zehetgruber H, Kainberger F, Wurnig C, Ba-Ssalamah A, Herneth AM, et al. Rotator cuff tears in asymptomatic individuals: a clinical and ultrasonographic screening study. Eur J Radiol. 2004; 51(3): 263-8. doi: 10.1016/S0720-048X(03)00159-1
  7. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010; 19(1): 116-20. doi: 10.1016/j.jse.2009.04.006
  8. Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010; 19(1): 116-20. doi: 10.1016/j.jse.2009.04.006
  9. Kang JH, Tseng SH, Jaw FS, Lai CH, Chen HC, Chen SC. Comparison of ultrasonographic findings of the rotator cuff between diabetic and nondiabetic patients with chronic shoulder pain: a retrospective study. Ultrasound Med Biol. 2010; 36(11): 1792-6. doi: 10.1016/j.ultrasmedbio.2010.08.006
  10. Naqvi GA, Jadaan M, Harrington P. Accuracy of ultrasonography and magnetic resonance imaging for detection of full thickness rotator cuff tears. Int J Shoulder Surg. 2009; 3(4): 94-7. doi: 10.4103/0973-6042.63218
  11. Uchendu E, Ayoola OO, Adetiloye VA, Ikem RT, Ikem IC. Sonographic assessment of the shoulders in asymptomatic elderly diabetics in a Nigerian population. SA Orthop J. 2015: 14(2). doi: 10.17159/2309-8309
  12. Jeong J, Shin DC, Kim TH, Kim K. Prevalence of asymptomatic rotator cuff tear and their related factors in the Korean population. J Shoulder Elbow Surg. 2017; 26(1): 30-5. doi: 10.1016/j.jse.2016.05.003
  13. Sipola P, Niemitukia L, Kröger H, Höfling I, Väätäinen U. Detection and quantification of rotator cuff tears with ultrasonography and magnetic resonance imaging - a prospective study in 77 consecutive patients with a surgical reference. Ultrasound Med Biol. 2010; 36(12): 1981-9. doi: 10.1016/j.ultrasmedbio.2010.09.001
  14. Rutten MJ, Spaargaren GJ, van Loon T, de Waal Malefijt MC, Kiemeney LA, et al. Detection of rotator cuff tears: the value of MRI following ultrasound. Eur Radiol. 2010; 20(2): 450-7. doi: 10.1007/s00330-009-1561-9
  15. Sharma G, Bhandary S, Khandige G, Kabra U. MR Imaging of Rotator Cuff Tears: Correlation with Arthroscopy. J Clin Diagn Res. 2017; 11(5): TC24-7. doi: 10.7860/JCDR/2017/27714.9911
  16. Borton Z, Shivji F, Simeen S, Williams R, Tambe A, Espag M, et al. Diabetic patients are almost twice as likely to experience complications from arthroscopic rotator cuff repair. Shoulder Elbow. 2020; 12(2): 109-13. doi: 10.1177/1758573219831691
  17. Aydeniz A, Gursoy S, Guney E. Which musculoskeletal complications are most frequently seen in type 2 diabetes mellitus? J Int Med Res. 2008; 36(3): 505-11. doi: 10.1177/147323000803600315
  18. Garcilazo C, Cavallasca JA, Musuruana JL. Shoulder manifestations of diabetes mellitus. Curr Diabetes Rev. 2010; 6(5): 334-40. doi: 10.2174/157339910793360824
  19. Cole A, Gill TK, Shanahan EM, Phillips P, Taylor AW, Hill CL. Is diabetes associated with shoulder pain or stiffness? Results from a population based study. J Rheumatol. 2009; 36(2): 371-7. doi: 10.3899/jrheum.080349
  20. Pal B, Anderson J, Dick WC, Griffiths ID. Limitation of joint mobility and shoulder capsulitis in insulin- and non-insulin-dependent diabetes mellitus. Br J Rheumatol. 1986; 25(2): 147-51. doi: 10.1093/rheumatology/25.2.147
  21. Smith KM, Presson AP, Zhang C, Horns JJ, Hotaling JM, Tashjian RZ, et al. Does diabetes mellitus predispose to both rotator cuff surgery and subsequent failure? JSES Int. 2021; 5(4): 636-41. doi: 10.1016/j.jseint.2021.03.002
  22. Rosenbloom AL, Silverstein JH. Connective tissue and joint disease in diabetes mellitus. Endocrinol Metab Clin North Am. 1996; 25(2): 473-83. doi: 10.1016/s0889-8529(05)70335-2
  23. Hsu CL, Sheu WH. Diabetes and shoulder disorders. J Diabetes Investig. 2016; 7(5): 649-51. doi: 10.1111/jdi.12491
  24. Yang L, Zhang J, Ruan D, Zhao K, Chen X, Shen W. Clinical and Structural Outcomes After Rotator Cuff Repair in Patients With Diabetes: A Meta-analysis. Orthop J Sports Med. 2020; 8(9): 2325967120948499. doi: 10.1177/2325967120948499
  25. Bedi A, Fox AJ, Harris PE, Deng XH, Ying L, Warren RF, et al. Diabetes mellitus impairs tendon-bone healing after rotator cuff repair. J Shoulder Elbow Surg. 2010;19(7): 978-88. doi: 10.1016/j.jse.2009.11.045
  26. Liang J, Liang Q, Wang X, Yun X. Perioperative glycemic control reduces the risk of retear in diabetic patients following arthroscopic rotator cuff repair: A meta-analysis. J Orthop Sci. 2025; 30(1): 78-84. doi: 10.1016/j.jos.2024.01.003
  27. Hong CK, Chang CJ, Kuan FC, Hsu KL, Chen Y, Chiang CH, et al. Patients With Diabetes Mellitus Have a Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair: A Meta-analysis. Orthop J Sports Med. 2020; 8(11): 2325967120961406. doi: 10.1177/2325967120961406
  28. Huang SW, Wang WT, Chou LC, Liou TH, Chen YW, Lin HW. Diabetes mellitus increases the risk of rotator cuff tear repair surgery: A population-based cohort study. J Diabetes Complications. 2016; 30(8): 1473-7. doi: 10.1016/j.jdiacomp.2016.07.015
  29. Zhao J, Luo M, Liang G, Wu M, Pan J, Zeng LF, et al. Risk Factors for Supraspinatus Tears: A Meta-analysis of Observational Studies. Orthop J Sports Med. 2021; 9(10): 23259671211042826. doi: 10.1177/23259671211042826
  30. Beall DP, Williamson EE, Ly JQ, Adkins MC, Emery RL, Jones TP, et al. Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol. 2003; 180(3): 633-9. doi: 10.2214/ajr.180.3.1800633
  31. Moosmayer S, Smith HJ, Tariq R, Larmo A. Prevalence and characteristics of asymptomatic tears of the rotator cuff: an ultrasonographic and clinical study. J Bone Joint Surg Br. 2009; 91(2): 196-200. doi: 10.1302/0301-620X.91B2.21069
  32. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2010; 33 Suppl 1(Suppl 1): S62-9. doi: 10.2337/dc10-S062
  33. Ashir A, Lombardi A, Jerban S, Ma Y, Du J, Chang EY. Magnetic resonance imaging of the shoulder. Pol J Radiol. 2020; 85: e420-39. doi: 10.5114/pjr.2020.98394
  34. McKean D, Teh J. Imaging of the Long Head of Biceps Tendon and Rotator Interval. Semin Musculoskelet Radiol. 2022; 26(5): 566-76. doi: 10.1055/s-0042-1758850
  35. Spencer EE Jr, Dunn WR, Wright RW, Wolf BR, Spindler KP, McCarty E, et al. Interobserver agreement in the classification of rotator cuff tears using magnetic resonance imaging. Am J Sports Med. 2008; 36(1): 99-103. doi: 10.1177/0363546507307504
  36. Zlatkin MB, Iannotti JP, Roberts MC, Esterhai JL, Dalinka MK, Kressel HY, et al. Rotator cuff tears: diagnostic performance of MR imaging. Radiology. 1989; 172(1): 223-9. doi: 10.1148/radiology.172.1.2740508
  37. McCreesh KM, Crotty JM, Lewis JS. Acromiohumeral distance measurement in rotator cuff tendinopathy: is there a reliable, clinically applicable method? A systematic review. Br J Sports Med. 2015; 49(5): 298-305. doi: 10.1136/bjsports-2012-092063
  38. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res. 1994; (304): 78-83.
  39. Miyazaki AN, Santos PD, da Silva LA, Sella Gdo V, Miranda ER, Zampieri R. Fatty muscle infiltration in cuff tear: Pre and post operative evaluation by MRI. Acta Ortop Bras. 2015; 23(5): 251-4. doi: 10.1590/1413-785220152305119821
  40. Cho NS, Rhee YG. The factors affecting the clinical outcome and integrity of arthroscopically repaired rotator cuff tears of the shoulder. Clin Orthop Surg. 2009; 1(2): 96-104. doi: 10.4055/cios.2009.1.2.96
  41. Schumaier A, Kovacevic D, Schmidt C, Green A, Rokito A, Jobin C, et al. Defining massive rotator cuff tears: a Delphi consensus study. J Shoulder Elbow Surg. 2020; 29(4): 674-80. doi: 10.1016/j.jse.2019.10.024
  42. Lädermann A, Denard PJ, Collin P. Massive rotator cuff tears: definition and treatment. Int Orthop. 2015; 39(12): 2403-14. doi: 10.1007/s00264-015-2796-5
  43. Hirji Z, Hunjun JS, Choudur HN. Imaging of the bursae. J Clin Imaging Sci. 2011; 1: 22. doi: 10.4103/2156-7514.80374
  44. Clement ND, Hallett A, MacDonald D, Howie C, McBirnie J. Does diabetes affect outcome after arthroscopic repair of the rotator cuff? J Bone Joint Surg Br. 2010; 92(8): 1112-7. doi: 10.1302/0301-620X.92B8.23571
  45. Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am. 2006; 88(8): 1699-704. doi: 10.2106/JBJS.E.00835
  46. Yamaguchi K, Tetro AM, Blam O, Evanoff BA, Teefey SA, Middleton WD. Natural history of asymptomatic rotator cuff tears: a longitudinal analysis of asymptomatic tears detected sonographically. J Shoulder Elbow Surg. 2001; 10(3): 199-203. doi: 10.1067/mse.2001.113086
  47. Nakajima T, Rokuuma N, Hamada K, Tomatsu T, Fukuda H. Histologic and biomechanical characteristics of the supraspinatus tendon: Reference to rotator cuff tearing. J Shoulder Elbow Surg. 1994; 3(2): 79-87. doi: 10.1016/S1058-2746(09)80114-6
  48. Goodmurphy CW, Osborn J, Akesson EJ, Johnson S, Stanescu V, Regan WD. An immunocytochemical analysis of torn rotator cuff tendon taken at the time of repair. J Shoulder Elbow Surg. 2003; 12(4): 368-74. doi: 10.1016/s1058-2746(03)00034-x
  49. Thomopoulos S, Parks WC, Rifkin DB, Derwin KA. Mechanisms of tendon injury and repair. J Orthop Res. 2015; 33(6): 832-9. doi: 10.1002/jor.22806
  50. Rudzki JR, Adler RS, Warren RF, Kadrmas WR, Verma N, Pearle AD, et al. Contrast-enhanced ultrasound characterization of the vascularity of the rotator cuff tendon: age- and activity-related changes in the intact asymptomatic rotator cuff. J Shoulder Elbow Surg. 2008; 17(1 Suppl): 96S-100S. doi: 10.1016/j.jse.2007.07.004
  51. Bell DS. "Repetition strain injury": an iatrogenic epidemic of simulated injury. Med J Aust. 1989; 151(5): 280-4. doi: 10.5694/j.1326-5377.1989.tb101196.x
  52. Sayampanathan AA, Andrew TH. Systematic review on risk factors of rotator cuff tears. J Orthop Surg (Hong Kong). 2017; 25(1): 2309499016684318. doi: 10.1177/2309499016684318
  53. Longo UG, Berton A, Papapietro N, Maffulli N, Denaro V. Epidemiology, genetics and biological factors of rotator cuff tears. Med Sport Sci. 2012; 57: 1-9. doi: 10.1159/000328868
  54. Gumina S, Candela V, Passaretti D, Latino G, Venditto T, Mariani L, et al. The association between body fat and rotator cuff tear: the influence on rotator cuff tear sizes. J Shoulder Elbow Surg. 2014; 23(11): 1669-74. doi: 10.1016/j.jse.2014.03.016
  55. Vaidya R, Lake SP, Zellers JA. Effect of Diabetes on Tendon Structure and Function: Not Limited to Collagen Crosslinking. J Diabetes Sci Technol. 2023; 17(1): 89-98. doi: 10.1177/19322968221100842
  56. Connizzo BK, Bhatt PR, Liechty KW, Soslowsky LJ. Diabetes alters mechanical properties and collagen fiber re-alignment in multiple mouse tendons. Ann Biomed Eng. 2014; 42(9): 1880-8. doi: 10.1007/s10439-014-1031-7
  57. Lawrence RL, Moutzouros V, Bey MJ. Asymptomatic Rotator Cuff Tears. JBJS Rev. 2019; 7(6): e9. doi: 10.2106/JBJS.RVW.18.00149
  58. Minagawa H, Yamamoto N, Abe H, Fukuda M, Seki N, Kikuchi K, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop. 2013; 10(1): 8-12. doi: 10.1016/j.jor.2013.01.008
  59. Worland RL, Lee D, Orozco CG, SozaRex F, Keenan J. Correlation of age, acromial morphology, and rotator cuff tear pathology diagnosed by ultrasound in asymptomatic patients. J South Orthop Assoc. 2003; 12(1): 23-6.
  60. DeGroot J. The AGE of the matrix: chemistry, consequence and cure. Curr Opin Pharmacol. 2004; 4(3): 301-5. doi: 10.1016/j.coph.2004.01.007
  61. Reiser KM. Nonenzymatic glycation of collagen in aging and diabetes. Proc Soc Exp Biol Med. 1998; 218(1): 23-37. doi: 10.3181/00379727-218-44264
  62. Goldin A, Beckman JA, Schmidt AM, Creager MA. Advanced glycation end products: sparking the development of diabetic vascular injury. Circulation. 2006; 114(6): 597-605. doi: 10.1161/CIRCULATIONAHA.106.621854
  63. Ippolito E, Natali PG, Postacchini F, Accinni L, De Martino C. Morphological, immunochemical, and biochemical study of rabbit achilles tendon at various ages. J Bone Joint Surg Am. 1980; 62(4): 583-98.
  64. Li H, Tang K, Deng Y, Xie M, Chang D, Tao X, et al. [Effects of exogenous prostaglandin E2 on collagen content of Achilles tendon of rabbits in vivo]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012; 26(3): 352-8. Chinese.
  65. Cho NS, Hwang JH, Lee YT, Chae SW. Tendinosis-like histologic and molecular changes of the Achilles tendon to repetitive stress: a pilot study in rats. Clin Orthop Relat Res. 2011; 469(11): 3172-80. doi: 10.1007/s11999-011-2000-1
  66. Benson RT, McDonnell SM, Knowles HJ, Rees JL, Carr AJ, Hulley PA. Tendinopathy and tears of the rotator cuff are associated with hypoxia and apoptosis. J Bone Joint Surg Br. 2010; 92(3): 448-53. doi: 10.1302/0301-620X.92B3.23074
  67. Handa A, Gotoh M, Hamada K, Yanagisawa K, Yamazaki H, Nakamura M, et al. Vascular endothelial growth factor 121 and 165 in the subacromial bursa are involved in shoulder joint contracture in type II diabetics with rotator cuff disease. J Orthop Res. 2003; 21(6): 1138-44. doi: 10.1016/S0736-0266(03)00102-5
  68. Ryu JD, Kirpalani PA, Kim JM, Nam KH, Han CW, Han SH. Expression of vascular endothelial growth factor and angiogenesis in the diabetic frozen shoulder. J Shoulder Elbow Surg. 2006; 15(6): 679-85. doi: 10.1016/j.jse.2006.01.002.

Abstract   |   Reference

MOJ footer

About Us

The Malaysian Orthopaedic Journal is a peer-reviewed journal that is published three times a year in both print and electronic online version. The purpose of this journal is to publish original research studies, evaluation of current practices and case reports in various subspecialties of orthopaedics and traumatology, as well as associated fields like basic science, biomedical engineering, rehabilitation medicine and nursing.

Keep in Touch

creative-commons License