A Clinical Study of Elderly Patients with Rotator Cuff Tear in Relation to Acromial Bony Spur

Objective:To observe elderly patients with rotator cuff tear in relation to acromial bony spur by a retrospective analysis of preoperative Japanese patients'X-ray film with rotator cuff tear of elderly patients.Methods:456 roentgenograms of 427 elderly patients(≥61 yrs,from 1970 to 1998) with rotator cuff tear were collected in Nobuhara hospital of Japan.The clinical documents and the morphologic changes on roentgenograms of acromial spurs were reviewed and the size of spurs(Grade A≥1~5mm,Grade B≥5~10mm,Grade C≥10mm)and the interval between the acromion and the humeral head(AHI)were measured on the roentgenogram.Data analysis of clinical cases included:patient's age,sex,history and past history of shoulder disease,treatment,surgery and so on.All of clinical cases were analyzed statistically by SPSS 13.0 software.Results:According to the morphological changes of acromial Spur,Six types of classification of acromial spur shape were summarized:(TypeⅠ)Normal acromion(39.7%);(Type Ⅱ)Beneath the acromion(12.9%);(Type Ⅲ)Lateral to the acromion(2.6%);(Type Ⅳ)Attached to the CA-ligament(11.2%);(Type Ⅴ)At the AC joint(17.1%) and(Type Ⅵ)The double border sign of the acromion(16.7%).There were 202 shoulders(44.3%)with Grade A,68 shoulders(14.9%)with Grade B and 5 shoulders(1.1%)with Grade C in this research.The incidence of acromial bony spurs(5mm)with significant clinical symptoms was 16.0%.Trauma result in rotator cuff tear of 203 shoulders(44.5%).32 shoulders(7.0%)were caused by overuse and tiredness.There were nothing reasons for 221 shoulders(48.5%)with rotator cuff tear.The mean AHI(between the acromion and the humeral head) in this article were(8.6±2.7)mm[(8.7±2.4)mm in male,(8.4±2.3)mm in female,(P0.05)].The AHI of patients were(8.2±2.5)mm with bony spurs and(8.9±2.7)mm without bony spur(P0.05).There were 91 shoulders suffered from incomplete rotator cuff tear and 365 shoulders got complete rotator cuff tear.Conclusion:Our morphological classification of acromial bony spur on Shoulder X-ray film is helpful to doctor diagnosing elderly patients'shoulder disease.The rotator cuff tear significantly relate to acromial bony spur of shoulder in this study.With the patient's age increasing,the rotator cuff tendon and acromion gradually degenerating,mild micro-trauma could clearly cause rotator cuff tear.A 60-years-old or more senile person with acromial bony spur,combining with symptom of shoulder,should be considered on rotator cuff tear.