What is the most common tendon tear resulting from a fall?

From the Guidelines

The most common tendon tear resulting from a fall is the rotator cuff tear, particularly the supraspinatus tendon of the shoulder. When a person falls, they often instinctively extend their arm to break the fall, placing sudden stress on the shoulder joint and its supporting structures. The supraspinatus tendon, which helps lift the arm away from the body, is especially vulnerable during this type of trauma. Falls can cause either partial or complete tears of this tendon, resulting in pain, weakness, and limited range of motion in the affected shoulder. Older adults are at higher risk for these injuries due to age-related tendon degeneration, as falls are a major problem in community-dwelling older persons, with one-third of older persons living at home falling annually 1. Other common fall-related tendon tears include the Achilles tendon (when landing awkwardly on the foot), quadriceps tendon (when the knee buckles during a fall), and biceps tendon (when catching oneself with an outstretched arm).

Key Points to Consider

• The evaluation of a patient who has fallen or is at high risk of falling involves not only a thorough assessment for traumatic injuries but also an assessment of the cause of the fall and an estimation of future fall risk 1.
• Falls are increasingly common, occurring in up to 1/3 of the population over 65 years old, and can lead to significant morbidity and mortality compared to younger patients 1.
• Clinical practice guidelines for fall prevention and management recommend a multifaceted approach, including assessment of fall risk, evaluation of the cause of the fall, and implementation of strategies to prevent future falls 1.
• Treatment of tendon tears resulting from falls depends on the severity of the tear, ranging from conservative management with rest, ice, physical therapy, and anti-inflammatory medications for partial tears to surgical repair for complete tears or those that don't respond to conservative treatment.

Recommendations for Practice

• Clinicians should prioritize the prevention of falls in older adults, as falls are a major risk factor for morbidity and mortality in this population 1.
• A thorough assessment of the cause of the fall and an estimation of future fall risk should be performed for all patients who have fallen or are at high risk of falling 1.
• Clinical practice guidelines for fall prevention and management should be followed, and a multifaceted approach should be implemented to prevent future falls 1.

From the Research

Tendon Tears Resulting from a Fall

• The most common tendon tear resulting from a fall is a rotator cuff tear, with the supraspinatus tendon being the most frequently affected 2.
• A simple fall on the shoulder can cause an acute rotator cuff tear, and fall-related tears are not restricted to young individuals, but can affect patients of any age 2.
• The postulated pathomechanism is a sudden stretch of the tendon-muscle unit while contracting (eccentric loading), which can cause a partial or full-thickness tear 2.
• The supraspinatus tendon is involved in 84% of tears, and infraspinatus is torn in 39% of shoulders, while subscapularis tears are present in 78% of injuries 3.

Characteristics of Rotator Cuff Tears

• Rotator cuff tears can be caused by a combination of traumatic and degenerative elements, making surgical repair challenging 4.
• Tear size can vary, with 22% of tears being <3 cm, 36% being 3 to 5 cm, and 42% being >5 cm 3.
• Patient age, number of tendons involved, tear size, and smoking are risk factors for tendon "retears" after surgical intervention 4.

Treatment and Outcomes

• Platelet-rich plasma (PRP) injection has been studied as a potential treatment for rotator cuff tears, with some studies suggesting improved pain relief and function in the short term 5, 4.
• However, the long-term effects of PRP injection are less clear, and further investigation is needed to determine its efficacy compared to physiotherapy 5, 4.
• Surgical repair of traumatic rotator cuff tears can result in acceptable outcomes, with improved active forward elevation and UCLA and Constant scores 3.