Can a six-month-old infant have a rotator cuff injury?

Rotator Cuff Injuries in Six-Month-Old Infants

Rotator cuff injuries are extremely rare in six-month-old infants as these injuries typically occur in older children and adolescents who participate in overhead throwing sports or experience acute trauma. 1

Developmental Considerations

• Rotator cuff injuries in the pediatric population primarily affect adolescents and are associated with sports participation, particularly throwing activities 2, 3
• The skeletally immature shoulder has unique anatomical characteristics including atraumatic microinstability of the glenohumeral joint and weak rotator cuff muscles, but these typically become clinically relevant in older children 1
• Six-month-old infants lack the physical development and activities that typically lead to rotator cuff pathology 1

Age Distribution of Rotator Cuff Injuries

• Research studies on pediatric rotator cuff injuries report cases in children aged 8-18 years, with no documented cases in infants 2
• The mean age for pediatric rotator cuff injuries is approximately 15 years, with most cases occurring in adolescents 3
• Rotator cuff tears are described as "rare under the age of 40 unless accompanied by acute trauma" 4

Mechanism of Injury

• Pediatric rotator cuff injuries typically result from:

  • Repetitive overhead activities in sports (most common) 3, 5
  • Acute traumatic events such as falls or dislocations 6
  • Repetitive eccentric stress on the supraspinatus, external rotators, and scapular stabilizers 1

• Six-month-old infants do not engage in the activities associated with these injury mechanisms 1

Diagnostic Challenges

• If shoulder dysfunction is observed in a six-month-old infant, alternative diagnoses should be considered:

  • Birth-related brachial plexus injuries 2
  • Congenital anomalies of the shoulder 2
  • Non-accidental trauma 2

• MRI is the gold standard for diagnosing rotator cuff pathology in pediatric patients but would rarely be indicated in infants without specific trauma 2, 3

Clinical Implications

• Pain and weakness are common symptoms of rotator cuff dysfunction in older children, but these would be difficult to assess in a six-month-old 1
• The supraspinatus is the most frequently involved tendon in pediatric rotator cuff injuries (56% of cases) 2, 5
• Most pediatric rotator cuff tears are partial-thickness rather than full-thickness tears 2, 3

Management Considerations

• If a rotator cuff injury were to occur in an infant (extremely rare scenario), treatment would be primarily conservative 4
• Surgical management is typically reserved for complete tears or cases that fail conservative treatment in older pediatric patients 3, 6
• Early detection of any shoulder injury is important to prevent long-term functional impairment 1

Key Takeaway

• While rotator cuff injuries have been documented in children and adolescents, there is no evidence in the medical literature supporting the occurrence of rotator cuff injuries in six-month-old infants 1, 2, 3, 5
• If shoulder dysfunction is observed in an infant, consultation with a pediatric orthopedic specialist is warranted to evaluate for more age-appropriate diagnoses 2