How common are infraspinatus tears, especially in individuals over 40 years old who participate in sports or activities with repetitive overhead motions?

Are Infraspinatus Tears Common?

Yes, infraspinatus tears are relatively common, particularly as part of rotator cuff pathology that affects approximately 1 in 50 adults, with prevalence increasing substantially with age—especially in individuals over 40 who engage in repetitive overhead activities. 1

Prevalence in the General Population

The infraspinatus is part of the rotator cuff complex (along with supraspinatus, subscapularis, and teres minor), and rotator cuff tendinopathy affects approximately 2% of all adults (1 in 50) in the general population. 1 However, this prevalence increases dramatically with age:

• 13% of individuals in their 50s have rotator cuff tears 1
• 20% in their 60s 1
• 31% in their 70s 1
• 54% of asymptomatic patients aged 60 years or older have sustained rotator cuff tears 1

Importantly, not all of these tears are symptomatic, meaning many people have tears without knowing it. 1

High-Risk Populations Over Age 40

Individuals over 40 years old who participate in repetitive overhead activities face substantially elevated risk. 1 The American Academy of Orthopaedic Surgeons specifically identifies people older than 40 years as being at greater risk due to normal wear and tear that accompanies aging. 1

Specific High-Risk Groups:

• Athletes who throw repetitively (baseball pitchers, tennis players) are particularly vulnerable to overuse tears from repetitive microtrauma 1
• Overhead laborers (painters, carpenters) who work with arms overhead have greater chance for tears 1
• Dominant arm involvement is more common 1

Infraspinatus-Specific Considerations

While the supraspinatus is the most commonly affected rotator cuff tendon due to its anatomical position in a narrow space with impingement risk, the infraspinatus (located posteriorly) is frequently involved in rotator cuff pathology, particularly in overhead athletes. 1

Large combined tears involving both supraspinatus and infraspinatus are common in patients who perform overhead activities. 2 In overhead throwing athletes specifically, infraspinatus tears greater than 50% are significant enough to warrant surgical consideration when combined with other pathology. 3

Unique Infraspinatus Tear Patterns:

Musculotendinous infraspinatus ruptures represent a distinct entity where the tendon attachment remains intact but the muscle-tendon junction tears, typically presenting with:

• 78% non-traumatic onset 4
• Average age of 50 years 4
• 58% female predominance 4
• Progression to complete fatty infiltration within 6-12 months regardless of treatment 4

Clinical Burden

The overall burden of rotator cuff disease (including infraspinatus involvement) is substantial:

• Approximately 4.5 million patient visits for shoulder pain occur annually in the United States 1
• 250,000 rotator cuff repairs are performed annually 1
• 141% increase in rotator cuff repairs from 1996 to 2006 1
• More than two-thirds of patients treated with rotator cuff repair are of working age 1

Key Clinical Pitfalls

Degenerative tears are more common than acute traumatic tears, particularly in patients with previous rotator cuff pathology or those over 40. 1, 5 This is critical because patients and clinicians may attribute tears to specific traumatic events when the underlying pathology is degenerative. 5

Asymptomatic tears are extremely common—54% of patients over 60 have tears without symptoms—so finding a tear on imaging does not necessarily mean it is the source of current symptoms. 1