Increased Risk of Rotator Cuff Tear in U.S. Army Soldiers With a History of Prior Shoulder Impingement Syndrome

Introduction

Military populations and comparable groups of highly physically active civilians may experience increased shoulder loading due to occupational demands, fitness standards, and physical activity. These heightened upper extremity demands may increase the risk of developing shoulder impingement syndrome. Shoulder impingement is hypothesized to increase the risk of rotator cuff tears, an injury with long-term performance implications.

Methods

This is a nested, matched, case-control study using data from active-duty U.S. Army Soldiers from 2016 to 2021 (N=869,651). Incident rotator cuff cases were matched to 4 controls without a prior rotator cuff tear by age, sex at accession (male or female), calendar date of entry into the study, and service time. Poisson regression was used to determine incidence rates, and Cox models were used to estimate hazard ratios. This study was approved by the IRB of the U.S. Army Medical Research and Development Command.

Results

The incidence of shoulder impingements and rotator cuff tears was 2.24 (95% CI=2.10, 2.39) and 0.94 (95% CI=0.86, 1.03) per 1,000 person-years, respectively. Soldiers with a history of impingements had a higher hazard rate for developing a tear (hazard ratio=2.46, 95% CI=2.28, 2.66) than soldiers with no history of impingement.

Conclusions

Shoulder impingement syndrome is associated with an increased risk for rotator cuff tears. Across age groups, the injury risk window for a rotator cuff tear was 2–4 years and less than 1–2 years for those with a prior shoulder impingement.