Does sarcopenia influence rotator cuff tear patterns? Radiological insights from patients with rotator cuff syndrome

Objectives: This study aims to determine whether sarcopenia is associated with the presence, severity, or type of rotator cuff tears in patients with rotator cuff syndrome. It also assesses how the degree of shoulder pain and functional disability relate to the existence of sarcopenia in patients with rotator cuff syndrome, as well as examines the impact of the patients' clinical characteristics and physical activity levels on sarcopenia. Patients and methods: In this cross-sectional study conducted between October 2024 and October 2025, 130 patients with shoulder pain lasting at least three months were assessed, of whom 124 (25 males, 99 females; mean age: 60.4±10.3 years; range: 40 to 85 years) met the study criteria and were included in the analysis. Of these, 69 were sarcopenic, 15 presarcopenic, and 40 non-sarcopenic. Sarcopenia was evaluated using the ISarcoPRM diagnostic algorithm, which includes gait speed, handgrip strength, chair stand test, and ultrasonographic measurement of anterior thigh muscle thickness. Shoulder magnetic resonance imaging scans were assessed for the presence, type, and severity of rotator cuff tears, focusing particularly on supraspinatus tears, tendinosis, muscle atrophy (tangent sign), and impingement. Results: Comparative analysis of the three groups revealed no statistically significant differences in supraspinatus tear, supraspinatus tendinosis, tendinosis of other rotator cuff muscles, impingement, or tangent signs. The most prominent result of this study was the significantly higher prevalence of diabetes mellitus and hypertension among sarcopenic patients (p<0.001). Another important finding was that the tangent sign, a radiological indicator of rotator cuff atrophy, did not change with the presence of sarcopenia; however, it was more frequently positive in patients aged 60 years or older (p=0.013). Conclusion: While sarcopenia was not associated with differences in rotator cuff pathology or radiological atrophy as indicated by the tangent sign, it was significantly linked to a higher prevalence of diabetes mellitus and hypertension. Age, rather than sarcopenia, appeared to influence the presence of radiological markers of rotator cuff atrophy.