Association between hormone replacement therapy and clinical outcomes in women with rotator cuff tears
Andrew J. Nasr1,2, Wenting Liu3, Folefac Atem3, Rashmi Pathak4, Michael Khazzam5, Nitin B. Jain4
1School of Physical Therapy, Texas Woman's University, Dallas, TX, USA
2Institute for Women's Health, Texas Woman’s University, Dallas, TX, USA
3Department of Biostatistics and Data Science, University of Texas Health Science Center, Houston, TX, USA
4Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
5Baylor Scott & White, Orthopaedic Associates of Dallas, Complex Shoulder Institute, Grapevine, TX, USA
Keywords: Clinical outcomes, rotator cuff repair, rotator cuff tear, sex hormones, shoulder arthroscopy.
Abstract
Objectives: This study aims to evaluate the association between hormone replacement therapy (HRT) use and clinical outcomes in women with rotator cuff tears (RCTs) over a five-year follow-up period.
Patients and methods: Between February 2011 and June 2015, a total of 77 women aged ≥ 45 years with symptomatic RCTs in a multi-center cohort were retrospectively analyzed. The HRT status was self-reported. Patient-reported outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Shoulder Pain and Disability Index (SPADI), and Mental Health Inventory (MHI), assessed at multiple time points over 60 months. Magnetic resonance imaging data were used to evaluate tear size, muscle atrophy, and fatty infiltration.
Results: Of a total of 77 women included in the analysis, the HRT group consisted of 13 patients and the non-HRT group consisted of 64 patients. The mean age of women receiving HRT was 58.7 ± 7.0 years, compared to 63.5 ± 8.6 years in those not on HRT (p = 0.061). No statistically significant differences in baseline characteristics or clinical outcomes were observed between HRT and non-HRT groups (p > 0.05). Patients on HRT showed distinct recovery trends, particularly among those managed non-operatively, with early improvements in ASES and SPADI scores that fluctuated over time. Imaging analysis revealed significantly greater odds of moderate-to-severe muscle atrophy in the HRT group (p = 0.0187), although fatty infiltration and tear size did not significantly differ.
Conclusion: Hormone replacement therapy use demonstrated distinct functional recovery trends in women with rotator cuff tears, particularly among non-operatively managed patients, though no statistically significant differences in overall clinical outcomes were observed. These findings suggest that hormonal status may selectively influence musculoskeletal recovery and warrant further investigation to better inform sex-specific management for rotator cuff tears during and following the menopause transition
Citation: Nasr AJ, Liu W, Atem F, Pathak R, Khazzam M, Jain NB. Association between hormone replacement therapy and clinical outcomes in women with rotator cuff tears. Arch ISPRM 2026;1(2):180-190. https://doi.org/10.5606/archisprm.2026.19.
A.J.N., N.B.J.: Conceptualization, investigation, visualization; NA.J.N., F.A., W.L., R.P., N.B.J.: Methodology; F.A., W.L., R.P.: Software; A.J.N., F.A., W.L., R.P., N.B.J.: Validation; F.A., W.L., R.P.: Formal analysis; N.B.J.: Resources; A.J.N., F.A., W.L., R.P., M.K., N.B.J.: Data curation; A.J.N., W.L., R.P.: Writing-original draft preparation; A.J.N., W.L., F.A., R.P., M.K., N.B.J.: Writing-review and editing; N.B.J.: Supervision, funding acquisition;M.K., N.B.J.: Project administration. All authors have read and agreed to the published version of the manuscript.
The authors declare that there are no conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data Availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
This work was supported by NIH grant number: R01AR074989 (NIAMS).
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