Q: Is everything that goes wrong with muscles, tendons, and joints related to age? I've had two shoulder injuries that the surgeon says are both caused by "degeneration". One was a rotator cuff tear. The other was a tear in the biceps pulley I'm 72-years-old, so what's going to go next?

A: It's true there are certain changes that occur in the musculoskeletal system as we get older. For example, age-related loss in muscle mass, strength, and endurance of skeletal muscle is termed sarcopenia.

Sarcopenia involves both the reduction of muscle mass and/or function as well as the impairment of the muscle’s capacity to regenerate. Muscle mass is lost at a rate of four to six per cent per decade starting at age 40 in women and age 60 in men.

The greatest decline in both men and women occurs with inactivity, acute illness, and after age 70, at which time the mean loss of muscle mass has been measured as one per cent per year. At all ages, females appear to be more vulnerable to loss of lean tissue than males. However, in men and women, muscle strength can be maintained through exercise well into old age.

It remains unknown how much sarcopenia occurs as a result of decreased physical activity and exercise capacity or whether this decline is a function of age, lack of motivation, age-associated decreases in metabolism, or other factors such as anemia, diabetes, poor circulation or other chronic health problems.

Shoulder problems such as you have experienced are more common in older adults (65 years old and older). Rotator cuff tears (often accompanied by lesions of the biceps pulley), shoulder instability, osteoarthritis are the most common shoulder problems in this older age group. Everything points to the saying, "Use it or lose it." Good nutrition along with daily activity and exercise seem to be the ticket to healthy aging.

Reference: Sepp Braun, MD, et al. Lesions of the Biceps Pulley. In The American Journal of Sports Medicine. April 2011. Vol. 39. No. 4. Pp. 790-795.