Sunday, June 1, 2014

Rotator cuff tears: pain does not correlate with tear size

Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear.

The authors studied 393 subjects with an atraumatic symptomatic full-thickness rotator-cuff tears.

48% were female. average age 61 years, dominant shoulder involved in 69%. 
Duration of symptoms was up to three months for 30%, four to six months for 20%, seven to twelve months for 15%, and more than a year for 36%. 
The tear involved only the supraspinatus in 72%; the supraspinatus and infraspinatus in 21%; and only the subscapularis in 7%. 
Tendon retraction was minimal in 48%, midhumeral in 34%, glenohumeral in 13%, and to the glenoid in 5%. 
Humeral head migration was noted in 16%. 
The median baseline VAS pain score was 4.4.

Their analysis indicated that increased comorbidities, lower education level, and race (p = 0.041) were the only significant factors associated with pain on presentation. No measure of rotator cuff tear severity correlated with pain.

Comment: We had the opportunity to provide commentary on this article: Shoulder Pain Does Not Parallel Rotator Cuff Tear Size - What Does That Tell Us? We recalled that the indications for rotator cuff repair surgery remain ambiguous, especially since the clinical outcomes after cuff repair do not differ significantly between the patients who have durable healing of the repair and those who had failure of the repair to endure.

The authors observed that three patient characteristics - comorbidities, lower educational level and race but not tear severity - were associated with the level of pain. It is important to note that none of these three pain associated factors are changed by an attempt at surgical repair. Here are some further thoughts on indications for cuff repair. A complete discussion of cuff tears can be found here.


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