Thursday, January 22, 2015

Degenerative rotator cuff tears continue to degenerate over time.

A Prospective Evaluation of Survivorship of Asymptomatic Degenerative Rotator Cuff Tears

These authors conducted a prospective study of patients with an asymptomatic rotator cuff tear in one shoulder and pain due to rotator cuff disease in the contralateral shoulder. Initially there were 118 full-thickness tears, fifty-six partial-thickness tears, and fifty were intact. These shoulders were followed for a median of 5.1 years.

Half of the shoulders demonstrated tear enlargement with a median time to enlargement of 2.8 years.

Over 25% of the 50 intact shoulders progressed to cuff tears (9 to partial thickness and 5 to full thickness tears). Almost 20% of the 56 partial thickness tears progressed to full thickness tears.

Tear-enlargement rates were 61% in the full-thickness-tear group, 44% in the partial thickness-
tear group, and 14% in the control group.
Tear enlargement was associated with the onset of new pain.

Supraspinatus and infraspinatus muscle degeneration increased significantly more in shoulders with tear enlargement than in the shoulders with stable tears.

Comment: This study demonstrates that degenerative rotator cuff tears continue to progress with time. Shoulders with bigger tears are more likely to demonstrate tear progression.

While the authors state that such natural history studies "allow better assessment of the appropriate timing of intervention and identification of specific at-risk groups in which early intervention may be most beneficial," the indications for surgical repair of degenerative tears have yet to be clarified as shown here. The observation that large full-thickness tears are likely to progress over time cannot be taken as evidence that attempting a surgical repair of these tears will restore the integrity of the cuff or prevent degeneration of the associated muscle.


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