Monday, September 19, 2016

Cuff tear arthropathy - does progression of arthritis correlate with tear size and tear size progression?

Radiographic progression of arthritic changes in shoulders with degenerative rotator cuff tears

These authors sought to determine the midterm risk of and risk factors for rotator cuff tear arthropathy progression in a cohort of subjects with an asymptomatic rotator cuff tear.

Baseline (visit 1), 5-year (visit 2), and most recent follow-up (visit 3) radiographs were reviewed in a cohort of 105 subjects enrolled for longitudinal surveillance of asymptomatic degenerative rotator cuff tears and 33 controls. The radiographs were assessed in a blinded, randomized fashion by 3 observers who graded glenohumeral arthritic changes using the Hamada scores, Samilson-Prieto (SPO) scores, and acromiohumeral interval (AHI).

Osteoarthritis (SPO classification), cuff tear arthropathy (Hamada classification), and AHI progressed between visits 1 and 3 (median, 8 years; P < .001 in all cases). SPO progression was not significantly different for partial- vs. full-thickness vs. control baseline tear types (P = .19). Both full-thickness and partial-thickness tears had greater progression in Hamada scores than controls did in the first 5 years of follow-up (P = .02 and P = .03, respectively), but scores did not differ between partial- and full-thickness tears. Tears with and without enlargement did not differ in progression in SPO grade, Hamada grade, or AHI.

Progression in Hamada and SPO grades was not associated with the size of the tears at baseline. Progression of SPO grade, Hamada grade, and AHI was similar for tears that did and did not enlarge.

They concluded that glenohumeral arthritic changes progress significantly but remain minimal within an 8-year period in early to moderate degenerative cuff disease. Whereas the presence of a rotator cuff tear influences progression in Hamada grade, the magnitude of radiographic progression is not influenced by tear severity or enlargement at midterm time points.

Comment: Here's some illustrations of 'full blown' cuff tear arthropathy.
It is not clear whether cuff tear arthropathy represents combined degeneration of the cuff and joint cartilage or whether it is degeneration of the joint cartilage resulting from  the cuff degeneration. At present we do not know if attempting rotator cuff repair reduces the risk of a patient's developing clinically significant cuff tear arthropathy.

Additional information on cuff tear arthropathy can be found at this link