Saturday, October 15, 2016

Does cuff tear arthropathy progress in shoulders with asymptomatic cuff tears?.

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

These authors followed 105 subjects with asymptomatic degenerative rotator cuff tears and 33 controls to determine the progression of shoulder arthritis as reflected in 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).

SPO progression was not significantly related to the presence or severity of the cuff defect at baseline.

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.

The authors concluded that glenohumeral arthritic changes progress 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: While some surgeons believe that concern for the advent of cuff tear arthropathy is an indication for cuff repair - even in asymptomatic shoulders - this belief does not appear to be supported by the data presented here.

The term 'cuff tear arthropathy' refers to the loss of the integrity of both the rotator cuff and the glenohumeral articular cartilage. It has yet to be established that the former is the cause of the latter.