Tuesday, January 31, 2017

Rotator cuff pathology can be asymptomatic

Effects of asymptomatic rotator cuff pathology on in vivo shoulder motion and clinical outcomes

These authors suggest that the incidence of asymptomatic rotator cuff tears in population ranges from 15% to 39%. They assessed the effects of asymptomatic rotator cuff pathology on shoulder kinematics, strength, and patient-reported outcomes. They recruited 46 asymptomatic volunteers (age: 60.3± 7.5 years) with normal shoulder function and used ultrasound to document the condition of their rotator cuff. 70% of these asymptomatic patients had cuff pathology!

Shoulder motion was measured with a biplane x-ray imaging system, strength was assessed with a Biodex,, and patient-reported outcomes were assessed using the Western Ontario Rotator Cuff Index and visual analog scale pain scores.

While patients with rotator cuff pathology had somewhat less abduction and elevation strength, 

the authors found no significant differences in the Western Ontario Rotator Cuff Index, visual analog scale, or range of motion.

For shoulders with cuff pathology, the humerus was positioned more inferiorly on the glenoid (P = .018), and the glenohumeral contact path length was longer (P = .007). 

Comment: We do not know the extent of the cuff pathology in these volunteers - the authors only classified them as normal or pathological. Yet it is remarkable that 70% of individuals who felt they had normal function turned out to have rotator cuff pathology on ultrasound. While sophisticated testing could differentiate the two groups, the patients had similar comfort and function. 


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