Sunday, July 16, 2017

Does the size of the cuff tear matter?

Patient self-assessed shoulder comfort and function and active motion are not closely related to surgically documented rotator cuff tear integrity.

The rationale for rotator cuff repair surgery is that better integrity of the cuff should be associated with better comfort and function. However, in patients with cuff disease, there is not good evidence that the degree of rotator cuff integrity is closely associated with the shoulder's comfort, function, or active motion. The goal of this study was to explored these relationships in shoulders with surgically documented cuff disease.

In 55 shoulders having surgery for cuff-related symptoms, the authors correlated the preoperative Simple Shoulder Test score with the objectively measured preoperative active shoulder motion and with the integrity of the cuff observed at surgery.

The 16 shoulders with tendinosis or partial-thickness tears had an average Simple Shoulder Test score of 3.7 ± 3.3, active abduction of 111° ± 38°, and active flexion of 115° ± 36°. The corresponding values were 3.6 ± 2.8, 94° ± 47°, and 94° ± 52° for the 22 full-thickness supraspinatus tears and 3.9 ± 2.7, 89° ± 39°, and 100° ± 39° for the 17 supraspinatus and infraspinatus tears.

In the plots below, one can see the wide variations in the SST scores, the active flexion, and the active abduction in the shoulders with (a) 'intact' cuffs with tendinosis or partial tears, (b) full-thickness supraspinatus tears, and (c) supraspinatus and infraspinatus tears. In this group of shoulders with surgically-documented pathology, the size of the cuff tear did not have an effect on patient self-assessed comfort and function (as measured by the Simple Shoulder Test) or on active flexion or abduction (as objectively measured by the Kinect motion capture system).

Comment: In this study, surgically observed cuff integrity was not strongly associated with the shoulder's comfort or function. The management of patients with rotator cuff disorders needs to be informed by a better understanding of the factors other than cuff integrity that influence the comfort and functioning of shoulders with cuff disease.

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