Asymptomatic Rotator Cuff Tears

Abstract

• Asymptomatic rotator cuff tears (RCTs) are prevalent in the general population; they are positively associated with age and are common in the contralateral shoulder of individuals who are being treated for shoulder pain or a symptomatic RCT. • Asymptomatic RCTs are likely to become symptomatic over time, corresponding with decreased patient-reported function, strength, and range of motion. • Previous studies have largely reported inconsistent findings regarding patient-reported outcomes, strength, range of motion, and kinematics in individuals with asymptomatic RCTs. • Future research would benefit from characterizing any functional alteration that is associated with asymptomatic rotator cuff pathology, including determining whether such alterations are detrimental or compensatory and understanding the mechanism by which an asymptomatic RCT becomes symptomatic. Rotator cuff tears (RCTs) are common, affecting approximately 40% of the population who are >60 years of age 1-3 and substantially impacting an individual's function 4,5. Approximately 250,000 rotator cuff repairs are performed annually in the United States 6 , accounting for $3 to $5 billion per year in medical costs, Workers' Compensation benefits, and lost productivity 7,8. The rotator cuff has received considerable research attention over the last 30 to 40 years (Fig. 1), and these efforts have contributed greatly to our knowledge regarding the spectrum of rotator cuff pathology. For example, previous research has documented RCT risk factors 3,9-12 , natural history 13-17 , clinical imaging considerations 18 , and outcomes of nonsurgical 19-21 and surgical 22-24 interventions. Despite an increase over time in our understanding of the healthy and the pathologic rotator cuff and the advances in surgical repair techniques, a recent review by McElvany et al. concluded that clinical outcomes after rotator cuff repair have not improved appreciably over the last 30 years 25 .

Duration of Static and Dynamic Periods of the Upper Arm During Daily Life of Manual Wheelchair Users and Matched Able-Bodied Participants: A Preliminary Report

“…Increased PC-WUSPI (shoulder pain) scores of MWC users were associated with decreased consecutive dynamic periods in elevations above 120° on the dominant side. Determining effects of pain on arm use is complicated because risk factors for pain development are largely unknown, shoulder pathology can exist with and without pain, and experts disagree about the source of symptoms (Lawrence et al, 2019 ). Our participants had an average PC-WUSPI score that is a fairly low level of pain; a previous study enrolled participants without pain as defined as WUSPI scores <12 (Mulroy et al, 2015 ).…”

“…Current limitations in sensor technology and algorithms do not allow for the measurement/calculation of the plane of elevations that accompany the humeral elevation angles within the context of the field-based protocol we used. Yet, studies indicate that the plane of elevation affects the subacromial space for the tendon and the intramuscular pressure of the tendon (Järvholm et al, 1988 ; Palmerud et al, 2000 ; Lawrence et al, 2019 ), likely impacting risk to the tendons. Finally, a previous study found that up to 4 days of data collection are needed to reliably represent propulsion trends in a MWC user's daily life with a wearable accelerometer mounted on the wrist (Schneider et al, 2018 ).…”

Increased acromiohumeral distance in a double-row arthroscopic rotator cuff surgery compared to a single-row surgery after 12 months

“…Our study results show that the single- or double-row rotator cuff arthroscopic repairs do not significantly affect the RI. There are several studies for evaluating the superiority of the double-row repairs to the single-row repairs [ 1 – 3 , 7 , 15 – 17 ]. In some prospective randomized trials, Carbonel et al and Ma et al showed better functional results for double-row repairs on larger (>3cm) tears with no effect on RI [ 1 , 18 ].…”

What Is the Diagnosis in Patients with Type 2 Diabetes Who Have a Painful Shoulder? Results from a Prospective Cross-Sectional Study

“…In clinical practice, ultrasound findings should always be interpreted together with the clinical findings to determine the cause of symptoms. Several shoulder imaging studies have shown that asymptomatic pathology findings are present, for example supraspinatus tears and osteoarthritis of the AC joint [ 56 , 57 ], and these asymptomatic findings are likely to become symptomatic over time [ 57 ]. Surprisingly, we also found ultrasound abnormalities of subacromial pathology in 16 out of 17 patients with a clinical glenohumeral disorder, while only 2 out of these 17 patients had ultrasound evidence of glenohumeral pathology.…”