Factors associated with choice for surgery in newly symptomatic degenerative rotator cuff tears: a prospective cohort evaluation

Abstract

Background: The patient-related factors for the perceived need for surgery for degenerative rotator cuff tears are not known. The purpose of this study is to examine patient-and tear-specific factors leading to surgery in newly painful degenerative rotator cuff tears. Methods: Asymptomatic, degenerative rotator cuff tears were followed prospectively to identify the onset of pain and tear enlargement. Newly painful tears were continually monitored with a focus on identifying patient-specific (age, occupation, activity level) and tear-specific (tear type and size, tear progression, American Shoulder and Elbow Surgeons score, muscle degeneration) factors that are associated with surgical intervention. Results: Forty-eight of 169 newly painful shoulders were eventually managed surgically. Factors associated with surgical treatment included younger age (P ¼ .0004), pain development earlier in surveillance (P ¼ .0002), a greater increase in pain (P ¼ .0001), a decline in American Shoulder and Elbow Surgeons score (P < .0001), and a history of contralateral shoulder surgery (P ¼ .0006). Eighty-five of the 169 tears (50%) enlarged either before or within 2 years of pain development. Neither tear type (P ¼ .13), tear enlargement (P ¼ .67) nor tear size (P ¼ .51) was associated with surgery. Neither the severity of muscle degeneration, occupational status, hand dominance, Shoulder Activity Score, nor changes in RAND-12 mental or physical scales differed between groups. Discussion: For newly painful rotator cuff tears, patient-specific factors such as younger age and prior surgery on the contralateral shoulder are more predictive of future surgery than tear-specific factors or changes in tear size over time.

Relationship between the progression of posterosuperior rotator cuff tear size and shoulder abduction function: A cadaveric study via dynamic shoulder simulator

“…This controversy may result from the rotator cuff tear (RCT) size and the physical demand of individual patients ( Keener, et al, 2017 ; Rizvi, et al, 2021 ). Mild PSRCT patients with minimal physical requirements might not notice any symptoms, while severe PSRCT patients with more physical demands suffer greatly in daily life ( Kim, et al, 2019 ; Kwon, et al, 2019 ; Keener, et al, 2020 ). The former may respond favorably to non-operative treatment, and surgical intervention may be more suited for the latter.…”