Prospective cohort study of 195 subjects with asymptomatic rotator cuff tears. Tracks 44 who developed new shoulder pain against 55 who remained asymptomatic over two years. Asks what changes in tear size, shoulder function, and glenohumeral kinematics accompany the transition from asymptomatic to painful disease.
When a patient with a known asymptomatic rotator cuff tear develops new shoulder pain, this paper tells you it is not a benign event: roughly 1 in 4 will have measurable tear enlargement, and ASES scores drop nearly 30 points on average.
Use baseline tear width and side dominance to stratify surveillance. Tears wider than 13 mm and tears on the dominant side warrant closer follow-up intervals and earlier discussion of intervention thresholds.
The preserved external rotation strength in these patients is reassuring but can be misleading — the infraspinatus is intact in small tears, so ER strength testing alone will not reveal disease progression. Scapular plane abduction strength would be a more sensitive screen.
The finding that proximal humeral migration does not occur with small symptomatic tears is a key teaching point: superior migration on radiograph signals advanced disease with infraspinatus involvement, not early supraspinatus-only tears.
Prospective cohort study of 195 subjects with asymptomatic rotator cuff tears. Tracks 44 who developed new shoulder pain against 55 who remained asymptomatic over two years. Asks what changes in tear size, shoulder function, and glenohumeral kinematics accompany the transition from asymptomatic to painful disease.
When a patient with a known asymptomatic rotator cuff tear develops new shoulder pain, this paper tells you it is not a benign event: roughly 1 in 4 will have measurable tear enlargement, and ASES scores drop nearly 30 points on average.
Use baseline tear width and side dominance to stratify surveillance. Tears wider than 13 mm and tears on the dominant side warrant closer follow-up intervals and earlier discussion of intervention thresholds.
The preserved external rotation strength in these patients is reassuring but can be misleading — the infraspinatus is intact in small tears, so ER strength testing alone will not reveal disease progression. Scapular plane abduction strength would be a more sensitive screen.
The finding that proximal humeral migration does not occur with small symptomatic tears is a key teaching point: superior migration on radiograph signals advanced disease with infraspinatus involvement, not early supraspinatus-only tears.