Safran and colleagues rescanned nonoperatively treated full‑thickness cuff tears in patients 60 or younger after 2 to 3 years to see how often they grew.
Case series of 51 patients with 61 tears from one Jerusalem ultrasound practice, rescanned at a mean 29 months by the same sonographer.
Key Findings
Of 61 tears, 30 grew by 5 mm or more (mean 12 mm), 26 were unchanged and 5 shrank. Four of the 5 were no longer seen.
New full‑thickness tears appeared in 10 of 41 shoulders that were intact at the first scan.
Growth was not related to age, sex, prior trauma, initial tear size or having tears in both shoulders.
Tears grew in 56% of patients with considerable pain at follow‑up vs 25% of those with little or no pain (P = .002).
Repeat scans by the same sonographer varied by a mean 1.8 mm, which set the 5 mm threshold. How patients were chosen for nonoperative care is unknown.
Board pearl
Pain was the only factor linked to tear growth. It was measured at the follow‑up visit, alongside the second scan, so it marks an association rather than an early warning sign.
Authors' conclusion
Full-thickness rotator cuff tears tend to increase in size in about half of patients aged 60 years or younger. Surgery should be initially considered in these patients to prevent a probable increase in size tear. Patients treated nonoperatively should be routinely monitored for tear size increase, especially if they remain symptomatic.
Safran and colleagues rescanned nonoperatively treated full‑thickness cuff tears in patients 60 or younger after 2 to 3 years to see how often they grew.
Case series of 51 patients with 61 tears from one Jerusalem ultrasound practice, rescanned at a mean 29 months by the same sonographer.
Key Findings
Of 61 tears, 30 grew by 5 mm or more (mean 12 mm), 26 were unchanged and 5 shrank. Four of the 5 were no longer seen.
New full‑thickness tears appeared in 10 of 41 shoulders that were intact at the first scan.
Growth was not related to age, sex, prior trauma, initial tear size or having tears in both shoulders.
Tears grew in 56% of patients with considerable pain at follow‑up vs 25% of those with little or no pain (P = .002).
Repeat scans by the same sonographer varied by a mean 1.8 mm, which set the 5 mm threshold. How patients were chosen for nonoperative care is unknown.
Board pearl
Pain was the only factor linked to tear growth. It was measured at the follow‑up visit, alongside the second scan, so it marks an association rather than an early warning sign.
Authors' conclusion
Full-thickness rotator cuff tears tend to increase in size in about half of patients aged 60 years or younger. Surgery should be initially considered in these patients to prevent a probable increase in size tear. Patients treated nonoperatively should be routinely monitored for tear size increase, especially if they remain symptomatic.