Yamaguchi, J Bone Joint Surg Am 2006 - The Demographic and Morphological Features of Rotator Cuff Disease. A Comparison of Asymptomatic and Symptomatic Shoulders
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The Demographic and Morphological Features of Rotator Cuff Disease. A Comparison of Asymptomatic and Symptomatic Shoulders
Yamaguchi, Teefey, et al.·J Bone Joint Surg Am·2006·900 citations·Cross-sectional study
Yamaguchi and colleagues compared how often painful and painless rotator cuff disease occurred, and how the tears differed in form, in patients presenting with pain in one shoulder.
Bilateral ultrasound study of 588 consecutive patients with one painful shoulder, Washington University, St. Louis.
Methods
Design
Retrospective cross‑sectional review
Data source
Standardized ultrasound of both shoulders
Performed by 2 experienced radiologists
Patients
588 consecutive patients
Unilateral shoulder pain
Exposure
Age
Gender
Side
Cuff thickness
Tear presence and size
Outcomes
Tear status of each shoulder
Association of each factor with pain
Key Findings
Tear status tracked age: patients without a tear averaged 48.7 years, those with a tear on one side 58.7 years, and those with tears on both sides 67.8 years.
Of the 588 patients, 212 had intact cuffs on both sides, 199 had a partial- or full‑thickness tear in one shoulder, and 177 had tears in both.
In patients with tears on both sides but pain on only one, the painful tear was about 30% larger on average (p < 0.01).
Among 183 patients with a full‑thickness tear on the painful side, 35.5% (65) also had a full‑thickness tear in the painless shoulder.
Among 217 patients with a normal cuff on the painful side, only 1 (0.5%) had a full‑thickness tear on the other side, and 212 (97.7%) had normal findings there.
Because tear size appears to matter for symptoms, the authors recommended yearly surveillance of known tears managed nonoperatively.
Board pearl
By logistic regression, the likelihood of tears in both shoulders reached 50% after age 66 (p < 0.01).
Authors' conclusion
There is a high correlation between the onset of rotator cuff tears (either partial or full thickness) and increasing age. Bilateral rotator cuff disease, either symptomatic or asymptomatic, is common in patients who present with unilateral symptomatic disease. As the size of a tear appears to be an important factor in the development of symptoms, we recommend surveillance at yearly intervals for patients with known rotator cuff tears that are treated nonoperatively.
Yamaguchi and colleagues compared how often painful and painless rotator cuff disease occurred, and how the tears differed in form, in patients presenting with pain in one shoulder.
Bilateral ultrasound study of 588 consecutive patients with one painful shoulder, Washington University, St. Louis.
Methods
Design
Retrospective cross‑sectional review
Data source
Standardized ultrasound of both shoulders
Performed by 2 experienced radiologists
Patients
588 consecutive patients
Unilateral shoulder pain
Exposure
Age
Gender
Side
Cuff thickness
Tear presence and size
Outcomes
Tear status of each shoulder
Association of each factor with pain
Key Findings
Tear status tracked age: patients without a tear averaged 48.7 years, those with a tear on one side 58.7 years, and those with tears on both sides 67.8 years.
Of the 588 patients, 212 had intact cuffs on both sides, 199 had a partial- or full‑thickness tear in one shoulder, and 177 had tears in both.
In patients with tears on both sides but pain on only one, the painful tear was about 30% larger on average (p < 0.01).
Among 183 patients with a full‑thickness tear on the painful side, 35.5% (65) also had a full‑thickness tear in the painless shoulder.
Among 217 patients with a normal cuff on the painful side, only 1 (0.5%) had a full‑thickness tear on the other side, and 212 (97.7%) had normal findings there.
Because tear size appears to matter for symptoms, the authors recommended yearly surveillance of known tears managed nonoperatively.
Board pearl
By logistic regression, the likelihood of tears in both shoulders reached 50% after age 66 (p < 0.01).
Authors' conclusion
There is a high correlation between the onset of rotator cuff tears (either partial or full thickness) and increasing age. Bilateral rotator cuff disease, either symptomatic or asymptomatic, is common in patients who present with unilateral symptomatic disease. As the size of a tear appears to be an important factor in the development of symptoms, we recommend surveillance at yearly intervals for patients with known rotator cuff tears that are treated nonoperatively.