Commentary on an article by Nathan A. Mall, MD, et al.: “Symptomatic Progression of Asymptomatic Rotator Cuff Tears: A Prospective Study of Clinical and Sonographic Variables”

Abstract

The study by Mall et al. is an important, clinically relevant investigation that highlights the natural history of rotator cuff disease and specifically looks at the progression of asymptomatic tears and the factors associated with this progression. While rotator cuff disease is one of the most common orthopaedic conditions, little is known about its natural history1. The purposes of this study were to identify what happens when an asymptomatic tear becomes symptomatic and to determine what factors are associated with a tear becoming symptomatic. The authors studied a large prospective cohort of 195 patients with asymptomatic rotator cuff tears over a five-year period and found that 23% (forty-four) had pain develop after a relatively short time of approximately two years. The patients whose tears became symptomatic were compared with those who remained pain-free2. The authors found that larger tears were more likely to become symptomatic and that tear progression was associated with increased tear size (both for full-thickness and partial-thickness tears), decreased American Shoulder and Elbow Surgeons (ASES) scores, decreased shoulder range of motion, and increased compensatory scapulothoracic motion. They did not find an association with shoulder external rotation strength or fatty infiltration on imaging studies. They concluded that pain development in shoulders with asymptomatic rotator cuff tears was associated …