Factors associated with pain in nonsurgically treated rotator cuff tears -A study with magnetic resonance imaging

Yoshihiro Nakamura,Nobuo Adachi,Shin Yokoya,Yohei Harada,Mitsuo Ochi

doi:10.1186/s13018-019-1178-x

Abstract

BackgroundIn rotator cuff tears, some cases become asymptomatic with nonsurgical treatment, others remain symptomatic. The purpose of this study was to identify factors associated with pain in nonsurgically treated rotator cuff tears using magnetic resonance imaging (MRI).MethodsIn total, 108 shoulders diagnosed with supraspinatus (SSP) tendon tears using MRI were nonsurgically treated, and MRI was repeated after more than a year. The patients were divided into pain or improvement group according to whether the pain persisted or disappeared. Bursal fluid accumulation; SSP tendon retraction; subscapularis (SSC) tendon tears; infraspinatus (ISP) tendon tears; and Goutallier classification into SSC, SSP, and ISP were included as evaluation factors. Predictive factors for persistent pain on initial MRI and factors associated with persisting pain after nonsurgical treatment on repeat MRI were statistically analyzed using multivariate logistic regression analysis.ResultsThe improvement group showed a significant decrease in bursal fluid accumulation compared with the pain group (p < 0.01). SSC tendon tears (OR, 4.42; 95% CI, 1.16–16.9; P = 0.03) on initial MRI were significantly associated with persistent pain. Bursal fluid accumulation (OR, 2.44; 95% CI, 1.18–5.07; P = 0.02) and SSC tendon tears (OR, 2.25; 95% CI, 1.15–4.39; P = 0.02) on repeat MRI were significantly associated with persistent pain.ConclusionsBursal fluid accumulation decreased when pain improved. The involvement of SSC tendon tears can serve as a predictive factor for persistent pain. Pain may persist although patients with rotator cuff tears including SSC tendon tears are nonsurgically treated.Level of evidenceLevel IV case-control study

Highlights

In rotator cuff tears, some cases become asymptomatic with nonsurgical treatment, others remain symptomatic
Multivariate logistic regression analysis found that bursal fluid (OR, 2.80; 95% confidence intervals (CIs), 1.40–5.61; P = 0.04) and SSC tendon tears (OR, 2.37; 95% CI, 1.21–4.64; P = 0.01) on repeat magnetic resonance imaging (MRI) were significantly associated with persistent pain (Table 5)
We evaluated factors associated with pain in nonsurgically treated SSP tendon tears by MRI

Summary

Introduction

Some cases become asymptomatic with nonsurgical treatment, others remain symptomatic. The purpose of this study was to identify factors associated with pain in nonsurgically treated rotator cuff tears using magnetic resonance imaging (MRI). A rotator cuff tear is a common cause of pain and disability of the shoulder among adults. Some rotator cuff tears are symptomatic, whereas others are asymptomatic [1, 2]. Treatment strategy for rotator cuff tears remains unclear [3]. Because nonsurgical treatment often improves the pain and range of motion in patients with symptomatic rotator cuff tears [4], it is typically preferred as the first-line treatment [5, 6]. Surgical treatment is occasionally required when symptoms do not improve.

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