Abstract
Rotator cuff disease is one of the most prevalent shoulder disabilities especially in the elderly population. Tear progression is significantly greater in the symptomatic patients than in the asymptomatic ones. From these aspects, shoulder surgeons interpret surgical indications and counsel patients regarding the risk of non-operative treatments. However, there were a few reports that pain and duration of symptoms were not strongly associated with severity of rotator cuff tears, and non-operative management with physical therapy was effective. There have remained controversies for the treatment of rotator cuff tears.A 59-year-old man with a sedentary work life experienced right shoulder pain with abduction at night. However, the pain kept worsening after two months, and he finally visited our clinic three months after the onset of pain. Magnetic resonance imaging in the coronal and axial planes showed effusion around the subacromial and subcoracoid bursae and joint-side tear of the supraspinatus tendon. A range of motion in the right shoulder was severely restricted at the initial visit of our clinic. After sufficient rehabilitation, the symptoms were not changed and an arthroscopic rotator cuff repair was scheduled. However, during waiting for surgery, he felt something popped in the right shoulder while wearing a jacket. Immediately after this, pain during motion and at night decreased, and he experienced no difficulty with activities of daily living and the surgery was cancelled. This is the first case with a recovery of range of motion and a decrease in pain after progression of a supraspinatus tendon tear.
Highlights
Rotator cuff disease is very common in the elderly population and it is one of the most prevalent shoulder disabilities
The articular aspect of the anterior supraspinatus adjacent to the biceps tendon is the common location for degenerative tears [15, 16], propagating posteriorly into the supraspinatus and infraspinatus tendons [5]
The 15-mm area posterior to the biceps tendon lies at the junction of the supraspinatus and infraspinatus tendons [18] and correlates with the middle of the “rotator crescent”, with the thinner and avascular tissues being compared with the “rotator cable” [19]
Summary
Rotator cuff disease is very common in the elderly population and it is one of the most prevalent shoulder disabilities. Tear enlargement occurred in more severe types and there was development of pain in a time-dependent manner [11] Considering these aspects, shoulder surgeons interpret surgical indications and counsel patients regarding the risk of non-operative treatment [5]. Function and pain are not always associated with rotator cuff tears, and other approaches should be considered to provide better treatment to patients with shoulder problems. The Open Orthopaedics Journal, 2019, Volume 13 85 motion and decrease in pain after progression of a supraspinatus tendon tear
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