The rate of full-thickness rotator cuff tear progression.
Rotator cuff tears (RCTs) are thought to be the most common cause of shoulder pain in adults, with the prevalence ranging from 20-34%.
It is reported that most who have radiographically confirmed RCTs are symptomatic and 17-23% are asymptomatic. The fact that with an observable RCT, there is up to 1 in 4 chance that the individual is asymptomatic, has made the cause of the pain unclear.
In order to add light to the situation, this study sought to find the natural history of non-operatively treated symptomatic and asymptomatic full-thickness RCTs and note any observable difference in the rate of tear progression in each of the groups.
A systematic review was conducted to find studies which looked at the natural progression of full-thickness RCTs.
In order to be included in this review, the original studies had to have described the increase of tear size in 5 mm increments or greater. In the end, 8 studies were included for comparison.
When data were synthesised using the analytical computerised program, the rate of tear progression in asymptomatic tear group was found to be 40.6% over a period of 46.8 months. In the symptomatic tear group, the progression was 34.1% over a period of 37.8 months.
It can therefore be concluded that the rate of progression of full-thickness rotator cuff tears in symptomatic and asymptomatic groups is very similar over time.
Expert opinion by Jonathan Ko
The article was derived from a journal for arthroscopic surgery, so there is a need to examine and implement the data with caution when applying this to physiotherapy.
What this evidence suggests is that the rate of progression of the tear size is very similar in both the symptomatic and asymptomatic groups.
Whether or not there were changes in symptoms as the tear size increased in the asymptomatic group, or whether the pain had worsened with the tear progression in the symptomatic group is not discussed in the paper.
> From: Kwong et al., Arthroscopy 35 (2019) 228-234. All rights reserved to Elsevier Inc. Click here for the online summary.