Rotator cuff tears - does activity relate to progression?

Shoulder activity level and progression of degenerative cuff disease

These authors examined the relationship of shoulder activity with the risks of tear progression and pain development in 346 subjects (mean age 62 yrs) with an asymptomatic degenerative rotator cuff tear followed for a median duration of 4.1 years.

As determined by sequential interpretation of annual ultrasound reports, tear enlargement was seen in 177 shoulders (51.2%) and pain developed in 161 shoulders (46.5%) over time.

Tear progression was defined as tear enlargement or conversion to a more severe tear type (partial to full thickness tear or control to partial or full-thickness tear). Partial and full-thickness cuff tears were considered enlarged if the tear size increased 5 mm or greater in any dimension compared with baseline.

Of note is the fact that the median duration of study follow-up was almost twice as long for the shoulders with tears that enlarged (6.0 years; IQR, 3.1-8.9 years) compared with the shoulders with stable tears (3.1 years; IQR, 2.0-5.0 years; P < .001).

Shoulder activity level and occupational demand level were not predictive of tear enlargement. Interestingly, patients who developed shoulder pain were less active than patients who did not.

Tear enlargement and pain development in asymptomatic tears were more common with involvement of the dominant shoulder.

Comment: This is an interesting report of a large natural history study. It seems to indicate that in patients with asymptomatic rotator cuff tendon failure, tear size can progress with time independent of the shoulder's activity level. Of note, the authors do not suggest that the risk of tear progression is an indication for cuff repair.

This is surely good news for those of us with unoperated supraspinatus tears who continue to be active (and who avoided what would have been a painful 6 months of post-repair down time)!