Shoulder activity level and progression of degenerative cuff disease
Shoulder activity level and progression of degenerative cuff disease
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DOI：
10.1016/j.jse.2017.05.023
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发表时间：
2017-09-01
影响因子：
3
通讯作者：
Brophy, Robert H.
中科院分区：
文献类型：
--
作者：
Keener, Jay D.;Skelley, Nathan W.;Brophy, Robert H.
背景：本研究前瞻性地研究了肩部活动的直接和间接测量与无症状退行性肩袖撕裂受试者的撕裂进展和疼痛发展风险之间的关系。方法：每年前瞻性监测一组无症状退行性肩袖撕裂，通过超声成像记录撕裂尺寸进展和潜在的肩部疼痛发展。将肩部活动水平、自我报告的职业和身体需求水平以及手的优势与撕裂扩大和未来疼痛发展的风险进行比较。结果：该研究监测了 346 名平均年龄为 62.1 岁的个体，中位持续时间为 4.1 年（四分位距 [IQR]，2.4-7.9 年）。 177 个肩膀（51.2%）出现撕裂扩大，161 个肩膀（46.5%）随着时间的推移出现疼痛。优势肩部存在撕裂与撕裂扩大（风险比，1.40；P = .03）和疼痛发展（风险比，1.63；P = .002）的风险更大相关。肩部活动水平（P = .37）和职业需求水平（P = .62）不能预测撕裂扩大。体力劳动 (P = .047) 和“介于两者之间”(P = .045) 的职业需求类别比久坐需求具有更大的疼痛发生风险。出现疼痛的肩膀的肩部活动评分中位数低于保持无症状的肩膀（10.0 [IQR，7.0-13.0] vs. 11.0 [IQR，8.0-14.0]，P = 0.02）。结论：无症状眼泪中的泪液扩大和疼痛发展在主导肩部受累时更常见。肩部活动水平与撕裂进展风险无关。尽管职业要求较高的患者更有可能出现疼痛，但疼痛的发生与较低的肩部活动水平有关。 (C) 2017 年肩肘外科杂志董事会。版权所有。
Background: This study prospectively examined the relationship of direct and indirect measures of shoulder activity with the risks of tear progression and pain development in subjects with an asymptomatic degenerative rotator cuff tear.Methods: A cohort of asymptomatic degenerative rotator cuff tears was prospectively monitored annually, documenting tear size progression with ultrasound imaging and potential shoulder pain development. Shoulder activity level, self-reported occupational and physical demand level, and hand dominance were compared with risks of tear enlargement and future pain development.Results: The study monitored 346 individuals with a mean age of 62.1 years for a median duration of 4.1 years (interquartile range [IQR], 2.4-7.9 years). Tear enlargement was seen in 177 shoulders (51.2%), and pain developed in 161 shoulders (46.5%) over time. Tear presence in the dominant shoulder was associated with a greater risk of tear enlargement (hazard ratio, 1.40; P = .03) and pain development (hazard ratio, 1.63; P = .002). Shoulder activity level (P = .37) and occupational demand level (P = .62) were not predictive of tear enlargement. Occupational demand categories of manual labor (P = .047) and "in between" (P = .045) had greater risks of pain development than sedentary demands. The median shoulder activity score for shoulders that became painful was lower than for shoulders that remained asymptomatic (10.0 [IQR, 7.0-13.0] vs. 11.0 [IQR, 8.0-14.0], P = .02).Conclusions: Tear enlargement and pain development in asymptomatic tears are more common with involvement of the dominant shoulder. Shoulder activity level is not related to tear progression risks. Pain development is associated with a lower shoulder activity level even though patients with higher occupational demands are more likely to develop pain. (C) 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.