Symptomatic Progression of Asymptomatic Rotator Cuff Tears A Prospective Study of Clinical and Sonographic Variables
Symptomatic Progression of Asymptomatic Rotator Cuff Tears A Prospective Study of Clinical and Sonographic Variables
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DOI：
10.2106/jbjs.i.00506
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发表时间：
2010-11-17
影响因子：
5.3
通讯作者：
Yamaguchi, Ken
中科院分区：
文献类型：
--
作者：
Mall, Nathan A.;Kim, H. Mike;Yamaguchi, Ken
本研究的目的是确定无症状肩袖撕裂疼痛时撕裂尺寸、肩部功能和肩关节运动学的变化，并确定与无症状者相比，出现疼痛的个体的特征。方法对195名无症状肩袖撕裂患者进行前瞻性监测，并每年检查撕裂大小等各种参数的变化。44名受试者发现出现了新的疼痛，并将疼痛发展前后的参数进行比较，然后将44名受试者与55名两年无症状的受试者进行比较。结果随着疼痛的发展，全厚度肩袖撕裂的大小显著增加。与疼痛发作前的评估相比，18%的全层撕裂增加了0.5 mm， 40%的部分厚度撕裂进展为全层撕裂。美国肩关节外科医生对肩关节功能的评分显著降低，除了外展90度时的外旋，所有的肩关节活动范围都降低了。在早期肩关节外展伴随疼痛发展时，肩胛胸椎代偿性运动与肩关节运动相关增加保持无症状,结论无症状肩袖撕裂的肩部疼痛发展与撕裂大小的增加有关，较大的撕裂比较小的撕裂更容易在短期内发生疼痛，进一步的研究需要调查无症状肩的预防性治疗在避免疼痛发展和肩功能丧失方面的作用
Background The purposes of this study were to identify changes in tear dimensions, shoulder function, and glenohumeral kinematics when an asymptomatic rotator cuff tear becomes painful and to identify characteristics of individuals who develop pain compared with those who remain asymptomaticMethods A cohort of 195 subjects with an asymptomatic rotator cuff tear was prospectively monitored for pain development and examined annually for changes in various parameters such as tear size, fatty degeneration of the rotator cuff muscle, glenohumeral kinematics, and shoulder function Forty four subjects were found to have developed new pain, and the parameters before and after pain development were compared The forty four subjects were then compared with a group of fifty five subjects who remained asymptomatic over a two year periodResults With pain development, the size of a full thickness rotator cuff tear increased significantly, with 18% of the full thickness tears showing an increase of >5 mm, and 40% of the partial thickness tears had progressed to a full thickness tear In comparison with the assessments made before the onset of pain, the American Shoulder and Elbow Surgeons scores for shoulder function were significantly decreased and all measures of shoulder range of motion were decreased except for external rotation at 90 degrees of abduction There was an increase in compensatory scapulothoracic motion in relation to the glenohumeral motion during early shoulder abduction with pain development No significant changes were found in external rotation strength or muscular fatty degeneration Compared with the subjects who remained asymptomatic, the subjects who developed pain were found to have significantly larger tears at the time of initial enrollmentConclusions Pain development in shoulders with an asymptomatic rotator cuff tear is associated with an increase in tear size Larger tears are more likely to develop pain in the short term than are smaller tears Further research is warranted to investigate the role of prophylactic treatment of asymptomatic shoulders to avoid the development of pain and loss of shoulder function