Natural history of asymptomatic rotator cuff tears: A longitudinal analysis of asymptomatic tears detected sonographically
Natural history of asymptomatic rotator cuff tears: A longitudinal analysis of asymptomatic tears detected sonographically
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DOI：
10.1067/mse.2001.113086
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发表时间：
2001-05-01
影响因子：
3
通讯作者：
Middleton, WD
中科院分区：
文献类型：
--
作者：
Yamaguchi, K;Tetro, AM;Middleton, WD
本研究的目的是纵向检查5年内无症状肩袖恐惧的自然史，并评估症状发展和撕裂进展的风险。自1985年至今，对所有患者进行了双侧超声检查。回顾1989年至1994年的连续超声检查，发现58例单侧症状的潜在患者对侧无症状肩袖撕裂。在这58例患者中，45例（22例男性，23例女性）回答了综合问卷，23例另外返回进行检查和重复超声评价。问卷基于美国肩肘外科医生评分，包括几个基于结果的问题。体格检查按照沿着美国肩肘外科医师指南以标准化方式进行。由一名经验丰富的放射科医生重复进行高分辨率超声检查。然后由两名独立的经验丰富的放射科医生对初次和重复超声检查的撕裂大小和位置进行重新评估，这些放射科医生对临床数据结果不知情。23例（51%）既往无症状患者在平均2.8年内出现症状。无症状患者的平均日常生活活动评分为28.5分，而新近出现症状的患者为22.9分（P <0.5）。无症状患者的平均视觉模拟疼痛评分（1 =无疼痛）为1.1，新出现症状的患者为4.0。在23名返回进行超声检查的患者中，P无症状，14名有症状。只有2名无症状的P患者的泪液进展。总体而言，23例患者的P发生了撕裂进展。没有患者的撕裂尺寸减小。我们的研究结果表明，以前无症状的肩袖撕裂的患者在对侧有症状的撕裂的情况下也会出现症状。症状的发展与疼痛的显著增加和进行日常生活活动的能力下降相关（P <0.05）。随着时间的推移，似乎存在撕裂尺寸进展的风险。
The purpose of this study was to examine longitudinally the natural history of asymptomatic rotator cuff fears over a 5-year period and to assess the risk for development of symptoms and tear progression. Since 1985 through the present, bilateral sonograms were done on all patients. A review of consecutive sonograms done from 1989 to 1994 revealed 58 potential patients with unilateral symptoms who had contralateral asymptomatic rotator cuff tears. Of these 58 patients, 45 (22 men, 23 women) responded to a comprehensive questionnaire and 23 additionally returned for examination and repeat sonographic evaluation. The questionnaire was based on the American Shoulder and Elbow Surgeons score and included several outcome-based questions. A physical examination was performed in a standardized fashion along American Shoulder and Elbow Surgeons guidelines. Repeat high-resolution sonograms were performed by a single experienced radiologist. Primary and repeat sonograms were then reassessed for tear size and location by two independent experienced radiologists blinded to the clinical data results. Twenty-three (51%) of the previously asymptomatic patients became symptomatic over a mean of 2.8 years. The average Activities of Daily living score for those remaining asymptomatic was 28.5 of 30 and for those becoming newly symptomatic, 22.9 of 30 (P < .5). The mean visual analog pain score (1 = no pain) for those remaining asymptomatic was 1.1 and for the newly symptomatic patients, 4.0. Of the 23 patients who returned for ultrasound, P were asymptomatic and 14 symptomatic. Only 2 of the P patients remaining asymptomatic had progression of their tears. Overall, P of 23 patients had tear progression. No patient had a decrease in the size of the tear. Our results demonstrate that symptoms can develop in patients with previously asymptomatic rotator cuff tears when seen in the context of a contralateral symptomatic tear. Development of symptoms was associated with a significant increase in pain and decrease in the ability to perform activities of daily living (P < .05). There appears to be a risk for tear size progression over time.