Rotator Cuff Tears: Optimizing Diagnosis and Treatment Strategies

描述(由申请人提供)：肩袖撕裂是导致肩部残疾和疼痛的最常见原因，每年有450万次医生就诊和7.5万次手术。关于肩部临床病史和体检的诊断价值的证据很少。因此，磁共振成像(MRI)经常被用来诊断肩袖撕裂。肩部超声是便携式的，以办公室为基础，在诊断肩袖撕裂方面比MRI便宜约75%。然而，超声诊断的准确性尚未确定。这项研究将以MRI和专家临床诊断为标准，评估选定症状、体检结果和超声的组合的敏感性和特异性。几乎没有证据表明肩袖撕裂的最佳治疗方法，以及与手术和非手术治疗效果较好相关的因素。在这一领域，没有随机临床试验的证据。目前关于非手术治疗与手术治疗的决策主要基于轶事临床经验。我们的研究将在两年的随访期内确定肩袖撕裂非手术和手术治疗的疼痛和功能结果的预测因素。我们的研究结果将为临床决策提供依据。这项工作还将为手术与非手术治疗的随机对照试验奠定框架，该试验将在该奖项的最后几年提出。应聘者在康复医学方面的临床背景，以及以前在肌肉骨骼疾病和以患者为导向的研究方面的工作经验，非常适合这个以患者为导向的指导研究项目。他在布里格姆妇女医院和哈佛医学院的研究和临床环境为他提供了激励和丰富的学习机会。在K23获奖期间，候选人将获得研究方法、肩部疾病和成像方面的高级培训。候选人将受益于杰弗里·N·卡茨博士的指导，卡茨博士是肌肉骨骼疾病研究领域的领先国际专家。候选人的指导团队还将包括生物统计学家、独立资助的R01研究员Elena Losina博士，她在指导初级调查人员方面拥有丰富的经验；国际肩部疾病临床专家、布里格姆妇女医院运动医学和肩部外科主任Laurence Higgins博士；以及具有肩部超声波专业知识的放射科医生Joel Newman博士。应聘者具有先前的培训、研究效率和临床兴趣，具有独特的优势，能够交付建议的研究议程，并受益于一支高素质的指导团队。

DESCRIPTION (provided by applicant): Rotator cuff tears are the most common cause of shoulder disability and pain accounting for 4.5 million physician visits and 75,000 surgeries annually. There is paucity of evidence addressing the diagnostic value of clinical history and physical examination of the shoulder. Consequently, magnetic resonance imaging (MRI) is used frequently to make a diagnosis of rotator cuff tear. Shoulder ultrasound is portable, office-based, and ~ 75% less expensive than MRI for diagnosis of rotator cuff tears. However, the diagnostic accuracy of ultrasound has not been established. This study will assess the sensitivity and specificity of a combination of select symptoms, physical examination findings, and ultrasound as compared to MRI and expert clinical diagnosis as a criterion standard. There is little evidence on the best treatment approach for rotator cuff tears and on factors associated with better outcomes of operative and non-operative treatment. There is no evidence from randomized clinical trials in this area. Current decision-making on non-operative treatment versus surgery is based largely on anecdotal clinical experience. Our study will determine predictors of pain and functional outcomes of non-operative and operative treatment of rotator cuff tears at two year follow-up period. Results from our study will provide evidence to inform clinical decision-making. This work will also lay a framework for a randomized controlled trial of surgery versus non-operative treatment which will be proposed in the final years of this award. The candidate's clinical background in Rehabilitation Medicine, and prior work in musculoskeletal diseases and patient-oriented studies is ideally suited for this mentored patient-oriented research program. His research and clinical environments at Brigham and Women's Hospital and Harvard Medical School offer him stimulating and rich learning opportunities. During the K23 award period, the candidate will obtain advanced training in research methodology, and shoulder disorders and imaging. The candidate will benefit from mentorship of Dr. Jeffrey N. Katz, a leading international expert in musculoskeletal diseases research. The candidate's mentoring team will also include Dr. Elena Losina, a biostatistician and independently funded R01 investigator, with extensive experience in mentoring of junior investigators; Dr. Laurence Higgins, an international clinical expert in shoulder disorders and Chief of Sports Medicine and Shoulder Surgery at Brigham and Women's Hospital, and; Dr. Joel Newman, a radiologist with expertise in shoulder ultrasound. The candidate with his prior training, research productivity, and clinical interests is uniquely situated to deliver the proposed research agenda and benefit from a highly qualified mentoring team.