Journal article
Symptoms of Pain Do Not Correlate with Rotator Cuff Tear Severity: A Cross-Sectional Study of 393 Patients with a Symptomatic Atraumatic Full-Thickness Rotator Cuff Tear
Journal of bone and joint surgery. American volume, Vol.96(10), pp.793-800
05/21/2014
DOI: 10.2106/JBJS.L.01304
PMCID: PMC4018774
PMID: 24875019
Abstract
BACKGROUND:For many orthopaedic disorders, symptoms correlate with disease severity. The objective of this study was to determine if pain level is related to the severity of rotator cuff disorders.\nMETHODS:A cohort of 393 subjects with an atraumatic symptomatic full-thickness rotator-cuff tear treated with physical therapy was studied. Baseline pretreatment data were used to examine the relationship between the severity of rotator cuff disease and pain. Disease severity was determined by evaluating tear size, retraction, superior humeral head migration, and rotator cuff muscle atrophy. Pain was measured on the 10-point visual analog scale (VAS) in the patient-reported American Shoulder and Elbow Surgeons (ASES) score. A linear multiple regression model was constructed with use of the continuous VAS score as the dependent variable and measures of rotator cuff tear severity and other nonanatomic patient factors as the independent variables. Forty-eight percent of the patients were female, and the median age was sixty-one years. The dominant shoulder was involved in 69% of the patients. The duration of symptoms was less than one month for 8% of the patients, one to three months for 22%, four to six months for 20%, seven to twelve months for 15%, and more than a year for 36%. The tear involved only the supraspinatus in 72% of the patients; the supraspinatus and infraspinatus, with or without the teres minor, in 21%; and only the subscapularis in 7%. Humeral head migration was noted in 16%. Tendon retraction was minimal in 48%, midhumeral in 34%, glenohumeral in 13%, and to the glenoid in 5%. The median baseline VAS pain score was 4.4.\nRESULTS:Multivariable modeling, controlling for other baseline factors, identified increased comorbidities (p = 0.002), lower education level (p = 0.004), and race (p = 0.041) as the only significant factors associated with pain on presentation. No measure of rotator cuff tear severity correlated with pain (p > 0.25).\nCONCLUSIONS:Anatomic features defining the severity of atraumatic rotator cuff tears are not associated with the pain level. Factors associated with pain are comorbidities, lower education level, and race.\nLEVEL OF EVIDENCE:Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Details
- Title: Subtitle
- Symptoms of Pain Do Not Correlate with Rotator Cuff Tear Severity: A Cross-Sectional Study of 393 Patients with a Symptomatic Atraumatic Full-Thickness Rotator Cuff Tear
- Creators
- Warren Dunn - University of Wisconsin, Research Park Clinic Sports Medicine Clinic, 621 Science Drive, Madison, WI 53711John Kuhn - Vanderbilt University Medical Center, 4200 MCE South Tower, 1215 21st Avenue South, Nashville, TN 37232. E-mail address for J.E. Kuhn: j.kuhn@vanderbilt.eduRosemary Sanders - Vanderbilt University Medical Center, 4200 MCE South Tower, 1215 21st Avenue South, Nashville, TN 37232. E-mail address for J.E. Kuhn: j.kuhn@vanderbilt.eduQi An - St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 723, Memphis, TN 38105-3768Keith Baumgarten - Sports Medicine & Shoulder Surgery Orthopedic Institute, 810 East 23rd Street, Sioux Falls, SD 57117Julie Bishop - OSU Sports Medicine Center, 2050 Kenny Road, Suite 3300, Columbus, OH 43221-3502Robert Brophy - Department of Orthopaedic Surgery, Washington University School of Medicine, 14532 South Outer Forty Drive, Chesterfield, MO 63017James Carey - PENN Orthopaedics, Hospital of the University of Pennsylvania, Weightman Hall, 33rd and Spruce Streets, Philadelphia, PA 19104G Holloway - Shoulder and Elbow Institute Knoxville Orthopaedic Clinic, 260 Fort Sanders West Boulevard, Knoxville, TN 37922Grant Jones - OSU Sports Medicine Center, 2050 Kenny Road, Suite 3300, Columbus, OH 43221-3502C Ma - UCSF Sports Medicine, 1500 Owens Street, San Francisco, CA 94158Robert Marx - Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021Eric McCarty - CU Sports Medicine, 311 Mapleton Avenue, Boulder, CO 80304Sourav Poddar - CU Sports Medicine, 2000 South Colorado Boulevard, Colorado Center Tower One, Suite 4500, Denver, CO 80222Matthew Smith - Department of Orthopaedic Surgery, Washington University School of Medicine, 14532 South Outer Forty Drive, Chesterfield, MO 63017Edwin Spencer - Shoulder and Elbow Institute Knoxville Orthopaedic Clinic, 260 Fort Sanders West Boulevard, Knoxville, TN 37922Armando Vidal - CU Sports Medicine, 2000 South Colorado Boulevard, Colorado Center Tower One, Suite 4500, Denver, CO 80222Brian Wolf - University of Iowa, 2701 Prairie Meadow Drive, Iowa City, IA 52242-1088Rick Wright - Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St. Louis, MO 63110
- Resource Type
- Journal article
- Publication Details
- Journal of bone and joint surgery. American volume, Vol.96(10), pp.793-800
- DOI
- 10.2106/JBJS.L.01304
- PMID
- 24875019
- PMCID
- PMC4018774
- NLM abbreviation
- J Bone Joint Surg Am
- ISSN
- 0021-9355
- eISSN
- 1535-1386
- Publisher
- Journal of Bone and Joint Surgery Incorporated
- Language
- English
- Date published
- 05/21/2014
- Academic Unit
- Orthopedics and Rehabilitation; Physical Therapy and Rehabilitation Science
- Record Identifier
- 9984040241902771
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