Rotator cuff disease ranks among the most prevalent of surgically treated musculoskeletal disorders. As pain is the primary indication for treatment, our long-term goal is to better understand the natural history of symptom development in rotator cuff disease. This information is fundamental to establishing prognosis and guidelines for surgical vs. nonsurgical treatment. The primary objective of this study is to use ultrasonography of asymptomatic tears to longitudinally determine the relationship between tear deterioration and new symptom development.
Specific aims are:
Specific Aim 1 : To establish the probability that an asymptomatic rotator cuff tear seen in the context of contralateral symptoms will become symptomatic over time. A population of 235 individuals identified as having either an asymptomatic rotator cuff tear (N=185) or normal cuff (N=50) detected when obtaining bilateral ultrasound examinations for a contralateral painful shoulder will be recruited for study. They will be prospectively followed with exams and outcome evaluation for 3-5 years to study the prevalence of symptom development.
Specific Aim 2 : To determine with ultrasonography, the probability that a rotator cuff tear will enlarge over time. For all 185 individuals with asymptomatic cuff tears, a high resolution ultrasound will be performed yearly to determine whether or not there is any significant (>5mm) full-thickness tear size progression or whether partial tears progress to full tears over time.
Specific Aim 3 : To determine if symptom progression correlates with enlargement of the rotator cuff tear and/or degenerative changes on radiographs. Results from ultrasounds for tear enlargement and radiographs for degenerative changes will be correlated to the presence of new pain via a shoulder-specific validated assessment tool. Secondary aims will include comparison of results to asymptomatic individuals with no tear. This will control for pain variables accountable to the presence of the rotator cuff tear. Other secondary aims will include the comparison of multiple demographic variables to the development of pain. In our pilot studies, many asymptomatic patients appeared to develop symptoms. The proposed project would be innovative in that patients with asymptomatic tears can be longitudinally followed during this time of symptom development. Statistical power would exist to correlate tear size progression or other factors to symptoms. This knowledge should directly determine the necessity for early preventative treatment and cuff tear surveillance. Most importantly, the information should be critical in formulating indications and objectives for operative intervention a fundamental issue in caring for patients with rotator cuff tears.
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