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.

National Institute of Health (NIH)
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Research Project (R01)
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Skeletal Biology Structure and Regeneration Study Section (SBSR)
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Panagis, James S
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Washington University
Schools of Medicine
Saint Louis
United States
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Keener, Jay D; Patterson, Brendan M; Orvets, Nathan et al. (2018) Degenerative Rotator Cuff Tears: Refining Surgical Indications Based on Natural History Data. J Am Acad Orthop Surg :
Codding, Jason L; Keener, Jay D (2018) Natural History of Degenerative Rotator Cuff Tears. Curr Rev Musculoskelet Med 11:77-85
Chalmers, Peter N; Salazar, Dane; Steger-May, Karen et al. (2017) Does the Critical Shoulder Angle Correlate With Rotator Cuff Tear Progression? Clin Orthop Relat Res 475:1608-1617
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Hsu, Jason; Keener, Jay D (2015) Natural History of Rotator Cuff Disease and Implications on Management. Oper Tech Orthop 25:2-9
Jain, Nitin B; Yamaguchi, Ken (2014) The contribution of reverse shoulder arthroplasty to utilization of primary shoulder arthroplasty. J Shoulder Elbow Surg 23:1905-1912
Keener, Jay D (2013) Surveillance of conservatively treated rotator cuff tears is warranted. Commentary on an article by Stefan Moosmayer, MD, PhD, et al.: ""The natural history of asymptomatic rotator cuff tears. a three-year follow-up of fifty cases"". J Bone Joint Surg Am 95:e101 1-2
Wall, Lindley B; Teefey, Sharlene A; Middleton, William D et al. (2012) Diagnostic performance and reliability of ultrasonography for fatty degeneration of the rotator cuff muscles. J Bone Joint Surg Am 94:e83

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