The duration of symptoms does not correlate with rotator cuff tear severity or other patient-related features: a cross-sectional study of patients with atraumatic, full-thickness rotator cuff tears. The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. The outcome and structural integrity of arthroscopic rotator cuff repair with use of the double-row suture anchor technique. Surgical technique. Sleep Quality in Patients With Rotator Cuff Disease The effect of rotator cuff tear size on shoulder strength and range of motion. Combined tears of the subscapularis and supraspinatus tendon: clinical outcome, rotator cuff strength and structural integrity following open repair One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress Prediction of Rotator Cuff Repair Results by Magnetic Resonance Imaging Prospective analysis of arthroscopic rotator cuff repair: prognostic factors affecting clinical and ultrasound outcome. Influence of tendon healing after arthroscopic rotator cuff repair on clinical outcome using single-row Mason-Allen suture technique: a prospective, MRI controlled study Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings. The Results of Repair of Massive Tears of the Rotator Cuff*† A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears. Randomized Controlled Trial of Workplace-based Rehabilitation for Work-related Rotator Cuff Disorder Symptomatic progression of asymptomatic rotator cuff tears: a prospective study of clinical and sonographic variables. Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. Prospective Evaluation of the Effect of Rotator Cuff Integrity on the Outcome of Open Rotator Cuff Repairs Shoulder Activity Level Is Not Associated With the Severity of Symptomatic, Atraumatic Rotator Cuff Tears in Patients Electing Nonoperative Treatment Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears. The posterior impingement sign: diagnosis of rotator cuff and posterior labral tears secondary to internal impingement in overhand athletes. Surgical versus Non-surgical Management of Rotator Cuff Tears: Predictors of Treatment Allocation Fatty Infiltration and Atrophy of the Rotator Cuff do not Improve after Rotator Cuff Repair and Correlate with Poor Functional Outcome Platelet-Rich Plasma Augmentation for Arthroscopic Rotator Cuff Repair
HYPOTHESIS The purpose of this cross-sectional study is to determine whether the duration of symptoms influences the features seen in patients with atraumatic , full-thickness rotator cuff tears . Our hypothesis is that an increasing duration of symptoms will correlate with more advanced findings of rotator cuff tear severity on magnetic resonance imaging , worse shoulder outcome scores , more pain , decreased range of motion , and less strength . METHODS We enrolled 450 patients with full-thickness rotator cuff tears in a prospect i ve cohort study to assess the effectiveness of nonoperative treatment and factors predictive of success . The duration of patient symptoms was divided into 4 groups : 3 months or less , 4 to 6 months , 7 to 12 months , and greater than 12 months . Data collected at patient entry into the study included ( 1 ) demographic data , ( 2 ) history and physical examination data , ( 3 ) radiographic imaging data , and ( 4 ) vali date d patient-reported measures of shoulder status . Statistical analysis included a univariate analysis with the Kruskal-Wallis test and Pearson test to identify statistically significant differences in these features for different duration s of symptoms . RESULTS A longer duration of symptoms does not correlate with more severe rotator cuff disease . The duration of symptoms was not related to weakness , limited range of motion , tear size , fatty atrophy , or vali date d patient-reported outcome measures . CONCLUSIONS There is only a weak relationship between the duration of symptoms and features associated with rotator cuff disease BACKGROUND The reported rate of failure after  arthroscopic rotator cuff repair  has varied widely . The influence of the repair technique on the failure rates and functional outcomes after open or arthroscopic rotator cuff repair remains controversial . The purpose of the present study was to evaluate the functional and anatomic results of arthroscopic rotator cuff repairs performed with the double-row suture anchor technique on the basis of computed tomography or magnetic resonance imaging arthrography in order to determine the postoperative integrity of the repairs . METHODS A prospect i ve series of 105 consecutive shoulders undergoing arthroscopic double-row rotator cuff repair of the supraspinatus or a combination of the supraspinatus and infraspinatus were evaluated at a minimum of two years after surgery . The evaluation included a routine history and physical examination as well as determination of the preoperative and postoperative strength , pain , range of motion , and Constant scores .  All shoulders had a preoperative and postoperative computed tomography arthrogram ( 103 shoulders ) or magnetic resonance imaging arthrogram ( two shoulders ) . RESULTS There were thirty-six small rotator cuff tears , forty-seven large isolated supraspinatus or combined supraspinatus and infraspinatus tendon tears , and twenty-two massive rotator cuff tears . The mean Constant score ( and st and ard deviation ) was 43.2+/-15.1 points ( range , 8 to 83 points ) preoperatively and 80.1+/-11.1 points ( range , 46 to 100 points ) postoperatively . Twelve of the 105 repairs failed . Intact rotator cuff repairs were associated with significantly increased strength and active range of motion . CONCLUSIONS Arthroscopic repair of a rotator cuff tear with use of the double-row suture anchor technique results in a much lower rate of failure than has previously been reported in association with either open or arthroscopic repair methods . Patients with an intact rotator cuff repair have better pain relief than those with a failed repair . After repair , large and massive rotator cuff tears result in more postoperative weakness than small tears do BACKGROUND The reported rate of failure after  arthroscopic rotator cuff repair  has varied widely . The influence of the repair technique on the failure rates and functional outcomes after open or arthroscopic rotator cuff repair remains controversial . The purpose of the present study was to evaluate the functional and anatomic results of arthroscopic rotator cuff repairs performed with the double-row suture anchor technique on the basis of computed tomography or magnetic resonance imaging arthrography in order to determine the postoperative integrity of the repairs . METHODS A prospect i ve series of 105 consecutive shoulders undergoing arthroscopic double-row rotator cuff repair of the supraspinatus or a combination of the supraspinatus and infraspinatus were evaluated at a minimum of two years after surgery . The evaluation included a routine history and physical examination as well as determination of the preoperative and postoperative strength , pain , range of motion , and Constant scores .  All shoulders had a preoperative and postoperative computed tomography arthrogram ( 103 shoulders ) or magnetic resonance imaging arthrogram ( two shoulders ) . RESULTS There were thirty-six small rotator cuff tears , forty-seven large isolated supraspinatus or combined supraspinatus and infraspinatus tendon tears , and twenty-two massive rotator cuff tears . The mean Constant score ( and st and ard deviation ) was 43.2 + /- 15.1 points ( range , 8 to 83 points ) preoperatively and 80.1 + /- 11.1 points ( range , 46 to 100 points ) postoperatively . Twelve of the 105 repairs failed . Intact rotator cuff repairs were associated with significantly increased strength and active range of motion . CONCLUSIONS Arthroscopic repair of a rotator cuff tear with use of the double-row suture anchor technique results in a much lower rate of failure than has previously been reported in association with either open or arthroscopic repair methods . Patients with an intact rotator cuff repair have better pain relief than those with a failed repair . After repair , large and massive rotator cuff tears result in more postoperative weakness than small tears do Background : Little is known about the influence of rotator cuff pathology on sleep . The purpose of this study was to determine which patient-reported factors correlate with sleep disturbance in patients with rotator cuff disease . Methods : A nonr and omized , cross-sectional cohort study was performed to evaluate the effects of rotator cuff disease on sleep quality . Data collected at time zero ( before any treatment ) included the  Single Assessment Numeric Evaluation rating  , the  American Shoulder  and Elbow  Surgeons score , the  Pittsburgh Sleep Quality Index  , patient demographics , and medical comorbidities . Statistical analysis included the Pearson correlation and multiple regression analysis to determine which patient-reported factors were associated with sleep disturbance . Results : Nocturnal pain was reported by 91 % of the 391 participants ( 274 with tendinitis and 117 with rotator cuff tears ) . Participants had a mean age of 57 years . Pearson correlation coefficients determined that poor sleep quality in one group or both the tendinitis and the rotator cuff tear groups was associated with higher pain visual analog scale scores ( 0.27 and 0.31 ; P = 0.004 and P < 0.0001 , respectively ) , depression ( 0.27 and 0.30 ; P < 0.01 ) , female sex ( 0.24 and 0.27 ; P < 0.001 ) , presence of low back pain ( 0.25 and 0.27 ; P < 0.01 ) , diabetes mellitus ( 0.24 in the rotator cuff tear group ; P < 0.01 ) , and increased body mass index ( 0.22 and 0.27 ; P = 0.02 ) . Discussion : The status of the rotator cuff did not correlate with increasing symptoms of shoulder pain or with worse sleep quality as measured by the Pittsburgh Sleep Quality Index . These results support the theory that worsening symptoms of shoulder pain may not be clearly associated with rotator cuff disease severity . Conclusion : Worse sleep quality scores in patients with rotator cuff disease are associated with pain , depression , female sex , low back pain , diabetes mellitus , and high body mass index . Overall , sleep quality did not differ among patients with varying rotator cuff disease severity . Only hypertension ( in patients with rotator cuff tears ) and concurrent cervical pathology ( in patients with tendinitis ) were uniquely related to the disease classification . Further investigation is needed to better define how these factors interact and influence nocturnal shoulder pain and sleep quality in patients with rotator cuff disease . Level of Evidence : Level III prognostic cohort STUDY DESIGN Prospect i ve cohort study . OBJECTIVES To determine the effect of rotator cuff tear size on shoulder strength and range of motion . BACKGROUND Patients with rotator cuff pathology typically present with weakness and motion loss in various motions . The extent to which the presence of a rotator cuff tear and the size of the tear affect strength and range of motion is not well understood . METHODS AND MEASURES Sixty-one patients scheduled for surgery , with a diagnosis of a rotator cuff tear and /or subacromial impingement , underwent examination for shoulder pain , function , range of motion , and strength . The extent of rotator cuff pathology was documented during subsequent surgery ( presence of tear , tear size , tear thickness ) . RESULTS There were 10 massive tears , 15 large tears , 13 medium tears , 12 small tears , and 11 rotator cuffs without a tear . Patients had marked weakness in abduction strength at 90 degrees and 10 degrees of abduction , in external rotation strength at 90 degrees , and in the " full can test " ( all , P<.0001 ) . Marked range of motion losses in shoulder flexion and external rotation at 0 degrees and 90 degrees abduction ( all , P<.001 ) were also observed . Abduction strength deficit at 10 degrees was affected by rotator cuff tear size ( P<.0001 ) . Twenty of 25 patients with large or massive tears had deficits greater than 50 % , compared with only 1 of 11 patients with no tear , 2 of 12 patients with a small tear , and 5 of 13 patients with a medium tear ( P<.0001 ) . Other strength and range of motion deficits or indices of pain and function were unaffected by tear size . CONCLUSIONS Weakness of greater than 50 % relative to the contralateral side in shoulder abduction at 10 degrees of abduction was indicative of a large or massive rotator cuff tear Background Anterosuperior rotator cuff tears involving the subscapularis and supraspinatus tendons are less common than other tears of the rotator cuff . The purpose of this study was to report the clinical outcome , rotator cuff strength and structural integrity of open repair of combined anterosuperior rotator cuff tears . Patients and methods Forty-eight patients at an average age of 58 years underwent open repair of a combined supraspinatus and subscapularis tendon tear . The follow-up evaluation included clinical scores , rotator cuff strength testing with a custom-made force measurement plate ( FMP ) and postoperative MRI to evaluate repair integrity and muscle cross-sectional area . Results After a mean follow-up of 49 months the average Constant score improved from 43 points preoperatively to 79 points postoperatively . The SST and the pain VAS were significantly improved by the procedure ( each < 0.05 ) . The combined tear group with partial subscapularis tears ( G1 ) did not achieve significantly better score results than the combined tear group with a full-thickness subscapularis tear ( G2 ) ( p > 0.05 ) . Strength for all rotator cuff components was reduced significantly ( p < 0.05 ) compared with the contralateral shoulder in both groups . MRI revealed a retear-rate of 4 % for the subscapularis and a retear-rate of 19 % for the supraspinatus . Postoperative muscle cross-sectional area of all rotator cuff muscles did not differ significantly between G1 and G2 ( p > 0.05 ) . Conclusion Open repair of combined anterosuperior rotator cuff tears achieved good postoperative results despite a residual rotator cuff strength deficit . Combined supraspinatus-/full-thickness subscapularis tears achieved equal clinical and radiographic results compared with supraspinatus-/partial-thickness subscapularis tears Background Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative self- assessment s of pain and function . In several other areas of orthopaedics , higher levels of distress correlate with a higher likelihood of persistent pain and disability after recovery from surgery . To our knowledge , the relationship between psychological distress and outcomes after arthroscopic rotator cuff repair has not been similarly investigated . Questions / purpose s(1 ) Are higher levels of preoperative psychological distress associated with differences in outcome scores ( visual analog scale [ VAS ] for pain , Simple Shoulder Test , and American Shoulder and Elbow Surgeons score ) 1 year after arthroscopic rotator cuff repair ? ( 2 ) Are higher levels of preoperative psychological distress associated with less improvement in outcome scores ( VAS for pain , Simple Shoulder Test , and American Shoulder and Elbow Surgeons score ) 1 year after arthroscopic rotator cuff repair ? ( 3 ) Does the prevalence of psychological distress in a population with full-thickness rotator cuff tears change when assessed preoperatively and 1 year after arthroscopic rotator cuff repair ? Methods Eighty-five patients with full-thickness rotator cuff tears were prospect ively enrolled ; 70 patients ( 82 % ) were assessed at 1-year followup . During the study period , the three participating surgeons performed 269  rotator cuff repairs ; in large part , the low overall rate of enrollment was related to two surgeons enrolling only two patients total in the initial 14 months of the study . Psychological distress was quantified using the Distress Risk Assessment Method question naire , and patients completed self- assessment s including the VAS for pain , the Simple Shoulder Test , and the American Shoulder and Elbow Surgeons score preoperatively and 1 year after arthroscopic rotator cuff repair . Fifty of 85 patients ( 59 % ) had normal levels of distress , 26 of 85 ( 31 % ) had moderate levels of distress , and nine of 85 ( 11 % ) had severe levels of distress . Statistical models were used to assess the effect of psychological distress on patient self- assessment of shoulder pain and function at 1 year after surgery . Results With the numbers available , distressed patients were not different from nondistressed patients in terms of postoperative VAS for pain ( 1.9 [ 95 % confidence interval { CI } , 1.0–2.8 ] versus 1.0 [ 95 % CI , 0.5–1.4 ] , p = 0.10 ) , Simple Shoulder Test ( 9 [ 95 % CI , 8.1–10.4 ] versus 11 [ 95 % CI , 10.0–11.0 ] , p = 0.06 ) , or American Shoulder and Elbow Surgeons scores ( 80 [ 95 % CI , 72–88 ] versus 88 [ 95 % CI , 84–92 ] , p = 0.08 ) 1 year after arthroscopic rotator cuff repair . With the numbers available , distressed patients also were not different from nondistressed patients in terms of the amount of improvement in scores between preoperative assessment and 1-year followup on the VAS for pain ( 3 [ 95 % CI , 2.2–4.1 ] versus 2 [ 95 % CI , 1.4–2.9 ] , p = 0.10 ) , Simple Shoulder Test ( 5.2 [ 95 % CI , 3.7–6.6 ] versus 5.0 [ 95 % CI , 4.2–5.8 ] , p = 0.86 ) , or American Shoulder and Elbow Surgeons scale ( 38 [ 95 % CI , 29–47 ] versus 30 [ 95 % CI , 25–36 ] , p = 0.16 ) . The prevalence of psychological distress in our patient population was lower at 1 year after surgery 14 of 70 ( 20 % ) versus 35 of 85 ( 41 % ) preoperatively ( odds ratio , 0.36 ; 95 % CI , 0.17–0.74 ; p = 0.005 ) . Conclusions Mild to moderate levels of distress did not diminish patient-reported outcomes to a clinical ly important degree in this small series of patients with rotator cuff tears . This contrasts with reports from other areas of orthopaedic surgery and may be related to a more self-limited course of symptoms in patients with rotator cuff disease or possibly to a beneficial effect of rotator cuff repair on sleep quality or other unrecognized determinants of psychosocial status . Level of Evidence Level I , prognostic study Thirty chronic rotator cuff tears were repaired consecutively and evaluated prospect ively using a precise anatomic description of the tear that included the rotator interval , the Constant functional score , and an assessment of the tendon state and the atrophy of the supraspinatus muscle by preoperative and postoperative magnetic resonance imaging . Early correlations ( mean followup , 21.1 months ) attempted to define predictive factors of the final outcome of the repair , physical factors indicative of final tendon state , and postoperative evolution of supraspinatus atrophy . Magnetic resonance imaging oblique sagittal views showed that supraspinatus atrophy correlated with the sagittal and coronal extent of the tear and represented a strong predictive factor of postoperative retearing . At followup , 15 ( 50 % ) cuffs were continuous and thick , seven ( 23 % ) were continuous but thin , and six ( 20 % ) were retorn . Two ( 7 % ) cuffs had been repaired only partly . In the group with a persistent tear , flexion strength and differential Constant score were correlated with the final tendon state with no excellent or good results , and with less than 4 kg of strength . Supraspinatus atrophy improved in 18 of the 22 postoperative continuous cuffs , but never decreased in persistent tears , although there was pain relief and functional gain The purpose of this study was to identify potential predictors of function and tendon healing after  arthroscopic rotator cuff repair  that will enable the orthopaedic surgeon to determine which patients can expect a successful outcome . Between 2003 and 2005 , the Arthroscopic Rotator Cuff Registry was established to collect demographic , intraoperative , functional outcome , and ultrasound data prospect ively on all patients who underwent primary arthroscopic rotator cuff repair . At total of 193 patients met the study criteria , and 127 ( 65.8 % ) completed the 2-year follow-up . The most significant independent factors affecting  ultrasound outcome were age ( odds ratio [ OR ] , 1.08 ; 95 % confidence interval [ CI ] , 1.02 - 1.14 ; P = .006 ) and tear size ( OR , 2.29 ; 95 % CI , 1.55 - 3.38 ; P < .001 ) . After adjustment for age and tear size , the intraoperative factors found to be significantly associated with a tendon defect were concomitant biceps procedures ( OR , 11.39 ; 95 % CI , 2.90 - 44.69 ; P < .001 ) and acromioclavicular joint procedures ( OR , 3.85 ; 95 % CI , 1.46 - 10.12 ; P = .006 ) . In contrast to the ultrasound data , the functional outcome variables , such as satisfaction ( OR , 3.92 ; 95 % CI , 2.00 - 7.68 ; P < .001 ) and strength ( OR , 10.05 ; 95 % CI , 1.61 - 62.77 ; P = .01 ) , had a greater role in predicting an American Shoulder and Elbow Surgeons score greater than 90 . The progression from a single-tendon rotator cuff tear to a multiple-tendon tear with associated pathology increased the likelihood of tendon defect by at least 9 times , and therefore , earlier surgical intervention for isolated , single-tendon rotator cuff tears could optimize the likelihood of ultrasound healing and an excellent functional outcome The reported functional results of rotator cuff repair performed arthroscopically have been good . Only little is known about the cuff integrity after arthroscopic repair and how it influences the outcome . The aim of the study is to set a baseline of what rate of healing response respectively re-tears to expect and how cuff integrity alters the outcome . Fifty-three consecutive patients with an isolated supraspinatus tendon tear were arthroscopically operated and their tendons repaired . All pre- and postoperative data were prospect ively collected . At a minimum follow-up after 24 months ( average 26.4 months ) , the integrity of the cuff was evaluated by an open magnetic resonance imaging and the patients ’ function and satisfaction were documented and grade d to the sex- and age-related Constant-score also using a dynamometer for strength testing . The re-tear rate was 24.5 % with 13 non-healed tendons . The Constant-score of all patients improved significantly . The scores of the patients with a re-tear were significantly lower than those of the patient with an intact cuff . That was due to a less good performance in strength testing . The other categories of the Constant-score did not show any differences . The age of the patients with a re-tear was significantly higher . With the exception of age , we did not find any negative prognostic factor for a re-tear , and with the exception of re-tear no other factor influenced the Constant-score .  Arthroscopic supraspinatus tendon repair yields a re-tear rate of 25 % which is comparable with the results of open or mini/open repair . Cuff integrity influences postoperative strength and Constant-score .  Patients older than 65 years show a higher re-tear rate . Therapeutic Level IV is the level of evidence BACKGROUND Many studies have attempted to correlate radiographic acromial characteristics with rotator cuff tears , but the results have not been conclusive . Therefore , the purpose of this study was to determine the relationship between rotator cuff disease and the development of symptoms with different radiographic acromial characteristics , including shape , index , and presence of a spur . MATERIAL S AND METHODS The records of 216 patients enrolled in an ongoing prospect i ve , longitudinal study investigating asymptomatic rotator cuff tears were review ed . All patients underwent st and ardized radiographic evaluation , clinical evaluation , and shoulder ultrasonography at regularly scheduled surveillance visits . Three blinded observers review ed all radiographs to determine the acromial morphology , presence , and size of an acromial spur , as well as the acromial index . These findings were analyzed to determine an association with the presence of a full-thickness rotator cuff tear . RESULTS The 3 observers demonstrated poor agreement for acromial morphology ( κ = 0.41 ) , substantial agreement for the presence of an acromial spur ( κ = 0.65 ) , and excellent agreement for the acromial index ( κ = 0.86 ) . The presence of an acromial spur was highly associated with the presence of a full-thickness rotator cuff tear ( P = .003 ) , even after adjusting for age . No association was found between the acromial index and rotator cuff disease ( P = .92 ) . CONCLUSION The presence of an acromial spur is highly associated with the presence of a full-thickness rotator cuff tear in symptomatic and asymptomatic patients . The acromial morphology classification system is an unreliable method to assess the acromion . The acromial index shows no association with the presence of rotator cuff disease Background : Massive tears of the tendons of the rotator cuff cause atrophy and fatty degeneration of the rotator cuff muscles and painful loss of function of the shoulder . Repair of massive rotator cuff tears is often followed by retears of the tendons , additional muscular degeneration , and a poor clinical outcome . The purpose s of this study were to determine whether a new method of repair of rotator cuff tendons can yield a lower retear rate and a better clinical outcome than previously reported methods , to assess the muscular changes following repair of massive tears of the musculotendinous units , and to correlate findings on magnetic resonance imaging with the clinical results . Methods : Twenty-nine massive rotator cuff tears involving complete detachment of at least two tendons were repaired operatively with use of a new laboratory-tested technique in a prospect i ve study . At least two years ( average , thirty-seven months ; range , twenty-four to sixty-one months ) postoperatively , twenty-seven patients were evaluated clinical ly and with magnetic resonance imaging to determine the clinical outcome , the integrity of the repair , and the condition of the rotator cuff muscles . Results : The age and gender-adjusted Constant score improved from an average of 49 percent preoperatively to an average of 85 percent postoperatively , corresponding to a subjective shoulder value of 78 percent of that of a normal shoulder . Pain-free flexion improved from an average of 92 degrees to an average of 142 degrees , and abduction improved from an average of 82 degrees to an average of 137 degrees . Pain decreased and performance of activities of daily living improved significantly ( p < 0.05 ) . The seventeen patients who had a structurally successful repair all had an excellent clinical outcome . Muscle atrophy could not be reversed except in successfully repaired supraspinatus musculotendinous units . Fatty degeneration increased in all muscles . Conclusions : The method of repair of massive rotator cuff tears that was used in this study yielded a comparatively low retear rate and good-to-excellent clinical results ; however , the repair did not result in substantial reversal of muscular atrophy and fatty degeneration . Retears occurred more often in patients who had had a shorter interval between the onset of the symptoms and the operation ( p < 0.05 ) . Patients who had a retear had improvement of the shoulder compared with the preoperative state , but they had less improvement than did those who had a successful repair BACKGROUND The purpose of this prospect i ve study was to report the long-term risks of rotator cuff tear enlargement and symptom progression associated with degenerative asymptomatic tears . METHODS Subjects with an asymptomatic rotator cuff tear in one shoulder and pain due to rotator cuff disease in the contralateral shoulder enrolled as part of a prospect i ve longitudinal study . Two hundred and twenty-four subjects ( 118 initial full-thickness tears , fifty-six initial partial-thickness tears , and fifty controls ) were followed for a median of 5.1 years . Vali date d functional shoulder scores were calculated ( visual analog pain scale , American Shoulder and Elbow Surgeons [ ASES ] , and simple shoulder test [ SST ] scores ) . Subjects were followed annually with shoulder ultrasonography and clinical evaluations . RESULTS Tear enlargement was seen in 49 % of the shoulders , and the median time to enlargement was 2.8 years . The occurrence of tear-enlargement events was influenced by the severity of the final tear type , with enlargement of 61 % of the full-thickness tears , 44 % of the partial-thickness tears , and 14 % of the controls ( p < 0.05 ) . Subject age and sex were not related to tear enlargement . One hundred subjects ( 46 % ) developed new pain . The final tear type was associated with a greater risk of pain development , with the new pain developing in 28 % of the controls , 46 % of the shoulders with a partial-thickness tear , and 50 % of those with a full-thickness tear ( p < 0.05 ) . The presence of tear enlargement was associated with the onset of new pain ( p < 0.05 ) . Progressive degenerative changes of the supraspinatus muscle were associated with tear enlargement , with supraspinatus muscle degeneration increasing in 4 % of the shoulders with a stable tear compared with 30 % of the shoulders with tear enlargement ( p < 0.05 ) . Nine percent of the shoulders with a stable tear showed increased infraspinatus muscle degeneration compared with 28 % of those in which the tear had enlarged ( p = 0.07 ) . CONCLUSIONS This study demonstrates the progressive nature of degenerative rotator cuff disease . The risk of tear enlargement and progression of muscle degeneration is greater for shoulders with a full-thickness tear , and tear enlargement is associated with a greater risk of pain development across all tear types . LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence Introduction Return to work following an occupational injury is a multifactoral process although many traditional clinic-based rehabilitation programs do not appreciate the importance of workplace factors . A r and omized controlled trial was conducted to investigate the effect of workplace-based rehabilitation program on the return to work outcome of work-related rotator cuff disorder , which is based on the therapeutic use of actual work facilities and work environment . Methods A total of 103 workers were recruited and r and omly assigned into Clinic-based Work Hardening ( CWH ) or Workplace-based Work Hardening ( WWH ) groups . The CWH group were given traditional generic work hardening training while WWH group received workplace-based work hardening training with rehabilitative principles of athletic rotator cuff pathology , biomechanics and specific job activities . Results After four weeks , a higher return to work rate was obtained in WWH group compared to CWH group ( 71.4 % vs. 37 % , p < 0.01 ) . A statistically significant difference ( p < 0.05 ) was also noted in lowering of self-reported shoulder problems and functional work capabilities in the WWH group versus the CWH group . Conclusion Workplace-based rehabilitation program appeared to be more effective in facilitating the return to work process of the injured worker as assessed immediately following intervention . In particular this approached was associated with many of the psychosocial workplace factors related to separation from the work routine . The influence of peer group and /or employer could be minimized . This initial attempt with rotator cuff injuries appears promising however long-term outcome needs to be determined BACKGROUND The purpose s of this study were to identify changes in tear dimensions , shoulder function , and glenohumeral kinematics when an asymptomatic rotator cuff tear becomes painful and to identify characteristics of individuals who develop pain compared with those who remain asymptomatic . METHODS A cohort of 195 subjects with an asymptomatic rotator cuff tear was prospect ively monitored for pain development and examined annually for changes in various parameters such as tear size , fatty degeneration of the rotator cuff muscle , glenohumeral kinematics , and shoulder function . Forty-four subjects were found to have developed new pain , and the parameters before and after pain development were compared . The forty-four subjects were then compared with a group of  fifty-five subjects who remained asymptomatic over a two-year period . RESULTS With pain development , the size of a full-thickness rotator cuff tear increased significantly , with 18 % of the full-thickness tears showing an increase of > 5 mm , and 40 % of the partial-thickness tears had progressed to a full-thickness tear . In comparison with the assessment s made before the onset of pain , the American Shoulder and Elbow Surgeons scores for shoulder function were significantly decreased and all measures of shoulder range of motion were decreased except for external rotation at 90 ° of abduction . There was an increase in compensatory scapulothoracic motion in relation to the glenohumeral motion during early shoulder abduction with pain development . No significant changes were found in external rotation strength or muscular fatty degeneration . Compared with the subjects who remained asymptomatic , the subjects who developed pain were found to have significantly larger tears at the time of initial enrollment . CONCLUSIONS Pain development in shoulders with an asymptomatic rotator cuff tear is associated with an increase in tear size . Larger tears are more likely to develop pain in the short term than are smaller tears . Further research is warranted to investigate the role of prophylactic treatment of asymptomatic shoulders to avoid the development of pain and loss of shoulder function PURPOSE To assess the effectiveness of a specific nonoperative physical therapy program in treating atraumatic full-thickness rotator cuff tears using a multicenter prospect i ve cohort study design . MATERIAL S AND METHODS Patients with atraumatic full-thickness rotator cuff tears who consented to enroll provided data via question naire on demographics , symptom characteristics , comorbidities , willingness to undergo surgery , and patient-related outcome assessment s ( Short Form 12 score , American Shoulder and Elbow Surgeons score , Western Ontario Rotator Cuff score , Single Assessment Numeric Evaluation score , and Shoulder Activity Scale )  . Physicians recorded physical examination and imaging data . Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks . At those visits , patients could choose 1 of 3 courses : ( 1 ) cured ( no formal follow-up scheduled ) , ( 2 ) improved ( continue therapy with scheduled re assessment in 6 weeks ) , or ( 3 ) no better ( surgery offered ) . Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit . A Wilcoxon signed rank test with continuity correction was used to compare initial , 6-week , and 12-week outcome scores . RESULTS The cohort consists of 452 patients .  Patient-reported outcomes improved significantly at 6 and 12 weeks . Patients elected to undergo surgery less than 25 % of the time . Patients who decided to have surgery generally did so between 6 and 12 weeks , and few had surgery between 3 and 24 months . CONCLUSION Nonoperative treatment using this physical therapy protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75 % of patients followed up for 2 years Background Open rotator cuff repairs have led to excellent clinical results ; however , several studies have linked postoperative structural integrity to patient outcomes . The purpose of this study is to prospect ively assess postoperative cuff integrity after  open rotator cuff repair  and assess its relationship to clinical outcome . Hypothesis Preoperative rotator cuff tear size and postoperative rotator cuff integrity are important factors in overall clinical outcomes . Study Design Prospect i ve nonr and omized clinical outcomes study . Methods Forty-seven consecutive patients undergoing repair of full-thickness rotator cuff tears by a single surgeon were enrolled in this prospect i ve study . A st and ardized evaluation was performed preoperatively and postoperatively at annual intervals . All patients underwent  postoperative magnetic resonance imaging at least 1 year after surgery . Statistical evaluation was performed using paired and unpaired 2-tailed t tests for comparison . Results Thirty-two patients were available for evaluation . Overall , the patients experienced a significant ( P < .05 ) improvement in their American Shoulder and Elbow Surgeons survey ( 40 - 85 ) and Constant ( 53 - 80 ) scores . The overall retear rate was 31 % . Although patients with large tears preoperatively and retears postoperatively had lower overall outcomes scores , this was not significant . Conclusion These data support open rotator cuff repair as an effective technique that restores excellent shoulder function . The authors did not find postoperative cuff integrity to have a significant effect on outcomes when compared with those with an intact cuff . In fact , those with a retear still had a significant improvement in all clinical areas assessed , including strength Background : Patient activity level  may be an important prognostic variable relating to outcomes in patients with shoulder disorders . Little is known about the predictors of activity level in patients with shoulder disorders . Hypothesis : Tear size and patient variables would be predictive of shoulder activity level in a cohort of patients who have selected initial nonoperative treatment for a symptomatic , atraumatic rotator cuff tear on magnetic resonance imaging ( MRI ) .  Study Design : Cross-sectional study ; Level of evidence , 3 . Methods : Patients with an atraumatic rotator cuff tear on MRI were prospect ively enrolled in the Multicenter Orthopaedic Outcomes Network ( MOON ) shoulder study of nonoperative treatment . As part of routine data collection , these patients were asked to complete a previously vali date d  shoulder activity scale . A regression analysis was performed to assess the association of shoulder activity level to rotator cuff tear characteristics , including tendon involvement and retraction , and patient factors such as age , sex , smoking , and occupation . Results : A total of 434 patients ( 220 male , 214 female ) with a mean age of 62.7 years ( range , 31 - 90 years ) completed the activity scale . Shoulder activity was not associated with severity of the rotator cuff tear , but it was negatively associated with age ( P = .0001 ) and female sex ( P = .001 ) . The only other factor associated with shoulder activity level in this cohort was occupation ( P = .0006 ) . Conclusion : Shoulder activity level in patients with an atraumatic rotator cuff tear confirmed on MRI is not associated with severity of the tear but is affected by age , sex , and occupation BACKGROUND Patient-reported outcome measures have increasingly accompanied objective examination findings in the evaluation of orthopaedic interventions . Our objective was to determine whether a vali date d measure of mental health ( Short Form-36 Mental Component Summary [ SF-36 MCS ] ) or measures of tear severity on magnetic resonance imaging were more strongly associated with self-assessed shoulder pain and function in patients with symptomatic full-thickness rotator cuff tears . METHODS One hundred and sixty-nine patients with full-thickness rotator cuff tears were prospect ively enrolled . Patients completed the Short Form-36 , visual analog scales for shoulder pain  and function , the Simple Shoulder Test ( SST ) , and the American Shoulder and Elbow Surgeons ( ASES ) instrument at the time of diagnosis . Shoulder magnetic resonance imaging examinations were review ed to document the number of tendons involved , tear size , tendon retraction , and tear surface area . Age , sex , body mass index , number of medical comorbidities , smoking status , and Workers ' Compensation status were recorded . Bivariate correlations and multivariate regression models were calculated to identify associations with baseline shoulder scores . RESULTS The SF-36 MCS had the strongest correlation with the visual analog scale for shoulder pain ( Pearson correlation coefficient , -0.48 ; p < 0.001 ) , the visual analog scale for shoulder function ( Pearson correlation coefficient , -0.33 ; p < 0.001 ) , the SST ( Pearson correlation coefficient , 0.37 ; p < 0.001 ) , and the ASES score ( Pearson correlation coefficient , 0.51 ; p < 0.001 ) . Tear severity only correlated with the visual analog scale for shoulder function ; the Pearson correlation coefficient was 0.19 for tear size ( p = 0.018 ) , 0.18 for tendon retraction ( p = 0.025 ) , 0.18 for tear area ( p = 0.022 ) , and 0.20 for the number of tendons involved ( p = 0.011 ) . Tear severity did not correlate with other scores in bivariate correlations ( all p > 0.05 ) . In all multivariate models , the SF-36 MCS had the strongest association with the visual analog scale for shoulder pain , the visual analog scale for shoulder function , the SST , and the ASES score ( all p < 0.001 ) . CONCLUSIONS Patient mental health may play an influential role in patient-reported pain and function in patients with full-thickness rotator cuff tears . Further studies are needed to determine its effect on the outcome of the treatment of rotator cuff disease We conducted this study to determine whether a test , the posterior impingement maneuver , could be used to prospect ively identify articular side tears of the rotator cuff and /or posterior labrum . Sixty-nine athletes presented with posterior shoulder pain that developed during overh and athletics . Injured shoulders were placed into 90 degrees to 110 degrees of abduction , slight extension , and maximum external rotation , and an effort was made to elicit pain deep within the posterior aspect . Overall sensitivity of the test was 75.5 % , and specificity was 85 % . When only athletes with noncontact injuries ( gradual onset of pain ) were considered , sensitivity was 95 % and specificity was 100 % . A positive posterior impingement sign correlated highly with undersurface tearing of the rotator cuff and /or tearing of the posterior labrum in athletes with gradual onset of posterior shoulder pain during overh and athletics Objectives : Rotator cuff tears are a common shoulder disorder result ing in significant disability to patients and strain on the health care system . While both surgical and non-surgical management are accepted treatment options , little data exist to guide the surgeon in treatment allocation . Defining variables to guide treatment allocation may be important for patient education and counseling , as well as to deliver the most efficient care plan at the time of presentation . The objective of this study was to identify patient characteristics at the time of initial clinical presentation that are associated with allocation to surgical versus non-surgical management for patients with known full-thickness rotator cuff tears . Methods : 185 consecutive adult patients with known full-thickness rotator cuff tears were enrolled into a prospect i ve cohort study . Robust data were collected for each subject at baseline , including age , gender , body mass index ( BMI ) , shoulder activity score , smoking status , size of cuff tear , duration of symptoms , functional comorbidity index , treating surgeon , the American Shoulder and Elbow Society ( ASES ) score , the Western Ontario Rotator Cuff Index ( WORC ) , and the Veterans R and 12 Item Health Survey ( VR-12 ) . Logistic regression was performed in order to identity variables associated with treatment allocation , and the corresponding odds ratios were calculated . Results : Of the 185 subject enrolled , 100 underwent surgical intervention and 85 non-operative management . While controlling for co-variates , significant baseline patient characteristics predictive of eventual allocation to surgical treatment included the following : non-smoking status [ OR .039 ( 0.005 , 0.300 ) p=0.002 ] , lower functional comorbidity index [ OR 0.739 ( 0.518 , 1.055 ) p=0.096 ] , younger age [ OR 0.872 ( 0.820 , 0.927 ) p<0.001 ] , lower BMI [ OR 0.895 ( 0.826 , 0.970 ) p=0.007 ] , and symptoms present for fewer than 4 months [ OR 3.258 ( 1.070 , 9.921 ) p=0.038 ] . Factors that were not associated with treatment allocation included gender , tear size , diabetes , treating surgeon , or any of the patient derived outcome scores at presentation ( ASES , WORC , VR-12 , shoulder activity score ) . Conclusion : This prospect i ve cohort study suggests that the factors predictive of treatment allocation are related more to patient demographics at presentation than patient derived outcome scores or intrinsic characteristics of the rotator cuff such as tear size . Further study is warranted to help define appropriate indications for treatment allocation in patients with rotator cuff tears Background The role of degenerative changes in rotator cuff musculature with respect to the functional outcomes of rotator cuff repair have only recently been recognized and are still not well understood . In addition , the reversibility of these changes with repair of the tendons is question able . Hypothesis Poorer preoperative muscle quality negatively affects outcome , and a successful outcome ( in terms of a healed repair ) might demonstrate improvements in fatty infiltration and muscle atrophy . Study Design Cohort study ; Level of evidence , 2 . Methods Thirty-eight patients ( mean age , 62 years ) were prospect ively evaluated with preoperative and 1-year postoperative clinical examination and appropriate magnetic resonance image sequencing to determine grade s of muscle atrophy and fatty infiltration of the supraspinatus and infraspinatus muscles . American Shoulder and Elbow Society ( ASES ) , Constant , and pain scores were determined as well as strength measurements . The retear rate and progression of muscle degeneration were also evaluated . Independent predictors of outcome measurements and cuff integrity were determined . Results The overall clinical outcome , including ASES , Constant , and pain scores , improved significantly ( P < .0001 ) . Strength in forward elevation improved significantly ( P < .006 ) , while external rotation strength did not . There was a strongly negative correlation between muscle quality and outcome results in most cases . When the results were adjusted for multivariate effect , muscle atrophy and fatty infiltration of the infraspinatus muscle were the only independent predictors of ASES and Constant scores ( P < .03 ) . Tear size and rotator cuff healing did not play an independent role . Tear size , however , was the only independent predictor of ultimate cuff integrity ( P = .002 ) . Both atrophy and fatty infiltration progressed significantly over the course of the study . In cases in which the tendon had re-torn , the progression was found to be more significant than when the repair proved successful ( P < .003 ) . Conclusion Muscle atrophy and fatty infiltration of the rotator cuff muscles , particularly of the infraspinatus , play a significant role in determining functional outcome after cuff repair . Tear size appears to have the most influential effect on repair integrity . A successful repair did not lead to improvement or reversal of muscle degeneration and a failed repair result ed in significantly more progression . In general , healed repairs demonstrated minimal progression . These findings suggest that repairs should be performed , if possible , before more significant deterioration in the cuff musculature in order to optimize outcomes , and that underst and ing the degree of muscle atrophy and fatty infiltration before surgery can help guide patient expectations Background : After reinsertion on the humerus , the rotator cuff has limited ability to heal . Growth factor augmentation has been proposed to enhance healing in such procedure . Purpose : This study was conducted to assess the efficacy and safety of growth factor augmentation during rotator cuff repair . Study Design : R and omized controlled trial ; Level of evidence , 1 . Methods : Eighty-eight patients with a rotator cuff tear were r and omly assigned by a computer-generated sequence to receive arthroscopic rotator cuff repair without ( n = 45 ) or with ( n = 43 ) augmentation with autologous platelet-rich fibrin matrix ( PRFM ) . The primary end point was the postoperative difference in the Constant score between the 2 groups . The secondary end point was the integrity of the repaired rotator cuff , as evaluated by magnetic resonance imaging . Analysis was on an intention-to-treat basis . Results : All the patients completed follow-up at 16 months . There was no statistically significant difference in total Constant score when comparing the results of arthroscopic repair of the 2 groups ( 95 % confidence interval , −3.43 to 3.9 ) ( P = .44 ) . There was no statistically significant difference in magnetic resonance imaging tendon score when comparing arthroscopic repair with or without PRFM ( P = .07 ) . Conclusion : Our study does not support the use of autologous PRFM for augmentation of a double-row repair of a small or medium rotator cuff tear to improve the healing of the rotator cuff . Our results are applicable to small and medium rotator cuff tears ; it is possible that PRFM may be beneficial for large and massive rotator cuff tears . Also , given the heterogeneity of PRFM preparation products available on the market , it is possible that other preparations may be more effective
Results Weak to moderate cross-sectional associations were found for emotional or mental health with function or disability and pain in multiple studies .
Lower emotional or mental health function was associated with greater pain or disability or lower physical function at initial evaluation .
Conclusions At the initial evaluation of patients with rotator cuff tear , there was an association between self-reported function and pain and emotional or mental health .
However , these factors were not associated with patient-reported outcomes after intervention .
Preoperative patient expectation is an important predictor of patient-reported outcomes in patients after rotator cuff surgery and may be a modifiable target for enhancing recovery .
Background Psychosocial factors are key determinants of health and can influence patient-reported outcomes after rotator cuff tears .
However , to our knowledge , a systematic review of published studies has not been conducted to determine the degree of consistency and strength of the relationship between psychosocial factors and patient-reported outcomes in this patient population .
Questions / purpose s ( 1 ) Are psychosocial factors associated with patient-reported measures at initial clinical presentation in patients with rotator cuff tears ? (
2 ) Are psychosocial factors associated with patient-reported outcomes after treatment in patients with rotator cuff tears ?