Clinical and structural outcomes of nonoperative management of massive rotator cuff tears
P O Zingg, Bernhard Jost, A Sukthankar, M Buhler, C W A Pfirrmann & C Gerber
abstract
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BACKGROUND
The natural history of massive rotator cuff tears is not well known.
The purpose of this study was to determine the clinical and
structural mid-term outcomes in a series of nonoperatively managed
massive rotator cuff tears.
METHODS
Nineteen consecutive patients (twelve men and seven women; average
age, sixty-four years) with a massive rotator cuff tear, documented
by magnetic resonance imaging, were identified retrospectively.
There were six complete tears of two rotator cuff tendons and
thirteen complete tears of three rotator cuff tendons. All patients
were managed exclusively with nonoperative means. Nonoperative
management was chosen when a patient had low functional demands and
relatively few symptoms and/or if he or she refused to have surgery.
For the purpose of this study, patients were examined clinically and
with standard radiographs and magnetic resonance imaging.
RESULTS
After a mean duration of follow-up of forty-eight months, the mean
relative Constant score was 83% and the mean subjective shoulder
value was 68%. The score for pain averaged 11.5 points on a 0 to
15-point visual analogue scale in which 15 points represented no
pain. The active range of motion did not change over time. Forward
flexion and abduction averaged 136 degrees; external rotation, 39
degrees; and internal rotation, 66 degrees. Glenohumeral
osteoarthritis progressed (p = 0.014), the acromiohumeral distance
decreased (p = 0.005), the size of the tendon tear increased (p =
0.003), and fatty infiltration increased by approximately one stage
in all three muscles (p = 0.001). Patients with a three-tendon tear
showed more progression of osteoarthritis (p = 0.01) than did
patients with a two-tendon tear. Four of the eight rotator cuff
tears that were graded as reparable at the time of the diagnosis
became irreparable at the time of final follow-up.
CONCLUSIONS
Patients with a nonoperatively managed, moderately symptomatic
massive rotator cuff tear can maintain satisfactory shoulder
function for at least four years despite significant progression of
degenerative structural joint changes. There is a risk of a
reparable tear progressing to an irreparable tear within four years.
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citation
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Zingg P O, Jost B, Sukthankar A, Buhler M, Pfirrmann C W A, Gerber
C. Clinical and structural outcomes of nonoperative management of
massive rotator cuff tears. J Bone Joint Surg Am 2007; 89:1928-34.
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type
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journal paper/review (English)
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date of publishing
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9-2007
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journal title
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J Bone Joint Surg Am (89/9)
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ISSN print
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0021-9355
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pages
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1928-34
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PubMed
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17768188
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DOI
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10.2106/JBJS.F.01073
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