Warren R Dunn1, John E Kuhn2, Rosemary Sanders2, Qi An3, Keith M Baumgarten4, Julie Y Bishop5, Robert H Brophy6, James L Carey7, G Brian Holloway8, Grant L Jones5, C Benjamin Ma9, Robert G Marx10, Eric C McCarty11, Sourav K Poddar12, Matthew V Smith6, Edwin E Spencer8, Armando F Vidal12, Brian R Wolf13, Rick W Wright14. 1. University of Wisconsin, Research Park Clinic Sports Medicine Clinic, 621 Science Drive, Madison, WI 53711. 2. 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.edu. 3. St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 723, Memphis, TN 38105-3768. 4. Sports Medicine & Shoulder Surgery Orthopedic Institute, 810 East 23rd Street, Sioux Falls, SD 57117. 5. OSU Sports Medicine Center, 2050 Kenny Road, Suite 3300, Columbus, OH 43221-3502. 6. Department of Orthopaedic Surgery, Washington University School of Medicine, 14532 South Outer Forty Drive, Chesterfield, MO 63017. 7. PENN Orthopaedics, Hospital of the University of Pennsylvania, Weightman Hall, 33rd and Spruce Streets, Philadelphia, PA 19104. 8. Shoulder and Elbow Institute Knoxville Orthopaedic Clinic, 260 Fort Sanders West Boulevard, Knoxville, TN 37922. 9. UCSF Sports Medicine, 1500 Owens Street, San Francisco, CA 94158. 10. Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021. 11. CU Sports Medicine, 311 Mapleton Avenue, Boulder, CO 80304. 12. CU Sports Medicine, 2000 South Colorado Boulevard, Colorado Center Tower One, Suite 4500, Denver, CO 80222. 13. University of Iowa, 2701 Prairie Meadow Drive, Iowa City, IA 52242-1088. 14. Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St. Louis, MO 63110.
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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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