Rotator cuff disease in the shoulder is among the most common of all musculoskeletal disorders. About 2 million people in the United States visit a doctor each year for rotator cuff problems, and almost half of those older than 70 have rotator cuff tears.
Several such patients recently were on hand for an update on a landmark study on rotator cuff injury at the Eric P. Newman Education Center at Washington University School of Medicine in St. Louis. The study, “Asymptomatic Rotator Cuff Tears: A Model for Pain Development,” was funded by the National Institutes of Health. The program featured presentations from principal investigators Ken Yamaguchi, MD, the Sam and Marilyn Fox Distinguished Professor of Orthopaedic Surgery, and Jay D. Keener, MD, assistant professor of orthopaedic surgery. Sharlene A. Teefey, MD, professor of radiology, also is one of the study’s main investigators. The three also treat patients at Barnes-Jewish Hospital.
Since October 2002, 390 patients have enrolled in the study, which was designed to obtain long-term follow-up of patients with rotator cuff tears and to evaluate factors that contribute to the deterioration of tears and the development of symptoms such as pain.
Those involved in the study first went to their doctors for problems with a shoulder. After each was treated, the other nonpainful shoulder was examined. Many asymptomatic tears were discovered. Since then, study subjects have received annual exams, including X-rays and ultrasound imaging to evaluate the health of the muscles, tendons and bones in their shoulder joints.
The research has shown that patients whose “bad” shoulders have been treated are at high risk for developing problems in their “good” shoulders later. Yamaguchi, Teefey and Keener have learned that over the course of five years, roughly half of patients with asymptomatic tears will go on to develop an enlargement of the tear in those good shoulders. In addition, about half who hadn’t had symptoms despite the presence of a tear go on to develop pain.
The researchers have had a number of papers on the natural history of rotator cuff disease published in The Journal of Bone & Joint Surgery. They also have completed long-term data analysis about the risk of tear deterioration and plan to submit their latest findings for publication soon.