Rotator cuff pain linked with tear size progression

The risk of symptom progression for asymptomatic rotator cuff tears after a short-term follow-up interval is substantial. Pain development is associated with tear size progression (enlargement of full-thickness tears and conversion of partial-thickness to full-thickness tendon defects).

Mall and colleagues monitored 195 patients who had an asymptomatic rotator cuff tear. Both shoulders were evaluated annually (ultrasonography, radiography, clinical assessment) for tear size, tissue degeneration, shoulder joint kinematics, and shoulder function.

A total of 44 patients had new pain in the asymptomatic shoulder at an average of 1.93 years into the study. The onset of pain was consistently associated with a significant increase in the size of the tear: 40% of partial-thickness tears progressed to full-thickness, and 18% of full-thickness tears increased by more than 5 mm. Tears were significantly wider, but not longer, in the symptomatic versus the asymptomatic patients. Patients who became symptomatic during the study also had larger tears at baseline than those who remained pain-free.