Full-thickness rotator cuff tears tend to increase in size over time and rarely heal without surgery, researchers from Israel report in the February 10th online issue of The American Journal of Sports Medicine.

"Full-thickness rotator cuff tears tend to increase in size in about half of patients aged 60 years or younger," the investigators say. "Surgery should be initially considered in these patients to prevent a probable increase in size [of the] tear."

Nonsurgical treatment provides pain relief and improves range of motion in most patients with symptomatic rotator cuff tears, but the anatomic natural history of nonsurgically treated tears remains unclear.

Dr. Ori Safran and colleagues from Hadassah Hebrew University Medical Center, Jerusalem, used shoulder ultrasound examination to evaluate the change in size of nonoperatively managed full-thickness rotator cuff tears over two to three years in 51 patients aged 35 to 60 years.

There were 61 tears in 51 patients in the initial ultrasound examination. The follow-up ultrasound examination identified 66 tears. Ultrasound was performed on both shoulders by the same ultrasonographer at each examination.

Thirty (49%) of the initial 61 tears had increased by at least 5 mm, 26 (43%) tears had not changed in size, and 5 (8%) had decreased in size (4 of these had disappeared).

"It is apparent that rotator cuff tears can in some cases decrease in size and that the commonly accepted notion that rotator cuff lesions always fail to heal spontaneously is not completely accurate," the authors write. "The quality of the tissue forming in the tear site (synovial proliferation, scar tissue, or normal tendon tissue) in full-thickness tears has yet to be determined."

The new tears found on follow-up ultrasound averaged 10.5 mm in size and accounted for 24% of the intact rotator cuffs in the initial examination.

The existence of considerable pain at the time of the follow-up examination correlated significantly with an increase in tear size, but there was no correlation between the appearance of new rotator cuff tears and any of the factors examined (sex, preexisting trauma, or pain at follow-up).

"A limitation of our study is that we do not know how the decision was made to treat these patients nonoperatively," the researchers note. "Therefore, we do not know if these results represent all patients in this age group with rotator cuff tears."

"We also suggest that follow-up imaging might be beneficial in patients who are treated nonoperatively and who have continued pain, to monitor their tear size," they add. "A surgical repair may be warranted for those in whom a clinically significant increase in tear size is observed."

Am J Sports Med. Posted online February 10, 2011. Abstract

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