title: Natural history of nonoperatively treated symptomatic rotator cuff tears in patients 60 years old or younger.
abstract: BACKGROUND
  Rotator cuff tears are the most frequent tendon injury in the adult population. However, the natural history of nonoperatively treated full-thickness tears is poorly defined. Knowledge of the expected evolution in tear size is important when considering nonoperative versus surgical care, especially in relatively young, active patients.
  
  
  OBJECTIVE
  To evaluate the size change of nonoperatively treated full-thickness rotator cuff tears over 2 to 3 years' follow-up.
  
  
  METHODS
  Case series; Level of evidence, 4.
  
  
  METHODS
  The authors prospectively followed patients 60 years old or younger who had a full-thickness rotator cuff tear equal to or larger than 5 mm, as diagnosed by bilateral shoulder ultrasound, and who were treated nonoperatively. At 2 to 3 years after the index ultrasound examination, a repeat ultrasound examination was performed by the same ultrasonographer. Results of the follow-up ultrasound examinations of both shoulders were compared with those of the index ultrasound examinations for change in rotator cuff tear size. The correlations were examined between these changes and age, sex, history of initial trauma, size of tear on the index ultrasound, and current shoulder symptoms.
  
  
  RESULTS
  Fifty-one patients with 61 rotator cuff tears were evaluated. At a follow-up of 25 to 39 months (mean, 29), 49% of the tears (30 tears) increased in size, 43% (26 tears) had not changed, and 8% (5 tears) decreased in size. For 25% (10 shoulders ) of initially intact shoulders (41 shoulders), a new full-thickness rotator cuff tear was diagnosed. No correlation was found between the change in tear size and age of the patient (P = .85), sex (P = .93), existence of a prior trauma (P = .63), size of tear at index ultrasound (P = .62), and bilateral tears (P = 1.00). There was a correlation between the existence of considerable pain at the time of the follow-up ultrasound and a clinically significant increase in tear size (P = .002).
  
  
  CONCLUSIONS
  Full-thickness rotator cuff tears tend to increase in size in about half of patients aged 60 years or younger. Surgery should be initially considered in these patients to prevent a probable increase in size tear. Patients treated nonoperatively should be routinely monitored for tear size increase, especially if they remain symptomatic.
authors.affiliation: Department of Orthopedics, Hadassah Hebrew University Medical Center, Jerusalem, Israel. oris@hadassah.org.il
authors.forename: Ori
authors.initials: O
authors.lastname: Safran
authors.forename: Joshua
authors.initials: J
authors.lastname: Schroeder
authors.forename: Ronald
authors.initials: R
authors.lastname: Bloom
authors.forename: Yoram
authors.initials: Y
authors.lastname: Weil
authors.forename: Charles
authors.initials: C
authors.lastname: Milgrom
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000000981:diagnostic imaging / Q000628:therapy; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D016896:Treatment Outcome; D014463:Ultrasonography