title: Symptoms of pain do not correlate with rotator cuff tear severity: a cross-sectional study of 393 patients with a symptomatic atraumatic full-thickness rotator cuff tear.
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 &gt; 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.
  
  
  METHODS
  Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: University of Wisconsin, Research Park Clinic Sports Medicine Clinic, 621 Science Drive, Madison, WI 53711.
authors.forename: Warren R
authors.initials: WR
authors.lastname: Dunn
authors.affiliation: 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.
authors.forename: John E
authors.initials: JE
authors.lastname: Kuhn
authors.affiliation: 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.
authors.forename: Rosemary
authors.initials: R
authors.lastname: Sanders
authors.affiliation: St. Jude Children's Research Hospital, 262 Danny Thomas Place, Mail Stop 723, Memphis, TN 38105-3768.
authors.forename: Qi
authors.initials: Q
authors.lastname: An
authors.affiliation: Sports Medicine & Shoulder Surgery Orthopedic Institute, 810 East 23rd Street, Sioux Falls, SD 57117.
authors.forename: Keith M
authors.initials: KM
authors.lastname: Baumgarten
authors.affiliation: OSU Sports Medicine Center, 2050 Kenny Road, Suite 3300, Columbus, OH 43221-3502.
authors.forename: Julie Y
authors.initials: JY
authors.lastname: Bishop
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, 14532 South Outer Forty Drive, Chesterfield, MO 63017.
authors.forename: Robert H
authors.initials: RH
authors.lastname: Brophy
authors.affiliation: PENN Orthopaedics, Hospital of the University of Pennsylvania, Weightman Hall, 33rd and Spruce Streets, Philadelphia, PA 19104.
authors.forename: James L
authors.initials: JL
authors.lastname: Carey
authors.affiliation: Shoulder and Elbow Institute Knoxville Orthopaedic Clinic, 260 Fort Sanders West Boulevard, Knoxville, TN 37922.
authors.forename: G Brian
authors.initials: GB
authors.lastname: Holloway
authors.affiliation: OSU Sports Medicine Center, 2050 Kenny Road, Suite 3300, Columbus, OH 43221-3502.
authors.forename: Grant L
authors.initials: GL
authors.lastname: Jones
authors.affiliation: UCSF Sports Medicine, 1500 Owens Street, San Francisco, CA 94158.
authors.forename: C Benjamin
authors.initials: CB
authors.lastname: Ma
authors.affiliation: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Marx
authors.affiliation: CU Sports Medicine, 311 Mapleton Avenue, Boulder, CO 80304.
authors.forename: Eric C
authors.initials: EC
authors.lastname: McCarty
authors.affiliation: CU Sports Medicine, 2000 South Colorado Boulevard, Colorado Center Tower One, Suite 4500, Denver, CO 80222.
authors.forename: Sourav K
authors.initials: SK
authors.lastname: Poddar
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, 14532 South Outer Forty Drive, Chesterfield, MO 63017.
authors.forename: Matthew V
authors.initials: MV
authors.lastname: Smith
authors.affiliation: Shoulder and Elbow Institute Knoxville Orthopaedic Clinic, 260 Fort Sanders West Boulevard, Knoxville, TN 37922.
authors.forename: Edwin E
authors.initials: EE
authors.lastname: Spencer
authors.affiliation: CU Sports Medicine, 2000 South Colorado Boulevard, Colorado Center Tower One, Suite 4500, Denver, CO 80222.
authors.forename: Armando F
authors.initials: AF
authors.lastname: Vidal
authors.affiliation: University of Iowa, 2701 Prairie Meadow Drive, Iowa City, IA 52242-1088.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Wolf
authors.affiliation: Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St. Louis, MO 63110.
authors.forename: Rick W
authors.initials: RW
authors.lastname: Wright
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D000070636:Rotator Cuff Injuries; D012421:Rupture / Q000628:therapy; D020069:Shoulder Pain / Q000209:etiology*; D052256:Tendinopathy / Q000150:complications; D013708:Tendon Injuries / Q000628:therapy