title: A prospective evaluation of survivorship of asymptomatic degenerative rotator cuff tears.
abstract: BACKGROUND
  The purpose of this prospective study was to report the long-term risks of rotator cuff tear enlargement and symptom progression associated with degenerative asymptomatic tears.
  
  
  METHODS
  Subjects with an asymptomatic rotator cuff tear in one shoulder and pain due to rotator cuff disease in the contralateral shoulder enrolled as part of a prospective longitudinal study. Two hundred and twenty-four subjects (118 initial full-thickness tears, fifty-six initial partial-thickness tears, and fifty controls) were followed for a median of 5.1 years. Validated functional shoulder scores were calculated (visual analog pain scale, American Shoulder and Elbow Surgeons [ASES], and simple shoulder test [SST] scores). Subjects were followed annually with shoulder ultrasonography and clinical evaluations.
  
  
  RESULTS
  Tear enlargement was seen in 49% of the shoulders, and the median time to enlargement was 2.8 years. The occurrence of tear-enlargement events was influenced by the severity of the final tear type, with enlargement of 61% of the full-thickness tears, 44% of the partial-thickness tears, and 14% of the controls (p < 0.05). Subject age and sex were not related to tear enlargement. One hundred subjects (46%) developed new pain. The final tear type was associated with a greater risk of pain development, with the new pain developing in 28% of the controls, 46% of the shoulders with a partial-thickness tear, and 50% of those with a full-thickness tear (p < 0.05). The presence of tear enlargement was associated with the onset of new pain (p < 0.05). Progressive degenerative changes of the supraspinatus muscle were associated with tear enlargement, with supraspinatus muscle degeneration increasing in 4% of the shoulders with a stable tear compared with 30% of the shoulders with tear enlargement (p < 0.05). Nine percent of the shoulders with a stable tear showed increased infraspinatus muscle degeneration compared with 28% of those in which the tear had enlarged (p = 0.07).
  
  
  CONCLUSIONS
  This study demonstrates the progressive nature of degenerative rotator cuff disease. The risk of tear enlargement and progression of muscle degeneration is greater for shoulders with a full-thickness tear, and tear enlargement is associated with a greater risk of pain development across all tear types.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for J.D. Keener: keenerj@wustl.edu.
authors.forename: Jay D
authors.initials: JD
authors.lastname: Keener
authors.affiliation: Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for J.D. Keener: keenerj@wustl.edu.
authors.forename: Leesa M
authors.initials: LM
authors.lastname: Galatz
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110.
authors.forename: Sharlene A
authors.initials: SA
authors.lastname: Teefey
authors.affiliation: Mallinckrodt Institute of Radiology, Washington University, St. Louis, MO 63110.
authors.forename: William D
authors.initials: WD
authors.lastname: Middleton
authors.affiliation: Division of Biostatistics, Washington University School of Medicine, St. Louis, MO 63110.
authors.forename: Karen
authors.initials: K
authors.lastname: Steger-May
authors.affiliation: Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for J.D. Keener: keenerj@wustl.edu.
authors.forename: Georgia
authors.initials: G
authors.lastname: Stobbs-Cucchi
authors.affiliation: Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for J.D. Keener: keenerj@wustl.edu.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Patton
authors.affiliation: Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University, Campus Box 8233, 660 South Euclid Avenue, St. Louis, MO 63110. E-mail address for J.D. Keener: keenerj@wustl.edu.
authors.forename: Ken
authors.initials: K
authors.lastname: Yamaguchi
mesh_terms: D000368:Aged; D018450:Disease Progression; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011446:Prospective Studies; D012306:Risk; D017006:Rotator Cuff / Q000000981:diagnostic imaging; D000070636:Rotator Cuff Injuries; D020069:Shoulder Pain / Q000000981:diagnostic imaging* / Q000209:etiology; D013708:Tendon Injuries / Q000000981:diagnostic imaging*; D014463:Ultrasonography