| Rotator cuff tears are very common and it is well | | | | with rotator cuff tears who were managed |
| known that their prevalence increases with age. One | | | | non-operatively. Evaluations were performed via |
| common kinematic dysfunction seen in rotator cuff | | | | review of magnetic resonance imaging studies and |
| deficient patients is proximal migration of the humeral | | | | results were correlated with age and anatomical |
| head. This is particularly so since one major function of | | | | variables, among others. |
| the intact rotator cuff complex is to stabilize the | | | | Pertinent results from this study include: |
| humeral head within the center of the glenoid fossa | | | | Grouping follow-up time of non-operative |
| upon movement of the upper extremity. | | | | treatment on a continuous scale (from 25 months), the |
| Pain, tear location, and tear size all have been | | | | odds ratio for an increase in rotator cuff tear size was |
| implicated in altered glenohumeral mechanics, however, | | | | 2.1 as follow-up time doubled. Significantly more |
| their specific effects remain relatively unknown. These | | | | full-thickness tears increased in size as compared to |
| particular factors may play an important role for us as | | | | those partially torn. |
| diagnosticians and manual therapists, since a proper | | | | When patients were classified either as |
| understanding of each may influence the treatment | | | | younger-than or older-than 60 years of age, |
| plans within our scopes of practice. Specifically, do the | | | | significantly more tears progressed in size in the older |
| presence or characteristics of any of the above (or | | | | group. |
| other) predictive factors have the potential to guide the | | | | While only 8% of tears decreased in size over |
| management of rotator cuff disease and dictate | | | | time, none of these were from shoulders whose tears |
| whether or not conservative care will be sufficient, or | | | | involved more than one tendon. |
| can specific characteristics predict whether surgical | | | | No significant relationships were found among |
| management is warranted? These questions form the | | | | acromioclavicular joint arthritis, acromial spurs, and |
| basis of the studies included in this review. | | | | supraspinatus atrophy with tear progression. However, |
| Pertinent Results: | | | | tear size progression was significantly more common |
| To shed some light on the questions above, two | | | | in those shoulders that demonstrated fatty infiltration of |
| separate studies were reviewed together. | | | | the musculature. (Note: the presence of fatty infiltration |
| Keener et al. specifically examined the relative effects | | | | was no different in the partial- and full-thickness |
| that rotator cuff tear size and pain had on proximal | | | | groups.) |
| humeral migration in both symptomatic and | | | | Clinical Application & Conclusions: |
| asymptomatic individuals with rotator cuff deficient | | | | Various factors influencing the kinematics of the |
| shoulders. The premise for the inclusion of subjects | | | | glenohumeral joint were examined in the first study. |
| with and without pain was to provide insight as to | | | | Through the simultaneous inclusion of both |
| whether or not pain modalities and/or medication have | | | | symptomatic and asymptomatic individuals, as well as |
| the potential to influence glenohumeral kinematics in a | | | | a multivariate analysis of potential predictors, it was |
| clinical setting. | | | | revealed that proximal humeral migration was |
| Pertinent results from this study include: | | | | significantly related to rotator cuff tear size and the |
| Average proximal humeral migration in | | | | involvement of the infraspinatus tendon. |
| symptomatic individuals was significantly greater than in | | | | Further, long-term follow up of individuals who receive |
| those who did not suffer from pain (migration: 0.26 + | | | | conservative care for such injuries involving the rotator |
| 1.6 mm vs -0.28 + 1.3 mm) | | | | cuff complex provides valuable insight not only to |
| For both symptomatic and asymptomatic | | | | anatomical changes that may or may not result over |
| individuals, proximal humeral migration was significantly | | | | time, but also to the cost-effectiveness of such |
| greater in those shoulders whose tears involved the | | | | non-operative treatment. As such, it was |
| infraspinatus (either alone or in conjunction with the | | | | demonstrated that progression of rotator cuff tears |
| supraspinatus). Interestingly, infraspinatus involvement | | | | was more likely to occur in patients older than 60 |
| was significantly more frequent in the symptomatic | | | | years, those involving a full-thickness tear, and in |
| group. | | | | shoulders demonstrating fatty infiltration upon magnetic |
| Symptomatic rotator cuff tears with an area > | | | | resonance imaging. |
| 175mm-squared significantly correlated with altered | | | | As demonstrated from the findings within these two |
| glenohumeral mechanics (proximal migration) | | | | studies, one may deduce that conservative |
| While pain significantly correlated with migration | | | | management alone may not be sufficient in those |
| and tear area in full-thickness tears > 175mm-squared, | | | | individuals presenting with the specific characteristics |
| this relationship was negated upon multivariate analysis | | | | described above. Therefore, in conjunction with an initial |
| (where tear area was the most significant predictor of | | | | attempt at rehabilitative care, prudent |
| proximal migration). | | | | patient-management would also include simultaneous |
| Maman et al. evaluated the outcomes of individuals | | | | referral for orthopaedic consultation. |