Background: Very little comparative information is available
regarding the demographic and morphological characteristics of asymptomatic
and symptomatic rotator cuff tears. This information is important to provide
insight into the natural history of rotator cuff disease and to identify which
factors may be important in the development of pain. The purpose of the
present study was to compare the morphological characteristics and prevalences
of asymptomatic and symptomatic rotator cuff disease in patients who presented
with unilateral shoulder pain.
Methods: Five hundred and eighty-eight consecutive patients in whom
a standardized ultrasonographic study had been performed by an experienced
radiologist for the assessment of unilateral shoulder pain were evaluated with
regard to the presence and size of rotator cuff tears in each shoulder. The
demographic factors that were analyzed included age, gender, side, and cuff
thickness. All of these factors were evaluated with regard to their
correlation with the presence of pain.
Results: Of the 588 consecutive patients who met the inclusion
criteria, 212 had an intact rotator cuff bilaterally, 199 had a unilateral
rotator cuff tear (either partial or full thickness), and 177 had a bilateral
tear (either partial or full thickness). The presence of rotator cuff disease
was highly correlated with age. The average age was 48.7 years for patients
with no rotator cuff tear, 58.7 years for those with a unilateral tear, and
67.8 years for those with a bilateral tear. Logistic regression analysis
indicated a 50% likelihood of a bilateral tear after the age of sixty-six
years (p < 0.01). In patients with a bilateral rotator cuff tear in whom
one tear was symptomatic and the other tear was asymptomatic, the symptomatic
tear was significantly larger (p < 0.01). The average size of a symptomatic
tear was 30% greater than that of an asymptomatic tear. Overall, patients who
presented with a full-thickness symptomatic tear had a 35.5% prevalence of a
full-thickness tear on the contralateral side.
Conclusions: There is a high correlation between the onset of
rotator cuff tears (either partial or full thickness) and increasing age.
Bilateral rotator cuff disease, either symptomatic or asymptomatic, is common
in patients who present with unilateral symptomatic disease. As the size of a
tear appears to be an important factor in the development of symptoms, we
recommend surveillance at yearly intervals for patients with known rotator
cuff tears that are treated nonoperatively.