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Proximal Humeral Migration in Shoulders with Symptomatic and Asymptomatic Rotator Cuff Tears
Jay D. Keener, MD1; Anthony S. Wei, MD1; H. Mike Kim, MD1; Karen Steger-May, MA2; Ken Yamaguchi, MD1
1 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
2 Division of Biostatistics, Washington University, Campus Box 8067, 660 South Euclid Avenue, St. Louis, MO 63110
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Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants in excess of $10,000 from the National Institutes of Health. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Orthopaedic Surgery and the Division of Biostatistics, Washington University, St. Louis, Missouri

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2009 Jun 01;91(6):1405-1413. doi: 10.2106/JBJS.H.00854
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Background: Proximal humeral migration is commonly seen in rotator-cuff-deficient shoulders. The specific effects of the size of the rotator cuff tear and of pain on glenohumeral kinematics have been poorly defined. The purpose of this study was to examine the influences of cuff tear size and pain, separately, on humeral migration in a series of patients with symptomatic and asymptomatic rotator cuff tears.

Methods: Ninety-eight asymptomatic and sixty-two symptomatic shoulders were identified from a cohort of patients with unilateral shoulder pain related to rotator cuff disease. All shoulders underwent ultrasonographic evaluation of the rotator cuff and standardized radiographic evaluation. Humeral migration was measured by three observers using software-enhanced radiographic analysis.

Results: There was no significant difference in rotator cuff tear size between the asymptomatic and symptomatic shoulders, although more tears involved the infraspinatus in the symptomatic group (p = 0.01). Proximal humeral migration was greater in the shoulders with a symptomatic tear than it was in those with an asymptomatic tear (p = 0.03). Tears that involved the infraspinatus resulted in more migration than did isolated supraspinatus tears in both the symptomatic (p = 0.01) and the asymptomatic shoulders (p = 0.03). When the symptomatic tears of =175 mm2 were analyzed separately, the size of the tear was found to correlate strongly with humeral migration (p = 0.01). However, when the symptomatic tears that were <175 mm2 were analyzed, neither tear size nor pain was found to have a significant relationship with migration. When the analysis was limited to full-thickness symptomatic tears of =175 mm2, both pain (p = 0.002) and tear area (p = 0.0002) were found to have a significant effect on migration. Multivariate analysis showed that tear size (p = 0.01) was the strongest predictor of migration in symptomatic shoulders.

Conclusions: Proximal humeral migration correlates with rotator cuff tear size. Tears extending into the infraspinatus tendon are associated with greater humeral migration than is seen with isolated supraspinatus tears. Humeral migration resulting from symptomatic rotator cuff tears is greater than that resulting from asymptomatic tears. Additionally, there is a critical size for tendon tears resulting in humeral migration in painful shoulders. Although both pain and tear size influence glenohumeral kinematics in symptomatic shoulders, only tear size is an independent predictor of humeral migration.

Level of Evidence: Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

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    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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