Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA.
J Bone Joint Surg Am. 2010 Nov 17;92(16):2623-33. doi: 10.2106/JBJS.I.00506.
The purposes of this study were to identify changes in tear dimensions, shoulder function, and glenohumeral kinematics when an asymptomatic rotator cuff tear becomes painful and to identify characteristics of individuals who develop pain compared with those who remain asymptomatic.
A cohort of 195 subjects with an asymptomatic rotator cuff tear was prospectively monitored for pain development and examined annually for changes in various parameters such as tear size, fatty degeneration of the rotator cuff muscle, glenohumeral kinematics, and shoulder function. Forty-four subjects were found to have developed new pain, and the parameters before and after pain development were compared. The forty-four subjects were then compared with a group of fifty-five subjects who remained asymptomatic over a two-year period.
With pain development, the size of a full-thickness rotator cuff tear increased significantly, with 18% of the full-thickness tears showing an increase of >5 mm, and 40% of the partial-thickness tears had progressed to a full-thickness tear. In comparison with the assessments made before the onset of pain, the American Shoulder and Elbow Surgeons scores for shoulder function were significantly decreased and all measures of shoulder range of motion were decreased except for external rotation at 90° of abduction. There was an increase in compensatory scapulothoracic motion in relation to the glenohumeral motion during early shoulder abduction with pain development. No significant changes were found in external rotation strength or muscular fatty degeneration. Compared with the subjects who remained asymptomatic, the subjects who developed pain were found to have significantly larger tears at the time of initial enrollment.
Pain development in shoulders with an asymptomatic rotator cuff tear is associated with an increase in tear size. Larger tears are more likely to develop pain in the short term than are smaller tears. Further research is warranted to investigate the role of prophylactic treatment of asymptomatic shoulders to avoid the development of pain and loss of shoulder function.
本研究旨在确定无症状肩袖撕裂发展为疼痛时泪液尺寸、肩部功能和盂肱关节运动学的变化，并确定与仍无症状的个体相比，出现疼痛的个体的特征。
前瞻性监测 195 例无症状肩袖撕裂患者疼痛发展情况，并每年检查各种参数变化，如撕裂大小、肩袖肌肉脂肪变性、盂肱关节运动学和肩部功能。发现 44 例出现新疼痛，比较疼痛发展前后的参数。然后，将这 44 例患者与在两年期间仍无症状的 55 例患者进行比较。
随着疼痛的发展，全层肩袖撕裂的大小明显增加，18%的全层撕裂显示增加>5 毫米，40%的部分层撕裂进展为全层撕裂。与疼痛发作前的评估相比，美国肩肘外科医生评分的肩部功能明显降低，除外展 90°时的外旋外，所有肩部活动范围的测量值均降低。在肩带早期外展过程中，相对于盂肱关节运动，出现了代偿性肩胛胸壁运动的增加。在外旋力量或肌肉脂肪变性方面未发现明显变化。与仍无症状的患者相比，出现疼痛的患者在初始入组时撕裂明显更大。
无症状肩袖撕裂疼痛的发展与撕裂大小的增加有关。与较小的撕裂相比，较大的撕裂在短期内更有可能发展为疼痛。需要进一步研究以探讨对无症状肩部进行预防性治疗以避免疼痛和肩部功能丧失的作用。
