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Symptoms of Pain Do Not Correlate with Rotator Cuff Tear Severity: A Cross-Sectional Study of 393 Patients with a Symptomatic Atraumatic Full-Thickness Rotator Cuff Tear

Dunn, Warren R. MD, MPH1; Kuhn, John E. MD, MS2; Sanders, Rosemary BA2; An, Qi MS3; Baumgarten, Keith M. MD4; Bishop, Julie Y. MD5; Brophy, Robert H. MD6; Carey, James L. MD, MPH8; Holloway, G. Brian MD9; Jones, Grant L. MD5; Ma, C. Benjamin MD10; Marx, Robert G. MD, MS11; McCarty, Eric C. MD12; Poddar, Sourav K. MD13; Smith, Matthew V. MD6; Spencer, Edwin E. MD9; Vidal, Armando F. MD13; Wolf, Brian R. MD, MS14; Wright, Rick W. MD7; on behalf of the MOON Shoulder Group

Journal of Bone & Joint Surgery - American Volume: 21 May 2014 - Volume 96 - Issue 10 - p 793–800
doi: 10.2106/JBJS.L.01304
Scientific Articles

Background: For many orthopaedic disorders, symptoms correlate with disease severity. The objective of this study was to determine if pain level is related to the severity of rotator cuff disorders.

Methods: A cohort of 393 subjects with an atraumatic symptomatic full-thickness rotator-cuff tear treated with physical therapy was studied. Baseline pretreatment data were used to examine the relationship between the severity of rotator cuff disease and pain. Disease severity was determined by evaluating tear size, retraction, superior humeral head migration, and rotator cuff muscle atrophy. Pain was measured on the 10-point visual analog scale (VAS) in the patient-reported American Shoulder and Elbow Surgeons (ASES) score. A linear multiple regression model was constructed with use of the continuous VAS score as the dependent variable and measures of rotator cuff tear severity and other nonanatomic patient factors as the independent variables. Forty-eight percent of the patients were female, and the median age was sixty-one years. The dominant shoulder was involved in 69% of the patients. The duration of symptoms was less than one month for 8% of the patients, one to three months for 22%, four to six months for 20%, seven to twelve months for 15%, and more than a year for 36%. The tear involved only the supraspinatus in 72% of the patients; the supraspinatus and infraspinatus, with or without the teres minor, in 21%; and only the subscapularis in 7%. Humeral head migration was noted in 16%. Tendon retraction was minimal in 48%, midhumeral in 34%, glenohumeral in 13%, and to the glenoid in 5%. The median baseline VAS pain score was 4.4.

Results: Multivariable modeling, controlling for other baseline factors, identified increased comorbidities (p = 0.002), lower education level (p = 0.004), and race (p = 0.041) as the only significant factors associated with pain on presentation. No measure of rotator cuff tear severity correlated with pain (p > 0.25).

Conclusions: Anatomic features defining the severity of atraumatic rotator cuff tears are not associated with the pain level. Factors associated with pain are comorbidities, lower education level, and race.

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

1University of Wisconsin, Research Park Clinic Sports Medicine Clinic, 621 Science Drive, Madison, WI 53711

2Vanderbilt University Medical Center, 4200 MCE South Tower, 1215 21st Avenue South, Nashville, TN 37232. E-mail address for J.E. Kuhn:

3St. Jude Children’s Research Hospital, 262 Danny Thomas Place, Mail Stop 723, Memphis, TN 38105-3768

4Sports Medicine & Shoulder Surgery Orthopedic Institute, 810 East 23rd Street, Sioux Falls, SD 57117

5OSU Sports Medicine Center, 2050 Kenny Road, Suite 3300, Columbus, OH 43221-3502

6Department of Orthopaedic Surgery, Washington University School of Medicine, 14532 South Outer Forty Drive, Chesterfield, MO 63017

7Department of Orthopaedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, 11300 West Pavilion, St. Louis, MO 63110

8PENN Orthopaedics, Hospital of the University of Pennsylvania, Weightman Hall, 33rd and Spruce Streets, Philadelphia, PA 19104

9Shoulder and Elbow Institute Knoxville Orthopaedic Clinic, 260 Fort Sanders West Boulevard, Knoxville, TN 37922

10UCSF Sports Medicine, 1500 Owens Street, San Francisco, CA 94158

11Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021

12CU Sports Medicine, 311 Mapleton Avenue, Boulder, CO 80304

13CU Sports Medicine, 2000 South Colorado Boulevard, Colorado Center Tower One, Suite 4500, Denver, CO 80222

14University of Iowa, 2701 Prairie Meadow Drive, Iowa City, IA 52242-1088

A commentary by Frederick A. Matsen III, MD, is linked to the online version of this article at

Copyright 2014 by The Journal of Bone and Joint Surgery, Incorporated
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