How Do Asymptomatic Shoulder Tendon Tears Become Symptomatic?

When partial tear became full, or when full tears spread by >5 mm – it was more likely to become symptomatic. It was suggested that “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.” – ie when does one repair these asymptomatic tears – early or when they hurt?

J Bone Joint Surg Am. 2010 Nov;92(16):2623-2633.
Symptomatic Progression of Asymptomatic Rotator Cuff Tears: A Prospective Study of Clinical and Sonographic Variables
Mall NA, Kim HM, Keener JD, Steger-May K, Teefey SA, Middleton WD, Stobbs G, Yamaguchi K
abstract here

  • “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.”

Comment – Surgeons keep complaining that it is too late when full thickness tears are over 4 months. One would have to book surgery when one had a partial tear, and after the 2-3 year wait, it may have converted itself to full thickness tear –  and be just be the right timing for surgery… Boy am I getting cynical…

Any comments? pulsera pandora pulsera pandora

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3 Responses to How Do Asymptomatic Shoulder Tendon Tears Become Symptomatic?

  1. In advance sorry for my awlful english typewrinting. I´ve been a follower of your posts and I have to say congratulations and thanks for all your hard work. You can be sure that you´re helping a lot of people. I´m an orthopaedic doctor from Brazil, specialized in shoulder surgery. I believe that the torn rotator cuff become symptomatic when the rest of the tendons and muscle around the gleno humeral joint just can couple with the work left to them, in other words, the joint become unstable and the balance between those intricated tissues are disrupted. So… how can we predict when this balance will be changed? That´s the 1 million dollar question.

  2. There is no consensus on the cause of pain originating in the subacromial space, and shoulder pain can be referred elsewhere, so it may not even be identified as shoulder pain. This makes this topic controversial. I think that what happens over time, about 65 years according to Yamaguchi, is that the tendon gets thinner and eventually just spontaneously tears. It may not be sensed meaning it is asymptomatic because the nerves are gone after being chronically squeezed, compressed, blanched or impinged. Think of it as an internal and insensate pressure sore… Dr Ian MacNab described this histologically. I look for the “asymptomatic” shoulder and when I find it, my patients are so surprised they say: “I never even suspected my shoulder”. Anyway, I just found this site, and anyone interested can read my Letter to the Editor of Journal of Bone and Joint Surgery re The Yamaguchi article: http://www.ejbjs.org/cgi/eletters/92/16/2623
    Anyway, I suspect the “new” tear extends beyond the asymptomatic or nerve dead area of tendon into an area supplied by viable free nerve endings.

  3. There is no consensus on the cause of pain originating in the subacromial space, and shoulder pain can be referred elsewhere, so it may not even be identified as shoulder pain. This makes this topic controversial. I think that what happens over time, about 65 years according to Yamaguchi, is that the tendon gets thinner and eventually just spontaneously tears. It may not be sensed meaning it is asymptomatic because the nerves are gone after being chronically squeezed, compressed, blanched or impinged. Think of it as an internal and insensate pressure sore… Dr Ian MacNab described this histologically. I look for the “asymptomatic” shoulder and when I find it, my patients are so surprised they say: “I never even suspected my shoulder”. Anyway, I just found this site, and anyone interested can read my Letter to the Editor of Journal of Bone and Joint Surgery re The Yamaguchi article: http://www.ejbjs.org/cgi/eletters/92/16/2623
    Anyway, I suspect the “new” tear extends beyond the asymptomatic or nerve dead area of tendon into an area supplied by viable free nerve endings.

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