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Attrition of rotator cuff without progression to tears during 2-5 years of conservative treatment for impingement syndrome

 Tae-Hwan Yoon  ;  Chong-Hyuk Choi  ;  Sung-Jae Kim  ;  Yun-Rak Choi  ;  Soon-Phil Yoon  ;  Yong-Min Chun 
 Archives of Orthopaedic and Trauma Surgery, Vol.139(3) : 377-382, 2019 
Journal Title
 Archives of Orthopaedic and Trauma Surgery 
Issue Date
Conservative Treatment* ; Disease Progression ; Humans ; Retrospective Studies ; Rotator Cuff*/diagnostic imaging ; Rotator Cuff*/physiopathology ; Rotator Cuff Injuries*/diagnostic imaging ; Rotator Cuff Injuries*/physiopathology ; Rotator Cuff Injuries*/therapy ; Shoulder Impingement Syndrome/diagnostic imaging ; Shoulder Impingement Syndrome/physiopathology ; Shoulder Impingement Syndrome/therapy
Conservative ; Impingement ; Natural history ; Rotator cuff tear ; Subacromial spur
PURPOSE: The purpose of this study was to investigate the natural history of intact rotator cuff in impingement syndrome patients with concomitant spur protruding from the undersurface of acromion. METHODS: This retrospective study included 119 patients with an intact rotator cuff who underwent conservative treatment for a spur protruding from the undersurface of the acromion. The protruded spur was defined as a trapezoid- or tetragon-shaped bony protrusion with a downward peak extending more than 3 mm in length from the baseline drawn along the acromial undersurface on the coronal view of magnetic resonance imaging (MRI) or computed tomography arthrography (CTA). Functional outcomes were evaluated by the visual analogue scale for pain, subjective shoulder value, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and active range of motion (ROM). To evaluate cuff integrity, follow-up MRI, CTA, or ultrasound were performed at least 2 years after the initial presentation. RESULTS: No new rotator cuff tears were noted in any patient during the follow-up imaging studies. However, 18 patients (15%) underwent arthroscopic acromioplasty during the study period. During the arthroscopic examinations, moderate to severe attrition of the cuff was identified, although no tears were seen. At the final follow-up, pain level and shoulder function, including ROM, showed satisfactory outcomes. CONCLUSION: Spurs protruding from the acromial undersurface did not lead to rotator cuff tears during 2-5 years of conservative treatment. However, attrition of the rotator cuff was found during arthroscopic acromioplasty, suggesting that the protruding spurs caused extrinsic impingement of the cuff. LEVEL OF EVIDENCE: Therapeutic case series Level IV.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Yoon, Soon-Phil(윤순필)
Yoon, Tae Hwan(윤태환) ORCID logo https://orcid.org/0000-0002-2859-5240
Chun, Yong Min(천용민) ORCID logo https://orcid.org/0000-0002-8147-6136
Choi, Yun Rak(최윤락)
Choi, Chong Hyuk(최종혁) ORCID logo https://orcid.org/0000-0002-9080-4904
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