Abstract
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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Institutional review board approval was obtained, and the requirement for informed consent was waived.
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We obtained approval from Institutional review board of our institute and written informed consent was waived as this study is a retrospective analysis of medical and radiological data.
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Yoon, TH., Choi, CH., Kim, SJ. et al. Attrition of rotator cuff without progression to tears during 2–5 years of conservative treatment for impingement syndrome. Arch Orthop Trauma Surg 139, 377–382 (2019). https://doi.org/10.1007/s00402-018-3065-z
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DOI: https://doi.org/10.1007/s00402-018-3065-z