Asymptomatic Cuff Tears: A Model for Pain Development

无症状袖带撕裂：疼痛发展的模型

基本信息

批准号：
9967797
负责人：
Jay Keener
金额：
$ 36.67万
依托单位：
WASHINGTON UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2004
资助国家：
美国
起止时间：
2004-07-01 至 2022-11-30
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): This competitive renewal proposes to study the effect of surgical intervention to improve the natural history of degenerative rotator cuff tears by comparing disease progression risks following surgery to the defined risks of asymptomatic cuff tears we have established with longitudinal studies. Additionally, we will also focus on defining risk factors upon presentation of a painful cuff tear that may predict future symptomatic development in the contralateral shoulder. This renewal will better define the potential benefit of early surgical intervention. IIA) Specific Aim 1: To obtain long-term follow-up (minimum 8 years) of a cohort of asymptomatic rotator cuff tears in subjects aged 65 years or younger to define the risks of tear enlargement and factors related to pain development. The most clinically relevant subjects within our cohort are those that retain good potential for tendon healing with surgical intervention. Further monitoring of these subjects is needed to define the long-term risks of non-operative treatment. The debate for operative indications is most relevant for patients that retain good healing potential with surgery and cannot be answered with only 5 years follow-up. The risks of tear deterioration without surgery must be determined through a period of time until healing is not likely because of patient age. IIB) Specific Aim 2: To assess the ability of rotator cuff repair surgery to interrupt the natural progression of degenerative cuff disease. The ability of surgery to halt the natural progression of degenerative rotator cuff disease has not been characterized. Untreated full-thickness rotator cuff tears enlarge in 50% of subjects, short-term. Tear enlargement is associated with declining function and advancing muscle degeneration. The natural history for non-operatively treated rotator cuff tears is concerning, in the short-term for disease progression. Because younger age and smaller tear size have been established as good predictors of healing with surgery, many advocate early repair in this group. These potential benefits are only realized if the natural history for repaired tendons is superior. Prospectively defining the benefits of surgery in subjects with good healing potential compared to nonoperatively treated tears will better define the role of early surgery. IIC) Specific Aim 3: o determine factors predictive of contralateral symptomatic rotator cuff disease progression based on the clinical presentation of a symptomatic rotator cuff tear. Approximately 56% of subjects with a painful rotator cuff tear will have an asymptomatic tear in the contralateral shoulder. Analysis of features related to the painful shoulder that may be predictive of future pain in the asymptomatic shoulder has not been previously considered. The ability to define patient and tear-related factors in the painful shoulder that are predictive of disease progression in the asymptomatic side will identify higher risk patients. Defining these factors is fundamental for counseling patients with degenerative rotator cuff tears and provides a foundation for patient education and implementation of preventive treatment strategies.

描述（由适用提供）：该竞争性更新提案，以研究手术干预的影响，通过比较手术后的疾病进展风险与我们与纵向研究确定的不对称袖口泪液的确定风险，通过比较疾病进展风险来改善退行性肩袖撕裂的自然历史。此外，我们还将重点放在呈现疼痛的袖口撕裂后定义危险因素，该袖口撕裂可能预测对侧肩膀的未来症状发育。这种更新将更好地定义早期手术干预。 IIA）具体目标1：在65岁或更早的受试者中，要获得长期随访（至少8岁）的无症状肩袖撕裂，以定义泪液扩张的风险和与疼痛发展有关的因素。我们队列中最相关的受试者是那些通过手术干预保持肌腱愈合的良好潜力的受试者。需要进一步监测这些受试者，以定义非手术治疗的长期风险。有关操作指示的辩论与保留的患者最相关手术的良好治愈潜力，只有5年的随访就无法回答。必须通过一段时间确定撕裂定义的风险，直到由于患者的年龄不可能治愈。 IIB）特定目的2：评估旋转器的能力袖口修复手术可打断退化性袖口疾病的自然进展。尚未表征手术停止退行性肩袖疾病自然进展的能力。未经治疗的全厚度肩袖撕裂在50％的受试者中扩大了短期。泪液扩张与功能下降和肌肉变性有关。在短期的疾病进展中，涉及非手术肩袖撕裂的自然病史。由于已经确定了年轻和较小的泪水大小是通过手术治愈的良好预测指标，因此许多人主张早期修复该组。仅当修复后肌腱的自然历史较高时，才能实现这些潜在的好处。与非手术治疗的泪水相比，在具有良好愈合潜力的受试者中，前瞻性定义手术的益处将更好地定义早期手术的作用。 IIC）特定目标3：o确定基于对称肩袖撕裂的临床表现，确定对侧对称肩袖疾病进展的因素。大约56％的受试者患有疼痛的肩袖撕裂，在对比肩上会有不对称的撕裂。以前尚未考虑过与疼痛肩部有关的特征分析，这些特征可能预测了不对称肩部中未来疼痛的特征。在疼痛的肩膀上定义患者和泪液相关因素的能力可以预测渐近方面的疾病进展，这将确定较高的风险患者。定义这些因素对于为患者提供退化性肩袖撕裂的患者至关重要，并为患者教育和预防治疗策略的实施奠定了基础。

项目成果

期刊论文数量（20）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Natural History of Rotator Cuff Disease and Implications on Management.

DOI：
10.1053/j.oto.2014.11.006
发表时间：
2015-03-01
期刊：
Operative techniques in orthopaedics
影响因子：
0.1
作者：
Hsu J;Keener JD
通讯作者：
Keener JD

Surveillance of conservatively treated rotator cuff tears is warranted. Commentary on an article by Stefan Moosmayer, MD, PhD, et al.: "The natural history of asymptomatic rotator cuff tears. a three-year follow-up of fifty cases".

有必要对保守治疗的肩袖撕裂进行监测。

DOI：
10.2106/jbjs.m.00526
发表时间：
2013
期刊：
The Journal of bone and joint surgery. American volume
影响因子：
0
作者：
Keener,JayD
通讯作者：
Keener,JayD

Diagnostic performance and reliability of ultrasonography for fatty degeneration of the rotator cuff muscles.

超声检查对肩袖肌肉脂肪变性的诊断性能和可靠性。

DOI：
10.2106/jbjs.j.01899
发表时间：
2012
期刊：
The Journal of bone and joint surgery. American volume
影响因子：
0
作者：
Wall,LindleyB;Teefey,SharleneA;Middleton,WilliamD;Dahiya,Nirvikar;Steger-May,Karen;Kim,HMike;Wessell,Daniel;Yamaguchi,Ken
通讯作者：
Yamaguchi,Ken

The contribution of reverse shoulder arthroplasty to utilization of primary shoulder arthroplasty.