Craig Harris MBBS, Presenter: Nothing to Disclose

Lawrence M. White MD, Abstract Co-Author: Nothing to Disclose

Eran Maman MD, Abstract Co-Author: Nothing to Disclose

George Tomlinson, Abstract Co-Author: Nothing to Disclose

Erin Boynton MD, Abstract Co-Author: Nothing to Disclose

Analyze temporal MRI changes of non surgically treated rotator cuff tears (RCTs) with correlation to clinical exam.

59 shoulders (33 F: 26 M; mean age 59) with RCTs on initial MRI, managed nonoperatively (physiotherapy & rehabilitation) were prospectively studied. All patients had followup MRI >6 months after the initial study (mean 20 mos) and were assessed for pain, ROM and strength by a single orthopedic surgeon at baseline and followup time-points. All MRIs were assessed in blinded fashion for; RCT location, dimensions, and type (full/partial thickness RCTs [FTT/PTT]); ACJ OA; acromial shape/spurs; and muscular atrophy. Interval RCT size progression/diminution (defined as change in any dimension >2mm) was correlated to age, gender, other MRI findings and clinical findings.

Baseline MRI showed 29 FTTs, 26 PTTs and 4 combined FTT/PTTs. 58/59 RCTs involved supraspinatus, 10/59 involved multiple tendons. Followup MRI showed RCT progression in 21/59, apparent diminution in 10/59, and stability in 28/59. Factors associated with statistical trend toward RCT progression were increased age, and baseline MR findings of; FTT, ACJ OA, and muscle atrophy. Overall 44/59 shoulders had improved pain & ROM/strength. 9/10 RCTs showing an apparent decrease in size reported less pain & improved ROM/strength, and 1/10 worse pain & ROM/strength. Of the 21 RCTs with increased size, 1/21 had worse pain & function, 3/21 worse pain with stable ROM/strength, and 2/21 were stable and 15/21 improved clinically in reference to both pain & ROM/strength. 20/28 with stable RCTs showed improved pain & ROM/strength, with 4/28 deteriorating clinically, and 4/28 showing either improvement or stability on both pain & ROM/strength testing. No correlation was seen between interval RCT MRI changes and changes in clinical pain (Spearman correlation -0.02, p=0.89) or ROM/Strength assessments (Spearman correlation 0.02, p=0.86).

Temporal changes of RCTs on MRI are variable and do not correlate with changes in clinical findings of conservatively managed RCTs.

Symptoms of patients with rotator cuff tears can improve with conservative therapy and do not correlate directly to MRI changes on followup imaging.

Harris, C, White, L, Maman, E, Tomlinson, G, Boynton, E, Longitudinal MRI Follow-up of Conservatively Treated Rotator Cuff Tears with Clinical Correlation.  Radiological Society of North America 2006 Scientific Assembly and Annual Meeting, November 26 - December 1, 2006 ,Chicago IL. http://archive.rsna.org/2006/4429820.html