Incidence And Functional Outcome of Rotator Cuff Tears in Patients with Chronic Shoulder Pain

Chronic shoulder pain can affect people regardless of age or profession, whether they're in manual labor or are retirees, which is one of the world's most frequently reported issues in the musculoskeletal field [1]. It places restrictions on daily activities, lowers productivity, and affects the quality of life. It has a number of causes, including, but not limited to, degenerative joint disease, inflammatory conditions, bursitis, labral tears, and rotator cuff tears (RCTs) [2]. The most common and most severe of these causes is RCTs, and rotator cuff injuries in particular are really crucial since they impair the joint's stability and mobility, which is especially important for activities that are performed over the head, including lifting and twisting [3]. The shoulder girdle has four rotator cuff muscles: supraspinatus, infraspinatus, teres minor, and subscapularis. Their tendons, which serve to stabilize the head of the humerus to the glenoid fossa, can undergo degenerative changes, repetitive microtrauma (small injuries caused by repetitive motions, which can occur through daily life or activities associated with a particular sport), or acute injuries that result in partial or full thickness tears, which is known to happen with increasing frequency and age [4]. Studies that focus on various specific demographics indicate that as many as 20 to 40% of individuals 50 and over may have rotator cuff tears that are asymptomatic (tears that do not result in pain) [5]. On the other hand, symptomatic tears are frequently associated with chronic pain and loss of function, in addition to weakness. As a result, early diagnosis is critical, as, without intervention, the rotator cuff may undergo retraction, atrophy of the muscles, and infiltration of fat, which causes the associated loss of function to be worse [6]. Clinical Assessment, along with Imaging Modalities, is used together when evaluating diagnostics. Ultrasound can dynamically assess the tendons [7]. It is also effective and doesn't cause the patient any stress. Contrastingly, MRIs provide detailed visualizations of muscle atrophy, tendon tears, and other related entities. The strategies applied for treatment vary depending on the chronicity of the tear, the size of the tear, and the functional limitations. Management that is conservative, which includes alterations to activity, anti-inflammatories, physiotherapy, and can suffice for tears that are partial-thickness. Surgical repair is indicated for symptomatic full-thickness tears, persistent functional impairment, or failure of conservative therapy [8.9]. Functional outcomes are routinely evaluated using scoring systems that have been validated, such as the Constant-Murley score (CMS), the American Shoulder and Elbow Surgeons (ASES) score, or the Disabilities of the Arm, Shoulder, and Hand (DASH) score. These assess the patient's ability to perform routine activities, their motion range, strength, and also the pain they feel. Studies from the last half-decade have shown that outcomes are positively correlated when there is an early diagnosis, structured rehabilitation, and timely surgical intervention. Despite the increase in literature, study focused on assessing the incidence and functional prognosis of rotator cuff tears in patients with chronic shoulder pain is still growing in underserved areas [10].

 

Study Objectives

To examine how many patients with chronic shoulder pain have rotator cuff tears.

Study Design and Setting

This Cross sectional study conducted at Rahman Medical Institute from jan 2024 to jan 2025

Participants

Patients 18 years and older with chronic shoulder pain for more than three months were included in the study. Both male and female patients were included and had no occupational restrictions. Patients with a history of shoulder surgery, acute traumatic injury of the shoulder, shoulder infection, inflammatory arthropathy, or neurological disorders involving the upper limb were excluded. All participants had informed consent before inclusion in the study.

 

Sample Size Calculation

Sample size was calculated based on the expected prevalence of rotator cuff tears in 30\% of patients with chronic shoulder pain. A 95 % confidence interval (CI) and 5 percent margin of error were used. The minimum required sample size was 100 patients.

 

Inclusion criteria

 Adults aged 18 and older with chronic shoulder pain (lasting over 3 months).

 

Exclusion criteria

Participants with prior shoulder surgery acute shoulder trauma, shoulder-related infection, inflammatory arthropathy, or upper limb-related neurologic disorders. All study participants received clinical evaluations, imaging (either ultrasound or MRI), and function was assessed using the Constant-Murley Score. The study included both partial and full-thickness rotator cuff tears.

 

Diagnostic and Management Strategy

The patients diagnosis was based on clinical examination and confirmed with ultrasound or MRI. Conservatively, with physiotherapy and medication, partial-thickness tears were managed, while surgical repair was done on full-thickness tears. The Constant-Murley Score was used to measure functional outcomes at 3 months and 6 months, and was taken at baseline.

 

Statistical Analysis

Data were analyzed with SPSS version. Continuous variables were given as mean ± standard deviation, and categorical variables as frequencies and percentages. The paired t-test was used to assess changes in functional scores, while the chi-square test was used to compare categorical variables over time. A p-value of less than 0.05 was statistically significant

A total of 100 patients were enrolled comprising 52 males and 48 females, with a mean age of 52.3 ± 10.6 years. The right shoulder was affected in 56% of patients, while the left shoulder was involved in 44%. Rotator cuff tears were identified in 62 patients: 38% had partial-thickness tears, and 24% had full-thickness tears. The supraspinatus tendon was most frequently involved (68%), followed by infraspinatus (22%) and subscapularis (10%). Baseline functional assessment using the Constant-Murley Score showed a mean of 48.5 ± 12.4. At 3 months post-management, the mean score improved to 72.3 ± 10.8, and at 6 months, it further increased to 84.1 ± 9.6 (p < 0.001). Patients with partial-thickness tears exhibited faster functional recovery compared to full-thickness tears (mean improvement 38.6 vs 30.2 points; p = 0.02). No major complications were observed. These findings indicate that rotator cuff tears are prevalent in patients with chronic shoulder pain and that timely, targeted interventions substantially improve shoulder function.

 

Intervention Outcome

Conservative management for partial-thickness tears was effective with significant improvements in the pain and functional scores. Surgical repair for full-thickness tears also had substantial recovery with improved range of motion and strength at the 6-month follow-up. Overall, management of chronic shoulder pain was effective in optimizing functional outcomes and decreasing disability.

 

Table 1. Baseline Demographics of Study Participants

Variable	Frequency (n=100)	Percentage (%)
Gender (Male/Female)	52 / 48	52 / 48
Mean Age (years)	52.3 ± 10.6	–
Side Affected
- Right	56	56
- Left	44	44

 

This table summarizes the baseline characteristics of the 100 patients enrolled, including age, gender distribution, and the affected shoulder side.

 

Table 2. Incidence and Type of Rotator Cuff Tears

Tear Type	Frequency (n=100)	Percentage (%)
Partial-thickness	38	38
Full-thickness	24	24
No Tear	38	38
Tendon Involved
- Supraspinatus	42	68 of tears
- Infraspinatus	14	22 of tears
- Subscapularis	6	10 of tears

 

Distribution of rotator cuff tear types and tendon involvement among patients with chronic shoulder pain. Supraspinatus was the most commonly affected tendon.

 

Table 3. Functional Outcome Using Constant-Murley Score

Time Point	Mean CMS ± SD	p-value
Baseline	48.5 ± 12.4	–
3 months	72.3 ± 10.8	<0.001
6 months	84.1 ± 9.6	<0.001

 

Functional outcomes improved significantly over time in patients following targeted management, measured using the Constant-Murley Score (CMS). p-values indicate statistical significance compared to baseline.

 

Table 4. Functional Improvement by Tear Type

 

Comparison of functional improvement based on tear type. Partial-thickness tears showed greater recovery in Constant-Murley Score compared to full-thickness tears over 6 months.

Patients with chronic shoulder pain have been reported to have a 62% incidence of rotator cuff tears in this study; of these tears, 38% were partial thickness, and 24% were full thickness. Functional outcomes improved over 6 months (baseline Constant Murley Score 48.5± 12.4; 6 months 84.1± 9.6; p < 0.001), and recovery from partial tears was greater than from full-thickness tears (p = 0.02). These results align with recent studies indicating that most patients with chronic pain have a rotator cuff pathology, and with the right management, pain and function can be improved substantially [11,12]. Recent studies report a rise in rotator cuff pathology. In one cross-sectional study  22.2% full-thickness tears on the shoulder UW stem, Gallatin shoulder complex, Assif, Gallatin shoulder complex, Tinel, 2002, 2002, Tinel, and 2002. The studies, demonstrating the wide range of rotator cuff pathology's impact on a shoulder's function and the utilization of primary care, highlight the functional and symptom-related restrictions in the dominant arm. In relation to overwhelming rotator cuff pathology, the overwhelming rotator cuff pathology of the dominant arm impacts the over-impact prop shoulders, prop, prop, prop, prop, prop, prop, prop, prop, prop, shoulders. The prop rotator shoulder complex over rotator pathology of the over prop shoulder complex [13,14]. The functional restoration patterns in our patients correspond to the new updates on outcome data for arthroscopic surgery. A 2020 retrospective analysis of one of the first single-row arthroscopic rotator cuff repairs showed that significant positive changes of Constant Murley and ASES scores are present 6 and 12 months post-operatively, and the patients report less pain and more function. This aligns with the progressive recovery trend we see in our study [15]. In addition, in contrast to the progressive recovering trend we see in our study, the long-term follow-up data on the patients confirmed the positive impact of functional rotator cuff repairs, even without a functional, rotator, cut, age-related, or chronic, chronic mix, structural, or aerated rotator cuff, age-related, or chronic mix, chronic static, or aerated [16].Massive and irreparable tears in older adults showed that physiotherapy interventions resulted in significant functional improvements, as evidenced by increases in Constant Murley scores and decreases in disability and pain. This highlights the potential for non-surgical techniques to improve outcomes more than traditional methods, especially in cases where surgery is not a viable option [17]. This supports our findings as well, where non-operative care for partial tears resulted in significant functional improvements. This showcases the need for individualized treatment based on the severity of the tear and the patient [18]. Our results are also aligned with specific findings around measuring outcomes. Studies confirming the Constant Murley Score with various populations, including recent translations and correlation studies with other function measures, assure its consistency and importance in measuring shoulder problems related to rotator cuff disorders. Additionally, outcome studies comparing other function scores justify the use of multi-metric functional scores to track clinically important changes and support the positive impact of our functional outcome measures [19,20]. A common thread in studies over the last five years is the impact of specific tear characteristics (size, chronicity, and tendon involvement). Over the years, chronicity and larger tear size have been correlated with poor functional recovery and structural regression [21]. This is consistent with our finding that full-thickness tears had less and slower functional improvement. This reinforces the importance of timely recognition and targeted intervention, as management delays have been linked to poorer functional outcomes, especially in cases with significant tendon degeneration and/or fatty infiltration [22].In short, rotator cuff tears, along with functional outcomes and chronic shoulder pain cases, offer insight into pain case evidence and suggest that rotator cuff tears, chronic shoulder pain, and improved functional outcomes are appropriate [23]. Managing Finding integrating recent evidence, chronic studies, consistent surgical and pattern conservative treatment evidence suggest early prolonged, individualized recovery pathways. Managing Finding integrating recent evidence, chronic studies, consistent surgical and pattern conservative treatment evidence suggest early prolonged, individualized recovery pathways. Managing Finding integrating recent evidence, chronic studies, consistent surgical and pattern conservative treatment evidence studies suggest early prolonged, individualized recovery pathways. Additional functional outcomes, chronic and evidence-based, provide a study of the absence of longitudinal sustaining of evidence, and a lack of outcome functional studies in diverse populations.

 

Limitations

This study has some limitations because it's based on one center, and the sample size is rather small. A follow-up period of six months is rather short, and it does not explain long-term consequences, and the functional assessment relied chiefly on the Constant-Murley Score, omitting other patient-declared quality of life metrics.

 

CONCLUSION

Patients with chronic shoulder pain present rotator cuff tears, and in most cases, there are partial-thickness tears. Prompt detection and tailored management approaches like conservative treatment and/or surgical repair improve functional outcomes, reconstruct shoulder motion, and elevate life quality. These are some of the reasons why there is so much emphasis on the need for timely intervention from a clinical point of view.

 

 

Disclaimer: Nil

Conflict of Interest: Nil

Funding Disclosure: Nil

 

Authors Contributions

Concept & Design of Study: Aftab Rahim1

Drafting: Asif Khan2

Data Collection & Data Analysis:Saleem ullah3

Critical Review:Muhammad ismaeel4

Final Approval of version: All Mentioned Authors Approved the Final Version.

1.      Abboud JA, Cronin KJ. Shoulder Arthrodesis. The Journal of the American Academy of Orthopaedic Surgeons. 2022;30(16):e1066-e75.

2.      Alaiti RK, Caneiro JP, Gasparin JT, Chaves TC, Malavolta EA, Gracitelli MEC, et al. Shoulder pain across more movements is not related to more rotator cuff tendon findings in people with chronic shoulder pain diagnosed with subacromial pain syndrome. Pain reports. 2021;6(4):e980.

3.      Ergonenc T, Beyaz SG. Effects of ultrasound-guided suprascapular nerve pulsed radiofrequency on chronic shoulder pain. Medical ultrasonography. 2018;20(4):461-6.

4.      Haik MN, Alburquerque-Sendín F, Fernandes RAS, Kamonseki DH, Almeida LA, Liebano RE, et al. Biopsychosocial Aspects in Individuals with Acute and Chronic Rotator Cuff Related Shoulder Pain: Classification Based on a Decision Tree Analysis. Diagnostics (Basel, Switzerland). 2020;10(11).

5.      Ribeiro LP, Cools A, Camargo PR. Rotator cuff unloading versus loading exercise program in the conservative treatment of patients with rotator cuff tear: protocol of a randomised controlled trial. BMJ open. 2020;10(12):e040820.

6.      Sellers TR, Abdelfattah A, Frankle MA. Massive Rotator Cuff Tear: When to Consider Reverse Shoulder Arthroplasty. Current reviews in musculoskeletal medicine. 2018;11(1):131-40.

7.      Shepet KH, Liechti DJ, Kuhn JE. Nonoperative treatment of chronic, massive irreparable rotator cuff tears: a systematic review with synthesis of a standardized rehabilitation protocol. Journal of shoulder and elbow surgery. 2021;30(6):1431-44.

8.      Thorpe AM, O'Sullivan PB, Mitchell T, Hurworth M, Spencer J, Booth G, et al. Are Psychologic Factors Associated With Shoulder Scores After Rotator Cuff Surgery? Clinical orthopaedics and related study. 2018;476(10):2062-73.

9.      Wright MA, Abboud JA, Murthi AM. Subacromial Balloon Spacer Implantation. Current reviews in musculoskeletal medicine. 2020;13(5):584-91.

10.   Wu KT, Chou WY, Ko JY, Siu KK, Yang YJ. Inferior outcome of rotator cuff repair in chronic hemodialytic patients. BMC musculoskeletal disorders. 2019;20(1):209.

11.   Atar M, Korkmaz N, Aslan SG, Tezen Ö, Köylü SU, Demir Y, et al. Comparison of ultrasound-guided subacromial corticosteroid and ozone (O(2)-O(3)) injections in the treatment of chronic rotator cuff tendinopathy: a randomized clinical trial. The Korean journal of pain. 2023;36(1):128-36.

12.   Dukan R, Ledinot P, Donadio J, Boyer P. Arthroscopic Rotator Cuff Repair With a Knotless Suture Bridge Technique: Functional and Radiological Outcomes After a Minimum Follow-Up of 5 Years. Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association. 2019;35(7):2003-11.

13.   Gwon Y, Kim W, Park S, Kim YK, Kim H, Kim MS, et al. Tissue-engineered tendon nano-constructs for repair of chronic rotator cuff tears in large animal models. Bioengineering & translational medicine. 2023;8(1):e10376.

14.   Lee WY, Shin HD, Kim KC, Cha SM, Jeon YS, Song JH. Repair integrity and functional outcomes of arthroscopic repair in chronic anterior shoulder instability: single-loaded versus double-loaded single-row repair. Archives of orthopaedic and trauma surgery. 2022;142(1):131-8.

15.   Lemaster NG, Hettrich CM, Jacobs CA, Heebner N, Westgate PM, Mair S, et al. Which Risk Factors Are Associated with Pain and Patient-reported Function in Patients with a Rotator Cuff Tear? Clinical orthopaedics and related study. 2021;479(9):1982-92.

16.   Paul S, Yadav AK, Goyal T. Comparison of tear characteristics, outcome parameters and healing in traumatic and non-traumatic rotator cuff tear: a prospective cohort study. Musculoskeletal surgery. 2022;106(4):433-40.

17.   Strauss EJ, Kingery MT, Klein D, Manjunath AK. The Evaluation and Management of Suprascapular Neuropathy. The Journal of the American Academy of Orthopaedic Surgeons. 2020;28(15):617-27.

18.   Vaquerizo V, García-López M, Mena-Rosón A, Prado R, Padilla S, Anitua E. Plasma rich in growth factors versus corticosteroid injections for management of chronic rotator cuff tendinopathy: a prospective double-blind randomized controlled trial with 1 year of follow-up. Journal of shoulder and elbow surgery. 2023;32(3):555-64.

19.   Wagner ER, McLaughlin R, Sarfani S, Cofield RH, Sperling JW, Sanchez-Sotelo J, et al. Long-Term Outcomes of Glenohumeral Arthrodesis. The Journal of bone and joint surgery American volume. 2018;100(7):598-604.

20.   Zampeli F, Kazum E, Fadhel BW, Gomez AJ, Valenti P. Medialized rotator cuff repair for retracted, massive, postero superior tears: Clinical and radiological outcomes. Orthopaedics & traumatology, surgery & study : OTSR. 2023;109(2):103296.

21.   Chary-Valckenaere I, Loeuille D, Jay N, Kohler F, Tamisier JN, Roques CF, et al. Spa therapy together with supervised self-mobilisation improves pain, function and quality of life in patients with chronic shoulder pain: a single-blind randomised controlled trial. International journal of biometeorology. 2018;62(6):1003-14.

22.   Hill BW, Singh AM, Astolfi M, Horneff JG, Schoch BS, Abboud JA. Outcomes of rotator cuff repair with concurrent microfracture of focal glenohumeral osteoarthritis. Journal of shoulder and elbow surgery. 2021;30(7s):S66-s70.

23.   Patel P, Brkljac M, Sonar U, Kumar S. Heterotopic ossification following anterior shoulder dislocation. BMJ case reports. 2018;2018.