No doubt about it, rotator cuff tears can be confusing. It’s not that you can’t understand the idea of having a tear in your tendon. That’s easy.
It’s just that treating them can be counterintutive: some get better with therapy and others don’t. Some cause significant pain and others don’t. Some need surgery and others don’t.
A new study on rotator cuff tears is no less counterintutitive.
The study demonstrated that if you have a rotator cuff tear that was not caused by trauma (atruamatic), there is no link between the amount of pain you experience and the size of your tear.
Intuitively you would think that the larger a rotator cuff tear is, the more painful it would be. But that was not the case.
The goal of the study was to figure out whether there are certain factors that cause rotator cuff tears to be painful in some people and not others. They examined a number of potential variables-size being one of them.
The three most important factors that predict pain in atraumatic full thickness rotator cuff tears are: educational level, race, and whether you have a large number of other health problems.
In other words if you have a full thickness atraumatic rotator cuff tear, have a a high school education, are black, have multiple medical problems and you have an atraumatic rotator cuff tear, you have a higher chance of having a pain.
In some ways this is a frustrating finding for both patients and surgeons alike. The factors that seem to correlate with pain are not what we would considermodifiable risk factors. That is, we can’t do anything about them- not in the short term at least.
To me this study emphasizes that there is still a tremendous amount of art to medicine. It also drives home the point that even when treating something as specific as a rotator cuff tear, we are treating a person whose entire background including race, education and family support system factors into why they may be seeking treatment.
Knowing your patient is critical.