Factors associated with progression of symptomatic isolated supraspinatus tears 2 years after exercise therapy

Although exercise therapy is an effective treatment for individuals with symptomatic rotator cuff tendon tears, tear size can increase. Understanding factors associated with tear progression will provide information that may be used to develop treatment plans and/or monitor tear size progression. Therefore, this study aims to identify factors associated with tear progression in persons with an isolated symptomatic supraspinatus tendon tear that underwent 12 weeks of personalized exercise therapy.

Individuals with a symptomatic isolated supraspinatus tendon tear that was at least 50% partial- or full-thickness were prospectively enrolled in this observational study. Tear progression was evaluated using ultrasound and defined as more than 5 mm enlargement of tear size or change from partial thickness to full thickness tear at 2-year follow-up. One-hundred nine individuals were enrolled, of which 82 (mean age, 59.9 ± 9.1 years; 43 male) who underwent an ultrasound examination at 2 years follow-up or underwent rotator cuff surgery were included in the study. Factors possibly associated with tear propagation that were explored included age, sex, body mass index (BMI), hand dominance of the involved side, mechanism of onset of shoulder pain, history of smoking, work status, job type, tear size and thickness, and symptom duration at the time of enrollment. The variables were compared between those that did vs. did not have tear propagation using univariable and multivariable analyses.

Within 2 years of the exercise therapy, 25 (30.5%) had progression in the tear size. In the univariable analysis, BMI and history of smoking were significantly different between those with and without tear progression. (P = .021, P < .001, respectively). Multivariable analysis revealed that only history of smoking was associated with tear size progression while controlling for BMI (OR = 5.41, P = .002).

This study revealed that individuals who are current or previous smokers had a 5.4 times higher odds of tear progression than non-smokers when controlling for BMI. Based on this prospective longitudinal observational study, counseling regarding the risks associated with smoking and periodic monitoring of tear size should be considered for smokers with an isolated symptomatic supraspinatus tear.