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Title: Age related tendon degeneration : the relationship between rotator cuff tears, shoulder pain and functional loss
Author: Hinsley, Hannah
ISNI:       0000 0004 7232 9462
Awarding Body: University of Oxford
Current Institution: University of Oxford
Date of Award: 2018
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Background The shoulder is the third most common site of musculoskeletal symptoms with an estimated 20% of the population reporting symptoms at any given time. Rotator cuff tears are the most common shoulder disorder, and the major debilitation patients seek help for is pain. Full thickness rotator cuff tears have an estimated prevalence of between 7 and 27%, but studies have shown that not all of these are symptomatic. Many case series have been set in shoulder clinics and may have drawn false causality between rotator cuff tears and pain. This study uses a community population-based cohort to determine the epidemiology of rotator cuff tears and test the association between rotator cuff tears, pain, and functional losses. Methods 463 consecutive subjects (926 shoulders) have undergone a multidisciplinary assessment of their shoulders including high-definition ultrasound, the Oxford shoulder score and myometric strength testing. Individuals were part of the Chingford 1000 women cohort, which is a 20-year-old longitudinal population study comprising 1003 women aged between 64 and 87, and is representative of the population of the UK. Results The population prevalence of full-thickness tears was 22.2%, of which 4.6% were bilateral which increased significantly with age. The prevalence was greater in the dominant arm with a 1.64 increase in relative risk. The population prevalence of all tendon abnormalities was 59.3%, of which 30.2% were bilateral, increasing with age. Although 48.4% of full-thickness tears were asymptomatic there was an association between rotator cuff tears and patient reported symptoms. The relative risk of symptoms compared to normal tendons was 1.97 for abnormal tendons, 2.20 for full-thickness tears<2.5cm, and 4.74 for full-thickness tears >2.5cm (p<0.001). Individuals with at least one full-thickness tear had a relative risk of symptoms 1.97 that of those with bilateral normal tendons (p<0.001). Quantitative shoulder strength reduced with age, (10.2-16.2%, p<0.001), the non-dominant arm (4.9%, p<0.001), and the presence of pain (10.8%, p<0.001). Rotator cuff tears had no independent effect, but a significant interaction with age. Strength was preserved in the under 70's irrespective of rotator cuff tear, but in the over 70's there was decrease in strength of between 33% and 39% irrespective of pain (p=0.004). Conclusions This study provides an epidemiological basis to the understanding of rotator cuff tears. The prevalence of full-thickness tears in a female population aged 64-87 was 22.2%. Although only half of all full-thickness tears are symptomatic there is a statistically significant increase in the likelihood of symptoms with increasing tear pathology. There is also an association with loss of strength but only in the over 70's.
Supervisor: Carr, Andrew J. ; Arden, Nigel K. Sponsor: Arthritis Research UK
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available