A tear on the scan is not a verdict
Two thirds of the people carrying one did not know it was there.
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Feel-good Friday In one Japanese village they scanned 664 pairs of shoulders, and then asked people how they felt. If you have had a shoulder scan you may be carrying a sentence around in your head. Rotator cuff tear. It sounds like a rope that has parted… like something that has to be mended before you can use the arm again. So here are two sets of numbers I wish somebody had put in front of me… and the honest half that goes with each of them.
The village Researchers carried portable ultrasound into one village and scanned both shoulders of 664 residents. The average age was 69. 147 of them had a full thickness tear in the cuff. A hole clean through the tendon. That is 22 in every 100 people. And of those 147, about two thirds had no shoulder symptoms at all. The tear turned up twice as often in people who felt nothing as in people who hurt. It climbed with the years, steadily. None at all in the twenties through the forties. About 11 in 100 in the fifties. 15 in the sixties. 27 in the seventies. 37 in the eighties. So what does that make a tear Common. Closer to a gray hair in the tendon than a crack in a beam. Common by a certain age is the part that matters. Past seventy, more than one person in four has a hole in that tendon… and most of them are going about their day without complaint. It does not make a tear harmless. And it does not mean your tear is not your trouble. What it means is narrower and more useful than that. A tear on a scan cannot tell you, by itself, where your pain is coming from. Which is why a good clinician asks where it hurts and watches you move before looking at any picture. The other set of numbers The usual operation for this kind of shoulder pain shaves bone off that shelf above the joint, to open the gap up. British surgeons ran a trial that took some nerve. 313 people, all with at least three months of shoulder pain, split three ways. One group got the operation. A second got the camera put in with nothing taken out. The third got neither, just a review appointment three months on. At six months, on a 48 point shoulder score, the real operation came out at 32.7. The camera only group came out at 34.2. So the real operation did not beat the fake one. The difference ran the wrong way by 1.3 points, comfortably inside the range of chance. Both halves, carefully Both surgical groups did edge past the group who got neither. By three to four points, which the authors themselves said was not a gap big enough to matter to a person living in that shoulder. Now the line the headlines never draw. That trial was about shaving bone for ordinary shoulder pain. It was not about repairing a big tear after a fall, and it was not about replacing a worn out joint. Different questions, and they have different answers. Look also at who was kept out of it. Anyone with a full thickness tear in the cuff was excluded from that trial by design. So it has nothing to say about the shoulders we started today with. If you cannot lift your arm at all after an injury, none of this is about you. Go and be seen.
That was the week. Monday, the stretch across the chest rather than over the head. Tuesday, the four muscles and the gap they run through. Wednesday, fifteen reps three times a day and somebody watching. Thursday, sore arm in first and a pillow under the arm. None of it needs a waiting list.
Here is to a scan that does not get the last word, |