***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND The purpose of this prospect i ve study was to report the long-term risks of rotator cuff tear enlargement and symptom progression associated with degenerative asymptomatic tears . METHODS Subjects with an asymptomatic rotator cuff tear in one shoulder and pain due to rotator cuff disease in the contralateral shoulder enrolled as part of a prospect i ve longitudinal study . Two hundred and twenty-four subjects ( 118 initial full-thickness tears , fifty-six initial partial-thickness tears , and fifty controls ) were followed for a median of 5.1 years . Vali date d functional shoulder scores were calculated ( visual analog pain scale , American Shoulder and Elbow Surgeons [ ASES ] , and simple shoulder test [ SST ] scores ) . Subjects were followed annually with shoulder ultrasonography and clinical evaluations . RESULTS Tear enlargement was seen in 49 % of the shoulders , and the median time to enlargement was 2.8 years . The occurrence of tear-enlargement events was influenced by the severity of the final tear type , with enlargement of 61 % of the full-thickness tears , 44 % of the partial-thickness tears , and 14 % of the controls ( p < 0.05 ) . Subject age and sex were not related to tear enlargement . One hundred subjects ( 46 % ) developed new pain . The final tear type was associated with a greater risk of pain development , with the new pain developing in 28 % of the controls , 46 % of the shoulders with a partial-thickness tear , and 50 % of those with a full-thickness tear ( p < 0.05 ) . The presence of tear enlargement was associated with the onset of new pain ( p < 0.05 ) . Progressive degenerative changes of the supraspinatus muscle were associated with tear enlargement , with supraspinatus muscle degeneration increasing in 4 % of the shoulders with a stable tear compared with 30 % of the shoulders with tear enlargement ( p < 0.05 ) . Nine percent of the shoulders with a stable tear showed increased infraspinatus muscle degeneration compared with 28 % of those in which the tear had enlarged ( p = 0.07 ) . CONCLUSIONS This study demonstrates the progressive nature of degenerative rotator cuff disease . The risk of tear enlargement and progression of muscle degeneration is greater for shoulders with a full-thickness tear , and tear enlargement is associated with a greater risk of pain development across all tear types . LEVEL OF EVIDENCE Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence BACKGROUND Presently , there are no approved nonoperative therapies for the ongoing treatment of persistent shoulder pain .  Preliminary data suggest that intra-articular sodium hyaluronate injections may be beneficial for the treatment of persistent shoulder pain result ing from various etiologies . The present study evaluated the efficacy and safety of sodium hyaluronate ( Hyalgan ; molecular weight , 500 to 730 kDa ) for these patients . METHODS Six hundred and sixty patients with persistent shoulder pain and limitation result ing from glenohumeral joint osteoarthritis , rotator cuff tear , and /or adhesive capsulitis who had had a failure of conventional therapy were enrolled in this double-blind , r and omized , phosphate-buffered saline solution-controlled study , and 456 patients completed twenty-six weeks of follow-up . Patients were r and omized to receive either five weekly intra-articular injections of sodium hyaluronate , three weekly intra-articular injections of sodium hyaluronate followed by two weekly intra-articular injections of saline solution , or five weekly intra-articular injections of saline solution . The main outcomes were improvement in terms of shoulder pain on movement at thirteen weeks after the initiation of treatment ( as assessed with use of a 100-mm visual analog scale ) and the treatment effect throughout twenty-six weeks . RESULTS For the overall intent-to-treat population , patients who were managed with sodium hyaluronate had greater pain relief than controls did ; significant differences were noted at Week 7 ( for the five-injection hyaluronate group ) , Week 17 ( for the three and five-injection hyaluronate groups ) , and Week 26 ( for the three-injection hyaluronate group ) . Analysis of the stratified population s clearly established that this effect was due to benefits experienced by the patients with osteoarthritis . The treatment effect through twenty-six weeks was significant in patients with osteoarthritis in the three-injection ( p = 0.003 ) and five-injection ( p = 0.002 ) groups , with no significant difference for either regimen in patients without osteoarthritis . The safety profile was very favorable , with no product-related serious adverse effects and no between-group differences for any reported adverse event . CONCLUSIONS Although the primary end point of this study ( that is , improvement in terms of shoulder pain at thirteen weeks ) was not achieved , the overall findings , including secondary end points , indicate that sodium hyaluronate ( 500 to 730 kDa ) is effective and well tolerated for the treatment of osteoarthritis and persistent shoulder pain that is refractory to other st and ard nonoperative interventions PURPOSE To assess the effectiveness of a specific nonoperative physical therapy program in treating atraumatic full-thickness rotator cuff tears using a multicenter prospect i ve cohort study design . MATERIAL S AND METHODS Patients with atraumatic full-thickness rotator cuff tears who consented to enroll provided data via question naire on demographics , symptom characteristics , comorbidities , willingness to undergo surgery , and patient-related outcome assessment s ( Short Form 12 score , American Shoulder and Elbow Surgeons score , Western Ontario Rotator Cuff score , Single Assessment Numeric Evaluation score , and Shoulder Activity Scale )  . Physicians recorded physical examination and imaging data . Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks . At those visits , patients could choose 1 of 3 courses : ( 1 ) cured ( no formal follow-up scheduled ) , ( 2 ) improved ( continue therapy with scheduled re assessment in 6 weeks ) , or ( 3 ) no better ( surgery offered ) . Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit . A Wilcoxon signed rank test with continuity correction was used to compare initial , 6-week , and 12-week outcome scores . RESULTS The cohort consists of 452 patients .  Patient-reported outcomes improved significantly at 6 and 12 weeks . Patients elected to undergo surgery less than 25 % of the time . Patients who decided to have surgery generally did so between 6 and 12 weeks , and few had surgery between 3 and 24 months . CONCLUSION Nonoperative treatment using this physical therapy protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75 % of patients followed up for 2 years HYPOTHESIS The purpose of this cross-sectional study is to determine whether the duration of symptoms influences the features seen in patients with atraumatic , full-thickness rotator cuff tears . Our hypothesis is that an increasing duration of symptoms will correlate with more advanced findings of rotator cuff tear severity on magnetic resonance imaging , worse shoulder outcome scores , more pain , decreased range of motion , and less strength . METHODS We enrolled 450 patients with full-thickness rotator cuff tears in a prospect i ve cohort study to assess the effectiveness of nonoperative treatment and factors predictive of success . The duration of patient symptoms was divided into 4 groups : 3 months or less , 4 to 6 months , 7 to 12 months , and greater than 12 months . Data collected at patient entry into the study included ( 1 ) demographic data , ( 2 ) history and physical examination data , ( 3 ) radiographic imaging data , and ( 4 ) vali date d patient-reported measures of shoulder status . Statistical analysis included a univariate analysis with the Kruskal-Wallis test and Pearson test to identify statistically significant differences in these features for different duration s of symptoms . RESULTS A longer duration of symptoms does not correlate with more severe rotator cuff disease . The duration of symptoms was not related to weakness , limited range of motion , tear size , fatty atrophy , or vali date d patient-reported outcome measures . CONCLUSIONS There is only a weak relationship between the duration of symptoms and features associated with rotator cuff disease BACKGROUND The purpose s of this study were to identify changes in tear dimensions , shoulder function , and glenohumeral kinematics when an asymptomatic rotator cuff tear becomes painful and to identify characteristics of individuals who develop pain compared with those who remain asymptomatic . METHODS A cohort of 195 subjects with an asymptomatic rotator cuff tear was prospect ively monitored for pain development and examined annually for changes in various parameters such as tear size , fatty degeneration of the rotator cuff muscle , glenohumeral kinematics , and shoulder function . Forty-four subjects were found to have developed new pain , and the parameters before and after pain development were compared . The forty-four subjects were then compared with a group of  fifty-five subjects who remained asymptomatic over a two-year period . RESULTS With pain development , the size of a full-thickness rotator cuff tear increased significantly , with 18 % of the full-thickness tears showing an increase of > 5 mm , and 40 % of the partial-thickness tears had progressed to a full-thickness tear . In comparison with the assessment s made before the onset of pain , the American Shoulder and Elbow Surgeons scores for shoulder function were significantly decreased and all measures of shoulder range of motion were decreased except for external rotation at 90 ° of abduction . There was an increase in compensatory scapulothoracic motion in relation to the glenohumeral motion during early shoulder abduction with pain development . No significant changes were found in external rotation strength or muscular fatty degeneration . Compared with the subjects who remained asymptomatic , the subjects who developed pain were found to have significantly larger tears at the time of initial enrollment . CONCLUSIONS Pain development in shoulders with an asymptomatic rotator cuff tear is associated with an increase in tear size . Larger tears are more likely to develop pain in the short term than are smaller tears . Further research is warranted to investigate the role of prophylactic treatment of asymptomatic shoulders to avoid the development of pain and loss of shoulder function Objective : Assess platelet rich plasma ( PRP ) injection for rotator cuff tendinopathy ( RCT ) . Design : Prospect i ve open label study with 1-year follow-up . Methods : Participants recruited from an outpatient sports medicine clinic had clinical ly and magnetic resonance image (MRI)—demonstrated RCT refractory to physical therapy and corticosteroid injection . They received one ultrasound-guided injection of 3.0 mL of 1 % xylocaine followed by 3.5 mL of PRP at the lesion and surrounding tendon . Primary outcome : 0—10 visual analog scale ( VAS ; baseline , 8 , 12 , and 52 weeks ) . Secondary outcomes : functional shoulder tests assessing rotator cuff strength and endurance ( at baseline and 8 and 12 weeks ) , MRI severity ( 1—5 points [ at baseline and 4 and 8 weeks ] ) , and patient satisfaction ( 52 weeks ) . Results : Eighteen participants with 19 assessed shoulders  reported VAS pain score improvement from 7.5 ± 0.3 points to 0.5 ± 0.3 points by week 12 and 0.4 ± 0.2 ( P = .0001 ) points at week 52 . Functional outcomes significantly improved ; the largest effect was seen in the external rotation test : 33.5 ± 5.7 seconds to 62.6 ± 7.2 seconds at week 12 ( P = .0001 ) . MRI appearance improved by 1 to 3 points in 16 of 18 assessed shoulders . Seventeen participants were “ completely satisfied ” ( 12 ) or “ satisfied ” ( 5 ) . One participant was “ unsatisfied . ” Conclusions : A single ultrasound-guided , intralesional injection of PRP result ed in safe , significant , sustained improvement of pain , function , and MRI outcomes in participants with refractory RCT . R and omized multidisciplinary effectiveness trials that add ultrasound and vali date d clinical outcome measures are needed to further assess PRP for RCT Background : Patient activity level  may be an important prognostic variable relating to outcomes in patients with shoulder disorders . Little is known about the predictors of activity level in patients with shoulder disorders . Hypothesis : Tear size and patient variables would be predictive of shoulder activity level in a cohort of patients who have selected initial nonoperative treatment for a symptomatic , atraumatic rotator cuff tear on magnetic resonance imaging ( MRI ) .  Study Design : Cross-sectional study ; Level of evidence , 3 . Methods : Patients with an atraumatic rotator cuff tear on MRI were prospect ively enrolled in the Multicenter Orthopaedic Outcomes Network ( MOON ) shoulder study of nonoperative treatment . As part of routine data collection , these patients were asked to complete a previously vali date d  shoulder activity scale . A regression analysis was performed to assess the association of shoulder activity level to rotator cuff tear characteristics , including tendon involvement and retraction , and patient factors such as age , sex , smoking , and occupation . Results : A total of 434 patients ( 220 male , 214 female ) with a mean age of 62.7 years ( range , 31 - 90 years ) completed the activity scale . Shoulder activity was not associated with severity of the rotator cuff tear , but it was negatively associated with age ( P = .0001 ) and female sex ( P = .001 
    Output:
    
Evidence suggests it is safe to monitor symptomatic rotator cuff tears , as tear size and symptoms are not correlated with pain , function , and /or ultimate outcome .
CONCLUSIONS complete rotator cuff tears may be effectively treated with injections , exercise in the short and intermediate terms respectively .
Negative effect of corticosteroids on rotator cuff tissue has not been demonstrated .