The effect of expedited rotator cuff surgery in injured workers: a case-control study

Razmjou, Helen; Lincoln, S D; Boljanovic, Dragana; Gallay, Stephen H.; Henry, Patrick; Richards, Robin R.; Holtby, Richard

doi:10.1016/j.jse.2016.11.049

Cited by 13 publications

(12 citation statements)

References 26 publications

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“…22,23 Although surgical repair of rotator cuff tears can improve pain and shoulder function, previous studies have found that WCB recipients reported lower recovery rates than did non-recipients. [2][3][4]6,7,13,24 Previous research has also suggested that WCB recipients exhibited poorer preoperative condition. 4,6,7,13,24 However, these studies have not controlled for differences in patient and injury characteristics and have not considered the potential effects of preoperative dissimilarities on postoperative recovery.…”

Section: Discussionmentioning

confidence: 99%

“…However, several studies have reported that workers’ compensation board (WCB) benefit recipients with rotator cuff tears experience lower recovery rates and report lower patient satisfaction than do non-recipients. 1 –4 It has also been suggested that WCB recipients report worse pain and lower function before surgery compared to those with nonwork-related injuries. 2,4 –7 However, the factors most commonly believed to affect postoperative outcomes are fatty degeneration, diabetes mellitus, age, gender, smoking status, and tear size.…”

Section: Introductionmentioning

confidence: 99%

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Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case–control study

Kim

Lee

Shin

et al. 2018

J Orthop Surg (Hong Kong)

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Purpose: We compared preoperative and postoperative measures among workers' compensation board (WCB) recipients and non-recipients and determined the impact of WCB receipt on the 1-and 2-year outcomes of rotator cuff repair. Methods: We retrospectively reviewed patients with full-thickness rotator cuff tears who underwent arthroscopic repair between September 2011 and September 2014. Patients were divided into two groups based on WCB status: WCB recipients and non-recipients. All patients returned for follow-up functional evaluations at 1 and 2 years after the operation. Four outcome measures were evaluated: visual analog scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, the Shoulder Rating Scale of the University of California at Los Angeles (UCLA), and range of motion (ROM). Results: Seventy patients (38 males, 32 females) were evaluated, 20 of whom were WCB recipients. At 1 year after the operation, ASES, UCLA, and VAS scores as well as abduction ROM (Abd-ROM) had improved significantly in both groups. However, non-recipients showed significantly greater improvement than did WCB recipients in ASES, UCLA, and VAS scores and in forward flexion ROM and Abd-ROM (p ¼ 0.000, 0.009, 0.002, 0.046, and 0.020, respectively). However, at 2 years after the operation (after the end of WCB), there were no significant differences in any clinical outcome between WCB recipients and non-recipients (p ¼ 0.057, 0.106, 0.075, 0.724, and 0.787, respectively). Conclusion: Although workers' compensation recipients who underwent arthroscopic rotator cuff repair had worse outcomes while receiving WCB benefits, the outcomes were similar after WCB benefits ended.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case–control study

Kim

Lee

Shin

et al. 2018

J Orthop Surg (Hong Kong)

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“…The result of a retrospective analysis of prospectively collected data on patients presenting with acute rotator cuff tears was that early repair resulted in improved outcomes [57]. In a case-controlled study of expedited RC surgery in injured workers, the early repaired group of 119 patients was more likely to be working at the final follow up than the control group of 65 patients [58].…”

Section: Asymptomatic Ftrcts Increase With Agementioning

confidence: 99%

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2017

MOJOR

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The chronicity of rotator cuff tears and their cause with increasing age has been extensively studied resulting in widely varying prevalence estimates. Focusing on a reported prevalence rate that increases with age to as high as 80% for 70 year olds can result in denial of reimbursement for work-related rotator cuff tears based on the presumed existence of underlying tendon pathology. The age at which inherent degeneration of the rotator cuff becomes a consideration in worker's comp judgments is vague at best. There are instances of acute shoulder trauma that occur in individuals as young as 20 years and even younger in athletes before significant tendon degeneration occurs. Multiple studies report low prevalence rates of asymptomatic rotator cuff tears in individuals less than 50 years. Acute shoulder trauma occurring at work in young workers provides strong evidence that the exposure event underlies any resulting shoulder disorder rather than tendon degeneration and as such is compensable. It can be questioned whether work-related acute shoulder trauma occurring at any age should be attributed to inherent tendon degeneration. IntroductionRotator cuff disease is the most common upper extremity disability [1]. Tendons are connective tissues primarily made up of aligned type I collagen fibrils. The primary cells in tendons are fibroblasts which produce the extra cellular matrix components. As a tendon ages, there is a drop in both cell numbers and cell synthetic activity which could affect mechanical function as tendon structure and composition are altered. These changes likely underlie the increase in tendon injuries with aging [2]. The principal focus of this review is the determination between acute traumatic and chronic degenerative rotator cuff tears (RCTs) which has huge implications for compensation of workrelated injuries. Determining the underlying cause of an RCT is complicated by an increasing incidence of asymptomatic rotator cuff disease with increasing age due to ongoing degeneration of the shoulder tendons. As the age of patient's increases and along with possible RC degeneration, it becomes increasingly difficult to exclusively attribute shoulder injuries to work-related trauma. However, ethically and given the original intent of worker compensation legislation, work-related trauma to the shoulder should be compensable [3].Determining the chronicity of tendon tears remains an issue that is still being pursued. Codman in 1931 stated four prescient hypotheses for RC supraspinatus tendon lesions: (1) trauma, (2) calcification, (3) necrosis or osteoarthritis, or (4) direct result of attrition [4]. Extrinsic and intrinsic factors are recognized to affect rotator cuff tears. Neer identified extrinsic factors based on impingement of the cuff against the coracoacromial arch when the arm is elevated in a forward direction leading to tendonitis and tears [5]. Variable morphology of the acromion includes spurs [6][7][8] and a hook-shaped acromion [9,10] that influence the degree of impingement and li...

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“…4,[7][8][9][10] Apart from the severity of pathology, chronicity, age, sex, and mechanism of injury, the length of wait time to surgery is reported to affect recovery. 8,[11][12][13][14][15][16][17][18][19] Considering the linear relationship between wait times to receive surgery and developing chronic disability, [20][21][22][23][24] expediting surgery is expected to help with a more successful return to normal function. Expediting surgery in injured workers is not a new concept in Canada.…”

Section: Introductionmentioning

confidence: 99%

“…[25][26][27] However, there is only minimal information on the subject in the literature. 8,19,28 Considering, the enormous implications of RC injury for workers, employers, insurers, and health-care providers, further exploration of the impact of pathology on recovery and readiness to return to work will provide a more evidenced base care for this population.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of expedited rotator cuff surgery in injured workers: Impact of pathology on readiness for return to work

Singh

Mann

Razmjou

2018

J Orthop Surg (Hong Kong)

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Objectives: The objectives of this study were to (1) examine the overall recovery and satisfaction following an expedited rotator cuff (RC) decompression or repair at 3-6 months and (2) explore group differences (repair vs. decompression) in demographics, clinical, disability, and psychosocial factors. Methods: This was a prospective longitudinal study of injured workers whose surgery was expedited. The outcome measures were Quick disabilities of the arm, shoulder, and hand (QuickDASH), the Hospital Anxiety and Depression Scale (HADS), the readiness for return to work (RRTW) scale, and satisfaction with surgery and overall recovery. Results: Of 118 patients participated in the study, 106 patients, age: 51 (9), 71 males (67%) completed the study. Sixty-four (60%) patients underwent a RC repair and 42 (40%) had RC decompression. Patients improved on average in QuickDASH (p ¼ 0.004), anxiety (p ¼ 0.003), and depression scores (p ¼ 0.004). The majority of patients (75%) were satisfied with surgery. In the decompression group, the pre-contemplation (PC) stage of the RRTW which documents the absence of desire or planning for return to work in the non-working sample (r ¼ 0.81, p ¼ 0.008) and the uncertain maintenance (UM) stage of the RRTW which explores the worker's struggle to stay at work in the working sample correlated with physical disability as measured by the QuickDASH scores (r ¼ 0.62, p ¼ 0.0001). In the repair group, the above domains correlated with the depression HADS scores (PC: r ¼ 0.64, p ¼ 0.001 and UM: r ¼ 0.57, p < 0.0001). Conclusion: Expedited RC surgery improved physical disability and mental well-being and was associated with a relatively high satisfaction at a maximum of 6 months. The poorer report of readiness for return to work was associated with higher physical disability in the decompression group and higher report of depression in the repair group. These differential associations may emphasize the importance of physical versus psychological management in patients with different levels of pathology.

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The effect of expedited rotator cuff surgery in injured workers: a case-control study

Cited by 13 publications

References 26 publications

Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case–control study

Do patients receiving workers’ compensation who undergo arthroscopic rotator cuff repair have worse outcomes than non-recipients? Retrospective case–control study

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Outcomes of expedited rotator cuff surgery in injured workers: Impact of pathology on readiness for return to work

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