Which Risk Factors Are Associated with Pain and Patient-reported Function in Patients with a Rotator Cuff Tear?

Abstract

Background Patient-reported measures guide physicians in clinical decision making and therefore it is critical to determine what clinical factors are associated with these scores. Psychological and physical factors are commonly studied separately in patients with rotator cuff tears to determine their influence on outcomes. It is well established that psychological distress and scapular motion change in the presence of a symptomatic rotator cuff tear. However, these factors have not been studied simultaneously in a clinical setting to determine their association with shoulder outcome scores. Question/purpose After controlling for relevant confounding variables, what physical and psychological factors are associated with better (1) American Shoulder and Elbow Surgeons (ASES) scores for function, (2) ASES pain scores, and (3) total ASES scores? Methods Fifty-nine patients with a potential symptomatic rotator cuff tear were recruited and agreed to participate in this cross-sectional study. Of those, 85% (50 of 59) met eligibility criteria for a primary diagnosis of an MRI-confirmed symptomatic partial-thickness or full-thickness rotator cuff tear without a history of shoulder surgery. Demographics, rotator cuff tear size, arm flexion, and clinical scapular motion during active arm flexion were evaluated by experienced examiners using standardized procedures. Patients completed the ASES questionnaire and the Optimal Screening for Prediction of Referral and Outcomes-Yellow Flag assessment form, which measures 11 different pain-related psychological distress symptoms. Three separate stepwise multiple linear regression analyses were performed for ASES pain, function, and total scores, with significance set at p < 0.05. Results This model found that ASES function scores were associated with four factors: older age, increased arm flexion, increased percentage of scapular external rotation during arm flexion, and increased scores for acceptance of chronic pain (adjusted r2 = 0.67; p = 0.01). Those four factors appear to explain 67% of the observed variance in ASES function scores in patients with rotator cuff tears. Furthermore, increased percentage of scapular external rotation during arm flexion and decreased fear-avoidance beliefs related to physical activity scores (adjusted r2 = 0.36; p < 0.01) were associated with better ASES pain scores. And finally, better ASES total scores were associated with four factors: increased arm flexion, increased percentage of scapular upward rotation, increased scapular external rotation during arm flexion, and decreased fear-avoidance beliefs related to physical activity scores (adjusted r2 = 0.65; p < 0.001). Conclusion Our results favor adopting a comprehensive biopsychological clinical assessment for patients with rotator cuff tears that specifically includes humeral and scapular motion, fear-avoidance behaviors, and pain coping behaviors along with demographics. These particular physical and psychological variables were found to be associated with the ASES and, therefore, should be clinically examined simultaneously and targeted as part of a tailored treatment plan. Level of Evidence Level II, prognostic study.

The Effectiveness of Exercises with Electromyographic Biofeedback in Conservative Treatment of Massive Rotator Cuff Tears: A Randomized Controlled Study

“…Pain-free function acquisition is one of the important factors in patients with RC tears. 44 In the present study, a statistically significant reduction in pain was found in both groups similar to the literature, whereas none of the groups were superior to the other. 45,46 Patient satisfaction is an important parameter that evaluates the success of the treatment from the patient's perspective.…”

CORR Insights®: Which Risk Factors Are Associated with Pain and Patient-reported Function in Patients with a Rotator Cuff Tear?

“…Scapular dysfunction is common in patients with chronic shoulder pain and rotator cuff disease [4]. This study confirmed that scapular motion was associated with patient-reported shoulder pain and function [5]. But, again, further study is needed to determine which treatment strategies work to help improve this part of the problem.…”

“…In the current study, Lemaster et al [5] investigated the psychological and physical factors, as well as shoulder function by American Shoulder and Elbow Surgeons (ASES) score, in patients with rotator cuff tears. They found that patient factors (including age), physical factors (like scapular motion), and psychological factors (fear-avoidance beliefs or acceptance of chronic pain, for example) all were associated with ASES score.…”

Association Between Preoperative Multidimensional Psychological Distress and Physical Function After Surgery for Sports-Related Injury

“…We similarly found no relationship between OSPRO-YF score and the NRS pain score. This finding was surprising, as prior research has demonstrated that the constructs measured in the OSPRO-YF are associated with postoperative pain intensity 23,32,33,48 as well as perceived physical function. 2,20,23,41,48 Postoperative pain is a complex phenomenon with myriad contributing factors.…”

“…This finding was surprising, as prior research has demonstrated that the constructs measured in the OSPRO-YF are associated with postoperative pain intensity 23,32,33,48 as well as perceived physical function. 2,20,23,41,48 Postoperative pain is a complex phenomenon with myriad contributing factors. The mean postoperative NRS pain score was low (1.4 of 10), and 58.9% of patients reported no pain.…”