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Baltassat A, Riffault L, Villatte G, Meyer N, Antoni M, Clavert P. History of mood and anxiety disorders affects return to work and return to sports after rotator cuff repair. Orthop Traumatol Surg Res 2024; 110:103854. [PMID: 38432470 DOI: 10.1016/j.otsr.2024.103854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 09/19/2023] [Accepted: 10/17/2023] [Indexed: 03/05/2024]
Abstract
INTRODUCTION After rotator cuff repair (RCR), return to work and return to sports is affected by various psychosocial factors. The role of one of these factors - mood and anxiety disorders (MAD) - is still not clear. The primary objective of this study was to determine the influence of prior MAD on the return to work and return to sports after RCR. Our hypothesis was that patients with a history of MAD would take longer to return to work and to sports after RCR, and the rate of return would be lower, than for patients without MAD. MATERIALS AND METHODS This was a retrospective single-center study of patients who underwent arthroscopic RCR (distal supraspinatus tear). Patients who were employed and those who participated in sports before the surgery were included in the "working" and "sports" groups, respectively. The primary outcomes were the time to return to work and return to sports after surgery. The secondary outcomes were the ratio of patients returning to work and to sports at 3, 6 and 12 months; rate of return to same level of sports; need to change or stop working or sports. The effects of prior MAD on these various outcomes were determined using Bayesian multivariate analysis. RESULTS The "working" group consisted of 158 patients (of which 16.5% had MAD) and the "sports" group consisted of 118 patients (of which 17.8% had MAD). In those with a history of MAD, return to work was 21±11 weeks later and the return to sports was 17±8 weeks later than in those without MAD. There was a 98% probability that return to work or return to sports was delayed by at least 4 weeks in patients with history of MAD. The likelihood that patients with prior MAD who undergo RCR will completely abandon their sport was 2.8 times higher (OR=2.8 [1; 7.8]). CONCLUSION We found a negative influence of prior MAD on the return to work and return to sports after RCR. LEVEL OF EVIDENCE III; retrospective case-control study.
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Affiliation(s)
- Antoine Baltassat
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Louis Riffault
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Guillaume Villatte
- Service de chirurgie orthopédique et traumatologique, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Nicolas Meyer
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France; Pole de santé publique, secteur méthodologie et biostatistiques, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - Maxime Antoni
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France.
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2, CHU de Strasbourg, avenue Molière, 67000 Strasbourg, France
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Kim JH, Jung SH, Park DH, Kwon YU, Lee HY. Factors associated with patient satisfaction after arthroscopic rotator cuff repair: do they differ by age? Clin Shoulder Elb 2024; 27:345-352. [PMID: 39138940 PMCID: PMC11393441 DOI: 10.5397/cise.2024.00283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 06/26/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Several studies have investigated factors affecting patient satisfaction after arthroscopic rotator cuff repair (ARCR); however, it is unknown if these factors vary according to age. Therefore, this study aimed to evaluate the factors associated with satisfaction of ARCR in individuals 70 years and older versus younger patients. METHODS Among 319 consecutive patients who underwent ARCR, 173 were included. Patients were divided into an old age group (≥70 years) and a young age group (<70 years), and the two age groups were further divided into satisfied and unsatisfied subgroups. Patient satisfaction was evaluated at the final follow-up visit using a binary question (yes or no). Clinical outcomes were assessed preoperatively and at the final follow-up. RESULTS Satisfaction rates in the older and younger age groups were 75.41% and 79.47%, respectively. Mean changes in Constant and American Shoulder and Elbow Surgeons scores were significantly different between the satisfied and unsatisfied subgroups (P=0.031 and P=0.012, respectively) in the young patients. In the old patients, there was a significant difference in the mean change in depression subscale of the Hospital Anxiety and Depression Scale (P=0.031) and anxiety subscale of the Hospital Anxiety and Depression Scale (P=0.044) scores between the satisfied and unsatisfied subgroups. CONCLUSIONS Factors affecting patient satisfaction after ARCR differed according to age. Psychological improvement was more important to elderly patients, whereas restoration of function was more important to younger patients. Pain relief was important for both age groups. Level of evidence: III.
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Affiliation(s)
- Jung-Han Kim
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Soo-Hwan Jung
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Dae-Hyun Park
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Yong-Uk Kwon
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
| | - Hyo-Young Lee
- Department of Orthopedic Surgery, Inje University Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea
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Ward BA, Kowalsky MS. Treatment of race and ethnicity in shoulder and elbow research: An analysis of the most cited papers on rotator cuff repair. J Orthop 2024; 55:86-90. [PMID: 38665989 PMCID: PMC11039319 DOI: 10.1016/j.jor.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/02/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Background This study examined the current approach to the inclusion of race and ethnicity among frequently referenced shoulder surgery literature and discussed guidance for best practices for the inclusion of race and ethnicity in shoulder research. Methods The shoulder literature were systematically reviewed for the most frequently cited studies discussing rotator cuff repair, total shoulder arthroplasty, and Bankart repair. All reviewed studies met the timeline criteria (2013-2022). Only studies with clinical outcomes were included. Review articles, meta-analyses, systematic reviews, basic science studies, or any manuscript that did not represent clinical outcomes research were excluded. Author, year issued, the journal in which the paper was published, study design, the number of subjects, duration of follow-up, independent variables, dependent variables, results, and conclusions were extracted from the articles that met the inclusion criteria. Whether race and/or ethnicity were included in the study design in any way was also recorded. For those studies in which race and ethnicity were included, a detailed analysis of the paper's treatment of race using the JAMA Updated Guidance on Reporting of Race and Ethnicity in Medical and Science Journals was performed and recorded. Results In the "rotator cuff repair" cohort of papers, there were 2 articles that mention race. Out of the 2 articles that mentioned race, neither included race appropriately using the JAMA Updated Guidance on Reporting of Race and Ethnicity in Medical and Science Journals. In the "Bankart repair" cohort of papers, each article lacked the mention of race among their patient population. The "total shoulder arthroplasty" manuscripts also did not include treatment of race and ethnicity in any way. Discussion Race and ethnicity and other social determinants of health can be used to understand the source of healthcare disparities. Unless a thoughtful and deliberate consideration of race and ethnicity is undertaken, their inclusion in clinical research can be a double-edged sword due to the potential race and ethnicity-centered treatment involvement can be rooted in fallacies. In shoulder surgery clinical research, race and ethnicity should be considered in concert with social factors that could exacerbate poor patient outcomes in our patient population. Level of evidence Level V.
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Affiliation(s)
| | - Marc S. Kowalsky
- ONS Foundation for Clinical Research & Education, Orthopedic & Neurosurgery Specialists, 40 Valley Drive 6, Greenwich Office Park, Greenwich, CT, 06831, USA
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Moore BP, Forrister DZ, Somerson JS. A threshold of lower preoperative mental health is associated with decreased achievement of comfort and capability benchmarks following rotator cuff repair: a retrospective cohort study. J Shoulder Elbow Surg 2024; 33:e403-e414. [PMID: 38325556 DOI: 10.1016/j.jse.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND Preoperative biomedical patient characteristics are known to affect the time to achievement of clinically significant outcomes (CSOs) following arthroscopic rotator cuff repair (RCR). However, less is known about the association between preoperative mental status and the time to achievement of CSOs. We hypothesize that higher preoperative mental status is associated with faster achievement of CSOs following arthroscopic RCR. METHODS Patient-reported outcome measures (PROMs) were collected preoperatively and at postoperative intervals up to 2 years. PROMs included pain visual analog scale (VAS), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), Single Assessment Numeric Evaluation (SANE), and Veterans RAND 12-Item Health Survey (VR-12) scores. Threshold values for CSOs were obtained from previous literature. Mean time to achievement of CSOs was calculated using a Kaplan-Meier analysis. A Cox proportional hazards regression analysis was performed to identify preoperative variables associated with earlier achievement of CSOs. RESULTS Sixty-nine patients with an average age of 59 ± 8 years were included. Patients with higher preoperative mental status, as measured by VR-12 mental component summary (MCS), experienced significantly earlier substantial pain improvement postoperatively (P = .0471). Patients with higher preoperative mental status also achieved CSOs for physical health at earlier time points (P = .0187). Preoperative VR-12 MCS scores ≥ 40 were associated with earlier achievement of CSOs for pain (P = .0005) and physical health (P = .0015). Ninety-eight percent of patients with preoperative MCS scores ≥40 achieved acceptable pain relief at 4.5 months vs. 56% of all other patients at 12.3 months (P = .0001). Patients with preoperative MCS scores ≥40 experienced significantly faster improvement in physical health compared to patients with preoperative MCS scores <40 (P = .0006). CONCLUSIONS Higher preoperative mental status, especially a preoperative MCS score ≥40, is associated with significantly faster improvement in pain and physical function following arthroscopic RCR. Nearly all patients (98%) with preoperative MCS score ≥40 achieved an acceptable state of pain relief compared with only 56% of patients with preoperative MCS score <40. These findings indicate that a holistic approach with equal consideration of preoperative mental health and rotator cuff pathophysiology is vital to the successful management of rotator cuff tendinopathy.
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Affiliation(s)
- Brady P Moore
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - David Z Forrister
- John Sealy School of Medicine, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jeremy S Somerson
- Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, USA.
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Kerhoulas Z, Ojaghi R, Hayes E, Khoury J, Pollock J. What are the common factors that lead to the failure to achieve minimal clinically important difference after shoulder surgery? A scoping review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1749-1755. [PMID: 38480530 DOI: 10.1007/s00590-024-03867-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 02/16/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION The goal of this research is to identify the factors that negatively impact the achievement of the minimum clinically significant change (MCID) for the American Shoulder and Elbow Surgeons (ASES) score within the realm of various orthopedic shoulder procedures. METHODS We conducted a comprehensive review of studies published from 2002 to 2023, utilizing OvidMedline and PubMed databases. Our search criteria included terms such as "minimal clinically important difference" or "MCID" along with associated MeSH terms, in addition to "American shoulder and elbow surgeon" or "ASES." We selectively included primary investigations that assessed factors linked to the failure to achieve MCID for the ASES score subsequent to orthopedic shoulder procedures, while excluding papers addressing anatomical, surgical, or injury-related aspects. RESULTS Our analysis identified 149 full-text articles, leading to the inclusion of 12 studies for detailed analysis. The selected studies investigated outcomes following various orthopedic shoulder procedures, encompassing biceps tenodesis, total shoulder arthroplasty, and rotator cuff repair. Notably, factors, such as gender, body mass index, diabetes, smoking habits, opioid usage, depression, anxiety, workers' compensation, occupational satisfaction, and the preoperative ASES score, were all associated with the inability to attain MCID. CONCLUSION In summary, numerous factors exert a negative influence on the attainment of MCID following shoulder procedures, and these factors appear to be irrespective of the specific surgical technique employed. Patients presenting with these factors may perceive their surgical outcomes as less successful when compared to those without these factors. Identifying these factors can enable healthcare providers to provide more effective counseling to patients regarding their expected outcomes and rehabilitation course. Furthermore, these findings can aid in the development of a screening tool to better identify these risk factors and optimize them before surgery.
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Affiliation(s)
- Zoe Kerhoulas
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
| | - Reza Ojaghi
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada.
| | - Emmitt Hayes
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
| | - Jason Khoury
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
| | - J Pollock
- Division of Orthopedics, Department of Surgery, University of Ottawa, 415-203 Catherin St, Ottawa, ON, K2P 1J5, Canada
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Fukumoto Y, Tsuji Y, Kakuda A, Hori R, Kudo S. Non-invasive evaluation of autonomic responses in patients with rotator cuff tear-related nocturnal pain. J Phys Ther Sci 2024; 36:111-116. [PMID: 38434993 PMCID: PMC10904215 DOI: 10.1589/jpts.36.111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/25/2023] [Indexed: 03/05/2024] Open
Abstract
[Purpose] We aimed to determine the autonomic response in patients with rotator cuff tear-related nocturnal pain using nonlinear analysis of heart rate variability. [Participants and Methods] Twenty-eight patients with nocturnal pain who were diagnosed with a rotator cuff tear and received steroid injections, and whose nocturnal pain improved, were divided into a control group (14 patients) and a failure group (14 patients). Pulse wave was measured continuously using BACS Advance equipment (TAOS Co.) for a total of 17 min: 5 min before isometric hand grip, 2 min during isometric hand grip, 5 min after isometric hand grip, and 10 min after isometric hand grip. The autonomic nervous system activity was assessed using detrended fluctuation analysis and approximate entropy. [Results] The α1 values obtained from the detrended fluctuation analysis were significantly higher in the failure group than in the control group at each measurement period. The approximate entropy was normal in 12 (85%) patients in the control group and six (42%) patients in the failure group; it was abnormal in two (15%) patients in the control group and eight (58%) patients in the failure group. [Conclusion] Among patients experiencing nocturnal pain, several have abnormal autonomic response during isometric hand grip.
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Affiliation(s)
- Yusuke Fukumoto
- Graduate School of Health Sciences, Morinomiya University
of Medical Sciences: 1-26-16 Nankoukita Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
- Keimoto Orthopedic Rehabilitation and Osteoporosis Clinic,
Japan
| | - Yoshihiro Tsuji
- Graduate School of Health Sciences, Morinomiya University
of Medical Sciences: 1-26-16 Nankoukita Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
- Department of Clinical Engineering, Morinomiya University
of Medical Sciences, Japan
- Inclusive Medical Science Research Institute, Morinomiya
University of Medical Sciences, Japan
| | - Akihiro Kakuda
- Graduate School of Health Sciences, Morinomiya University
of Medical Sciences: 1-26-16 Nankoukita Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
- Inclusive Medical Science Research Institute, Morinomiya
University of Medical Sciences, Japan
| | - Ryuji Hori
- Graduate School of Health Sciences, Morinomiya University
of Medical Sciences: 1-26-16 Nankoukita Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
- Inclusive Medical Science Research Institute, Morinomiya
University of Medical Sciences, Japan
| | - Shintarou Kudo
- Graduate School of Health Sciences, Morinomiya University
of Medical Sciences: 1-26-16 Nankoukita Suminoe-ku, Osaka-shi, Osaka 559-8611, Japan
- Inclusive Medical Science Research Institute, Morinomiya
University of Medical Sciences, Japan
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Olson JJ, Hill JR, Wang J, Sefko JA, Teefey SA, Middleton WD, Keener JD. Predictors of pain development for contralateral asymptomatic degenerative rotator cuff tears based on features of an ipsilateral painful cuff tear: a prospective longitudinal cohort study. J Shoulder Elbow Surg 2024; 33:234-246. [PMID: 37844830 DOI: 10.1016/j.jse.2023.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/21/2023] [Accepted: 09/03/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Prior rotator cuff disease natural history studies have focused on tear-related factors that predict disease progression within a given shoulder. The purpose of this study was to examine both patient- and tear-related characteristics of a painful rotator cuff tear that predict future pain development and functional impairment in a shoulder with a contralateral asymptomatic cuff tear. METHODS This was a prospective longitudinal cohort study of patients aged ≤65 years who underwent surgery for a painful degenerative rotator cuff tear and possessed an asymptomatic contralateral tear. Patients were followed up prospectively by shoulder ultrasound, physical examination, and functional score assessment. The primary outcome was change in the American Shoulder and Elbow Surgeons (ASES) score at 2 years. Secondary outcomes included the Western Ontario Rotator Cuff Index (WORC) score, Patient-Reported Outcomes Measurement Information System (PROMIS) score, Hospital Anxiety Depression Scale (HADS) depression and anxiety scores, and Veterans RAND-12 (VR-12) mental component score (MCS). RESULTS Sixty-five patients were included, with a mean follow-up period of 37 months (range, 24-42 months). In 17 patients (26%), contralateral shoulder pain developed at a median of 15.2 months (interquartile range [IQR], 10.5 months). No difference in age, sex, Charlson Comorbidity Index, or occupational demand was noted between patients in whom pain developed and those in whom pain did not develop. In the presenting painful shoulder, there was no difference in baseline tear size, muscle degeneration, or biceps pathology between groups. The mean baseline tear length (8.6 mm vs. 3.8 mm, P = .0008) and width (8.4 mm vs. 3.2 mm, P = .0004) were larger in asymptomatic shoulders in which pain subsequently developed compared with those in which pain did not develop. However, there was no difference in mean tear enlargement (P = .51 for length and P = .90 for width). There were no differences in baseline ASES, WORC, Patient-Reported Outcomes Measurement Information System (PROMIS), or HADS depression and anxiety scores between shoulders in which pain developed and those in which pain did not develop; however, patients in whom pain developed reported a lower baseline VR-12 MCS (53.3 vs. 57.6, P = .04). Shoulders in which pain developed had higher visual analog scale pain scores (2.9 [standard deviation (SD), 2.5] vs. 0.6 [SD, 1.0]; P = .016), lower ASES scores 75 [SD, 33] vs. 100 [SD, 11.6]; P = .001), and significant changes in all WORC scales with pain onset compared with those that remained asymptomatic. The study showed no significant difference in changes in the HADS anxiety and depression scores but found a significant increase in the VR-12 MCS in patients in whom pain developed (7.1 [interquartile range, 12.6] vs. -1.9 [interquartile range, 8.7]; P = .036). CONCLUSION In one-quarter of patients with painful cuff tears, pain developed in a contralateral asymptomatic cuff tear that resulted in a measurable decline in function within 3 years. Our analysis showed that only the baseline tear size of the asymptomatic shoulder was predictive of pain development. There were no tear-related features of the presenting painful rotator cuff tear or indices of mental health and physical function or occupational demand that were predictive of future pain development at short-term follow-up.
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Affiliation(s)
- Jeffrey J Olson
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - J Ryan Hill
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Jinli Wang
- Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - Julianne A Sefko
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA
| | - Sharlene A Teefey
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - William D Middleton
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Jay D Keener
- Shoulder and Elbow Service, Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
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Feltri P, Monteleone AS, Audigé L, Marbach F, Filardo G, Candrian C. Patients with rotator cuff tears present a psychological impairment, not only a functional deficit: a systematic review. INTERNATIONAL ORTHOPAEDICS 2024; 48:169-181. [PMID: 37673844 DOI: 10.1007/s00264-023-05952-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION Psychological factors impact patients with rotator cuff tears (RCT) in terms of pain level, shoulder function, sleep disturbance, and quality of life (QoL). The aim of this study was to quantify the prevalence of psychological factors in those patients, evaluate their influence on patient-reported outcomes (PROMs), and assess the possible improvement with surgical treatment. METHODS The literature search was performed on PubMed, Web of Science, Wiley Cochrane Library up to January, 2023. INCLUSION CRITERIA RCT treated with arthroscopic rotator cuff reconstruction (ARCR), description of psychological variables evaluated with validated questionnaires, descriptions of PROMs. RESULTS Thirty-nine studies included 7021 patients. Depression was found in eight studies (19.2%), anxiety in 6 (13.0%), sleep disturbance in seven (71.3%), and distress in three studies (26.4%). Studies evaluating the relationship between psychological impairment and pain documented more pain and impaired shoulder function before and after ARCR in patients with altered psychological status. DISCUSSION An impaired psychological status has an important impact on patients' perception of their disease. RCT patients with psychological alterations often experience more pain and reduced shoulder function, thus having worse QoL. CONCLUSION This study underlines that psychological impairment largely affects RCT patient condition and treatment outcome, which underlines the importance of a multidisciplinary biopsychosocial intervention to achieve better results.
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Affiliation(s)
- Pietro Feltri
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
| | | | - Laurent Audigé
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Basel, Basel, Switzerland
- Research and Development, Shoulder and Elbow Surgery, Schulthess Clinic, Zurich, Switzerland
| | - Francesco Marbach
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Christian Candrian
- Service of Orthopaedics and Traumatology, Department of Surgery, EOC, 6900, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Brindisino F, Minnucci S, Sergi G, Lorusso M, Struyf F, Innocenti T. Does the psychological profile of a patient with frozen shoulder predict future outcome? A systematic review. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2024; 29:e2056. [PMID: 37867399 DOI: 10.1002/pri.2056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND AND PURPOSE Frozen shoulder (FS) is defined as a condition characterised by functional restriction and daily and nightly pain. As in other shoulder pathologies, the manifestation of psychological factors is recognised in FS; however, from a psychological point of view, only few studies have reported its prognostic value. The aim of this systematic review is to investigate, in patients with FS, the prognostic value of psychological factors on pain, function, disability, health-related quality of life, return to work and time to recovery. MATERIALS AND METHODS This systematic review was reported following the Preferred Reporting Items for Systematic reviews and Meta-Analysis-PRISMA 2020 guideline. The authors followed the Cochrane Handbook for Systematic review of Intervention as methodological guidance. The Quality in Prognostic Studies-QUIPS tool was used to assess the risk of bias. RESULTS Pain-related fear and depression could be prognostic regarding patient-reported outcome measures assessing shoulder function, disability, and pain; instead, pain catastrophizing could have a prognostic value assessed by the disability of the arm shoulder and hand -DASH scale. Anxiety would appear to impact on disability and pain. DISCUSSION AND CONCLUSIONS As widely reported in numerous musculoskeletal conditions, also in FS psychological factors influence the physical dimension such as pain, disability and function. Therefore, clinicians should be encouraged to identify these factors through a comprehensive assessment of the bio-psychological profile of each individual with FS. Perhaps, patients with FS that show such psychological prognostic factors could benefit from a comprehensive and shared approach with other dedicated professionals.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, Campobasso, Italy
| | - Silvia Minnucci
- Department of Clinical Sciences and Translational Medicine, University of Roma "Tor Vergata" c/o Medicine and Surgery School, Rome, Italy
| | | | - Mariangela Lorusso
- Department of Clinical Sciences and Translational Medicine, University of Roma "Tor Vergata" c/o Medicine and Surgery School, Rome, Italy
| | - Filip Struyf
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
- GIMBE Foundation, Bologna, Italy
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Dujeux C, Antoni M, Thery C, Eichler D, Meyer N, Clavert P. History of mood and anxiety disorders does not affect the outcomes of arthroscopic rotator cuff repair. Orthop Traumatol Surg Res 2023; 109:103550. [PMID: 36642405 DOI: 10.1016/j.otsr.2023.103550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/21/2022] [Accepted: 11/15/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND A pre-existing mood and anxiety disorder (MAD) is often present in patients with rotator cuff pathology, but its presumed negative effect on the outcomes has not been demonstrated. AIM OF STUDY AND HYPOTHESIS The primary objective of this study was to evaluate how a history of MAD affects the clinical outcomes 1 year after arthroscopic rotator cuff repair (RCR). The secondary objectives were to evaluate how a history of MAD affects tendon healing, analgesic consumption and the occurrence of complications. MATERIALS AND METHODS The study population consisted of 219 patients (mean age 54.5±6.6 years) who underwent arthroscopic repair for a distal supraspinatus tendon tear, with 17% (38/219) presenting an history of MAD (depression, unspecified mood disorder, anxiety, and bipolar disorder). Using univariate and multivariate analyses, the joint range of motion, Constant score, analgesic consumption, occurrence of complications during the first postoperative year and tendon healing at 1 year (MRI or CT arthrography) were compared between the two groups (with or without MAD). RESULTS The Constant score was lower preoperatively in patients with history of MAD (-4 points, p=.04) but there were no significant differences between the two groups at the various postoperative follow-up time points (p>.05). No significant difference was found between the two groups of patients in their analgesic consumption at the various postoperative time points (p>.05), tendon healing at 1 year (p=.17) or the occurrence of postoperative complications (p=.59). DISCUSSION/CONCLUSION Pre-existing MAD had no effect on the clinical outcomes after arthroscopic RCR at 1 year and no effect on tendon healing, analgesic consumption or the occurrence of complications in our study population. LEVEL OF EVIDENCE III; retrospective case-control study.
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Affiliation(s)
- Clément Dujeux
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Maxime Antoni
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France.
| | - Charles Thery
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - David Eichler
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
| | - Nicolas Meyer
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France; Pôle de santé publique, secteur méthodologie et biostatistiques, hôpitaux universitaires de Strasbourg, 1, place de l'hôpital, 67000 Strasbourg, France
| | - Philippe Clavert
- Service de chirurgie du membre supérieur, hôpital de Hautepierre 2 - CHU Strasbourg, avenue Molière, 67000 Strasbourg, France
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11
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Perez-Dominguez B, Perpiña-Martinez S, Garcia-Isidoro S, Escobio-Prieto I, Rodriguez-Rodriguez AM, Blanco-Diaz M. Associations between Preoperative Patient Socioeconomic Status and Pain-Related Outcomes with Pain and Function in Patients Undergoing Rotator Cuff Repairs. Healthcare (Basel) 2023; 11:2786. [PMID: 37893860 PMCID: PMC10606215 DOI: 10.3390/healthcare11202786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/15/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Patients undergoing rotator cuff repairs commonly experience postoperative pain and functional limitations. Various socioeconomic and pain-related factors have been recognized as influential in the prognosis of such patients. This study aims to investigate the associations between postoperative pain and functionality and preoperative pain-related outcomes and socioeconomic status in patients undergoing rotator cuff repairs. METHODS This cross-sectional study examines the relationship between the outcomes of rotator cuff repairs and participants' socioeconomic status and pain-related measures. Socioeconomic status was assessed through indicators such as educational level, monthly household income, and occupation. Pain-related outcomes included measures of kinesiophobia and pain self-efficacy. RESULTS A total of 105 patients (68 male, 37 female) were included in the analysis. The findings revealed no significant association between postoperative pain or functionality and the patients' socioeconomic status (p > 0.05). However, postoperative pain levels demonstrated a significant association with preoperative kinesiophobia (p < 0.05) and pain self-efficacy (p < 0.013). In contrast, functionality did not exhibit a significant association with these measures (p < 0.072 and 0.217, respectively). CONCLUSIONS Preoperative pain-related outcomes play a role in postoperative pain levels among patients undergoing rotator cuff repairs. However, they do not appear to be related to functionality. Additionally, socioeconomic status does not significantly impact either pain or functionality.
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Affiliation(s)
- Borja Perez-Dominguez
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46010 Valencia, Spain;
| | - Sara Perpiña-Martinez
- Faculty of Nursing and Physiotherapy Salus Infirmorum, Pontifical University of Salamanca, 28015 Madrid, Spain
| | | | - Isabel Escobio-Prieto
- Institute of Biomedicine of Seville (IBIS), Department of Physiotherapy, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, 41004 Seville, Spain;
| | - Alvaro Manuel Rodriguez-Rodriguez
- Faculty of Medicine and Health Sciences, Physiotherapy and Translational Research Group (FINTRA), Institute of Health Research of the Principality of Asturias, University of Oviedo, 33003 Oviedo, Spain; (A.M.R.-R.); (M.B.-D.)
| | - Maria Blanco-Diaz
- Faculty of Medicine and Health Sciences, Physiotherapy and Translational Research Group (FINTRA), Institute of Health Research of the Principality of Asturias, University of Oviedo, 33003 Oviedo, Spain; (A.M.R.-R.); (M.B.-D.)
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12
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Wagener N, Löchel J, Hipfl C, Perka C, Hardt S, Leopold VJ. Psychological status affects postoperative quality of life, function, and pain after periacetabular osteotomy. Bone Jt Open 2023; 4:758-765. [PMID: 37821094 PMCID: PMC10567161 DOI: 10.1302/2633-1462.410.bjo-2023-0104.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023] Open
Abstract
Aims Psychological status may be an important predictor of outcome after periacetabular osteotomy (PAO). The aim of this study was to investigate the influence of psychological distress on postoperative health-related quality of life, joint function, self-assessed pain, and sports ability in patients undergoing PAO. Methods In all, 202 consecutive patients who underwent PAO for developmental dysplasia of the hip (DDH) at our institution from 2015 to 2017 were included and followed up at 63 months (SD 10) postoperatively. Of these, 101 with complete data sets entered final analysis. Patients were assessed by questionnaire. Psychological status was measured by Brief Symptom Inventory (BSI-18), health-related quality of life was raised with 36-Item Short Form Survey (SF-36), hip functionality was measured by the short version 0f the International Hip Outcome Tool (iHOT-12), Subjective Hip Value (SHV), and Hip Disability and Outcome Score (HOS). Surgery satisfaction and pain were assessed. Dependent variables (endpoints) were postoperative quality of life (SF-36, HOS quality of life (QoL)), joint function (iHOT-12, SHV, HOS), patient satisfaction, and pain. Psychological distress was assessed by the Global Severity Index (GSI), somatization (BSI Soma), depression (BSI Depr), and anxiety (BSI Anx). Influence of psychological status was assessed by means of univariate and multiple multivariate regression analysis. Results In multiple multivariate regression, postoperative GSI, BSI Soma, and BSI Depr had a negative effect on postoperative SF-36 (e -2.07, -3.05, and -2.67, respectively; p < 0.001), iHOT-12 (e -1.35 and -4.65, respectively; p < 0.001), SHV (e -1.20 and -2.71, respectively; p < 0.001), HOS QoL (e -2.09 and -4.79, respectively; p < 0.001), HOS Function (e -1.00 and -3.94, respectively; p < 0.001), and HOS Sport (e -1.44 and -5.29, respectively; p < 0.001), and had an effect on postoperative pain (e 0.13 and 0.37, respectively; p < 0.001). Conclusion Psychological distress, depression, and somatization disorders affect health-related quality of life, perceived joint function, and sports ability. Pain perception is significantly increased by somatization. However, patient satisfaction with surgery is not affected.
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Affiliation(s)
- Nele Wagener
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Jannis Löchel
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Christian Hipfl
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Carsten Perka
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Sebastian Hardt
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
| | - Vincent J. Leopold
- Center for Musculoskeletal Surgery, Charité-University Medicine Berlin, Berlin, Germany
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13
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Mercurio M, Castioni D, de Filippis R, De Fazio P, Paone A, Familiari F, Gasparini G, Galasso O. Postoperative psychological factors and quality of life but not shoulder brace adherence affect clinical outcomes after arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2023; 32:1953-1959. [PMID: 37003425 DOI: 10.1016/j.jse.2023.02.138] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/31/2023] [Accepted: 02/20/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Despite the high prevalence, there is no consensus for postsurgical management after rotator cuff repair. We aimed to assess the impact of psychological well-being on patients who underwent rotator cuff repair. We also investigated correlations and possible predictors between patient demographics and adherence to the use of the shoulder brace and outcomes in terms of shoulder functionality and quality of life. METHODS We conducted a retrospective study with prospective data collection enrolling 120 consecutive patients who underwent shoulder arthroscopy for rotator cuff tear repair. Each patient was clinically evaluated after a mean follow-up of 24.2 (±9.8) months using (1) the Disability of the Arm, Shoulder and Hand (DASH) scale, (2) the Hospital Anxiety and Depression Scale (HADS), (3) the Rotator Cuff Quality of Life (RC-QoL), (4) the visual analog scale, and (5) the Medical Adherence Measure. RESULTS The final sample consisted of 100 patients (45 females, 45%) averaging 60.9 (±8.5) years. The average brace wearing time was 3.4 (±0.6) weeks, with an adherence superior to 80% in 84% of cases, and 96% of patients were living with family members. The mean postoperative DASH scores were 20.1 (±16.7), 23.4 (±25), and 18.9 (±21.5) for the general, work, and sport sections, respectively. The mean Medical Adherence Measure score reached 72.5 (±14.2) points, and the RC-QoL mean score was 30.4% (±20.5). The Hospital Anxiety and Depression Scale-Anxiety and Hospital Anxiety and Depression Scale-Depression scores' continuous mean values were 5.1 (±3.4) and 3.9 (±3.6), respectively. The DASH, Hospital Anxiety and Depression Scale-Anxiety, Hospital Anxiety and Depression Scale-Depression, and RC-QoL scores directly correlated with each other, and all these questionnaires directly correlated with the visual analog scale scores. Moreover, we found a direct correlation (r = 0.204, P = .033) between the female sex and adherence to the brace and a direct correlation (r = 0.242, P = .015) between adherence to the brace and the number of weeks it was worn according to the medical recommendation. A correlation between lower educational qualifications and poorer outcomes was found. No correlation emerged between adherence to the brace and functional results. According to the regression analysis, diabetes was found to be a predictor of worse postoperative DASH scores (β = 0.245, P = 0.28). CONCLUSION A lower perceived quality of life was associated with worse functional results, anxiety and depression symptoms, and pain after rotator cuff repair surgery. The adherence to the use of the shoulder brace was associated with the female sex and a longer prognosis, but no correlation emerged between adherence to the brace and functional outcomes.
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Affiliation(s)
- Michele Mercurio
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Davide Castioni
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy; Department of Orthopedic and Trauma Surgery, Girolamo Fracastoro Hospital, Verona, Italy
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy.
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Alfonso Paone
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Filippo Familiari
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Giorgio Gasparini
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
| | - Olimpio Galasso
- Department of Orthopaedic and Trauma Surgery, "Magna Græcia" University, "Mater Domini" University Hospital, Catanzaro, Italy
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Peng R, Yang R, Ning N. Central sensitization syndrome in patients with rotator cuff tear: prevalence and associated factors. Postgrad Med 2023; 135:593-600. [PMID: 37505056 DOI: 10.1080/00325481.2023.2241343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/24/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION A significant number of rotator cuff tear (RCT) patients developed chronic shoulder pain that did not correspond to physiological changes. Central sensitization syndrome (CSS) is a neurophysiological adaptation process that can result in hypersensitivity to peripheral stimuli. Although there is evidence of an association between CSS and musculoskeletal problems, no studies have focused on the association between CSS and RCT. The primary purpose of this study was to examine the prevalence of CSS in patients with RCT. The secondary purpose was to document the associated conditions and comorbidity that were associated with the CSS. METHODS This was a cross-sectional study of patients with RCT who completed the Central Sensitization Inventory (CSI). Patients with score of ≥ 40/100 were considered positive for CSS. Demographic and clinical data and CSI results were collected to analyze the prevalence and associated factors of CSS in RCT patients. RESULTS A total of 404 RCT patients were included, and the CSS prevalence was 39.4%. Compared to the non-CSS group, the CSS group had an odds ratio of 4.13 (95% CI, 2.70-6.32; p<0.001) for ages 51-60, 3.07 (95% CI, 2.00-4.69; p<0.001) for symptoms lasting more than 6 months, 6.08 (95% CI, 3.90-9.47; p<0.001) for nonphysical laborers, 3.69 (95%CI, 2.42-5.61; p<0.001) for long head of biceps (LHB) abnormality, 2.93 (95% CI, 1.93-4.45; p<0.001) for concurrent shoulder stiffness, 4.82 (95% CI, 2.55-9.10; p<0.001) for anxiety or panic episodes, and 2.11 (95% CI, 1.12, 4.00; p<0.001) for depression. CONCLUSIONS The prevalence of CSS in patients with RCT was relatively high at 39.4%. The CSS was associated with higher age, female gender, and clinical findings of symptoms lasting over six months, nonphysical laborers, abnormal LHB, concurrent shoulder stiffness, anxiety, and depression.
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Affiliation(s)
- Run Peng
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
| | - Rong Yang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Ning
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, China
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15
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Sahoo S, Derwin KA, Jin Y, Imrey PB, Ricchetti ET, Entezari V, Iannotti JP, Spindler KP, Ho JC. One-year patient-reported outcomes following primary arthroscopic rotator cuff repair vary little by surgeon. JSES Int 2023; 7:568-573. [PMID: 37426918 PMCID: PMC10328782 DOI: 10.1016/j.jseint.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Background This study's purpose was to investigate the extent to which differences among operating surgeons may influence 1-year patient-reported outcome measures (PROMs) in patients undergoing rotator cuff repair (RCR) surgery, after controlling for general and disease-specific patient factors. We hypothesized that surgeon would be additionally associated with 1-year PROMs, specifically the baseline to 1-year improvement in Penn Shoulder Score (PSS). Methods We used mixed multivariable statistical modeling to assess the influence of surgeon (and alternatively surgical case volume) on 1-year PSS improvement in patients undergoing RCR at a single health system in 2018, controlling for eight patient- and six disease-specific preoperative factors as possible confounders. Contributions of predictors to explaining variation in 1-year PSS improvement were measured and compared using Akaike's Information Criterion. Results 518 cases performed by 28 surgeons met inclusion criteria, with median (quartiles) baseline PSS of 41.9 (31.9, 53.9) and 1-year PSS improvement of 42 (29.1, 55.3) points. Contrary to expectation, surgeon and surgical case volume were neither statistically significantly nor clinically meaningfully associated with 1-year PSS improvement. Baseline PSS and mental health status (VR-12 MCS) were the dominant and only statistically significant predictors of 1-year PSS improvement, with lower baseline PSS and higher VR-12 MCS predicting larger 1-year PSS improvement. Conclusion Patients generally reported excellent 1-year outcomes following primary RCR. This study did not find evidence that the individual surgeon or surgeon case volume influences 1-year PROMs, independently of case-mix factors, following primary RCR in a large employed hospital system.
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Affiliation(s)
- Sambit Sahoo
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Kathleen A. Derwin
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Yuxuan Jin
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Peter B. Imrey
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Eric T. Ricchetti
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Vahid Entezari
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Kurt P. Spindler
- Department of Orthopaedic Surgery, Cleveland Clinic, Weston, FL, USA
| | - Jason C. Ho
- Department of Orthopaedic Surgery, Orthopedic and Rheumatologic Institute, Cleveland Clinic, Cleveland, OH, USA
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Longo UG, De Salvatore S, Piergentili I, Panattoni N, Marchetti A, De Marinis MG, Denaro V. Anxiety and Depressive Symptoms Correlated to Patient-Reported Outcome Measures after Rotator Cuff Repair: A Prospective Study in the Perioperative Period. J Clin Med 2023; 12:jcm12082999. [PMID: 37109336 PMCID: PMC10146391 DOI: 10.3390/jcm12082999] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 04/29/2023] Open
Abstract
Anxiety and depressive symptoms adversely affect surgical outcomes in patients with rotator cuff tear (RCT) undergoing surgical repair. Patients without a diagnosis of mood disorders, such as anxiety and depression, before rotator cuff repair (RCR) can be considered an optimal candidate for surgery. The objective of this prospective observational study was to evaluate the relationship between anxiety and depressive symptoms, using the Hospital Anxiety and Depression Scale (HADS) as an assessment tool, and patient-reported outcome measures in RCT after repair surgery. This study included patients with RCT undergoing arthroscopic rotator cuff repair (RCR). Forty-three patients were included who had completed the HADS, Constant Murley Score (CMS), and Short Form Health Survey 36 (SF-36) questionnaires before surgery and in the postoperative follow-up, at 1 month, 3 months, and 6 months. The Friedman test showed that there were statistically significant changes in the different times point for HADS (p < 0.001), anxiety subscale of HADS, i.e., HADS-A (p < 0.001), depression subscale of HADS, i.e., HADS-D (p < 0.001), CMS (p < 0.001), and SF-36 (p < 0.001). The average scores of HADS, HADS-A, and HADS-D improved at each follow-up, showing improvement in discomfort. From the third month after surgery, there was an improvement in anxiety and depression disorders related to improved quality of life, functionality, and pain perception. The trend remained stable until the sixth month of follow up. This study shows that anxiety and depressive symptoms in RCT patients are significantly reduced after RCR with subsequent important improvements in terms of functionality, ability to carry out activities of daily living, perceived pain, and quality of life.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
| | - Ilaria Piergentili
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
| | - Nicolò Panattoni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Anna Marchetti
- Research Unit Nursing Science, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Maria Grazia De Marinis
- Research Unit Nursing Science, Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Rome, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Rome, Italy
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Nichols MS, Jacobs CA, Lemaster NG, Magnuson JA, Mair SD, Ortiz SF, Hettrich CM. Psychosocial factors play a greater role in preoperative symptoms for patients with atraumatic shoulder instability: data from the MOON-Shoulder Instability group. J Shoulder Elbow Surg 2023; 32:533-538. [PMID: 36179960 PMCID: PMC9957806 DOI: 10.1016/j.jse.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/28/2022] [Accepted: 08/11/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies have demonstrated that psychosocial factors and comorbid depression are associated with worse preoperative baseline measures, clinical outcomes, and recovery in patients undergoing shoulder surgery. It is unknown whether this potential link would differ between those with traumatic vs. atraumatic shoulder instability, as symptoms may persist longer in atraumatic instability prior to surgical intervention. The purpose of this study was to determine if psychosocial factors and/or comorbid depression more heavily influence preoperative symptoms for patients with traumatic vs. atraumatic shoulder instability. METHODS Prospective baseline data from 1552 patients in the Multicenter Orthopaedic Outcomes Network (MOON) Shoulder Instability cohort were analyzed based on mechanism of injury while controlling for age, sex, and direction of instability. Multivariable linear regressions were performed to determine whether psychological factors (RAND 36 Mental Component Score [MCS], depression diagnosis, Personality Assessment Screener-22) were predictive of preoperative American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) and Western Ontario Shoulder Instability Index (WOSI) scores in the atraumatic group. The same model was repeated for the traumatic instability group, and the model fit was compared between groups, with P < .05 considered statistically significant. RESULTS Female sex and lower MCS were significantly associated with worse preoperative ASES and WOSI scores for the group with atraumatic instability (ASES R2 = 0.15, P < .001; WOSI R2 = 0.17, P < .001). The same model performed significantly worse (P < .05) for both ASES and WOSI scores in the group with traumatic instability (ASES R2 = 0.07, WOSI R2 = 0.08). CONCLUSIONS Worse preoperative psychosocial factors were found to be more strongly associated with shoulder-related pain and function for patients with atraumatic instability. Across multiple orthopedic conditions, depression and emotional well-being have been associated with worse preoperative symptoms and inferior postoperative patient-reported outcomes. Despite the stronger and significant association in atraumatic patients, worse psychosocial factors did not have as large an impact as has been seen in other, more chronic conditions such as osteoarthritis or rotator cuff tears. In addition to medically optimizing patients prior to surgery, the current findings identify a subset of shoulder instability patients that may benefit from a behavioral health intervention either prior to surgery or early in the postoperative period to potentially improve postoperative outcomes.
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Affiliation(s)
- Michael S Nichols
- University of Kentucky Orthopaedic Surgery and Sports Medicine, Lexington, KY, USA
| | - Cale A Jacobs
- University of Kentucky Orthopaedic Surgery and Sports Medicine, Lexington, KY, USA.
| | - Nicole G Lemaster
- University of Kentucky Orthopaedic Surgery and Sports Medicine, Lexington, KY, USA
| | - Justin A Magnuson
- University of Kentucky Orthopaedic Surgery and Sports Medicine, Lexington, KY, USA
| | - Scott D Mair
- University of Kentucky Orthopaedic Surgery and Sports Medicine, Lexington, KY, USA
| | - Shannon F Ortiz
- University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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18
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Longo UG, Papalia R, De Salvatore S, Marinozzi A, Piergentili I, Lalli A, Bandini B, Franceschetti E, Denaro V. Establishing the Minimum Clinically Significant Difference (MCID) and the Patient Acceptable Symptom Score (PASS) for the Hospital Anxiety and Depression Scale (HADS) in Patients with Rotator Cuff Disease and Shoulder Prosthesis. J Clin Med 2023; 12:jcm12041540. [PMID: 36836074 PMCID: PMC9967741 DOI: 10.3390/jcm12041540] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/10/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023] Open
Abstract
Insufficiently treated shoulder pain may cause mental disturbances, including depression and anxiety. The Hospital Anxiety and Depression Scale (HADS) is a patient-reported outcome measure (PROM) that aims to identify depression and anxiety in patients in nonpsychiatric wards. The aim of this study was to identify the minimum clinically important difference (MCID) and patient acceptable symptom state (PASS) scores for the HADS in a cohort of individuals with rotator cuff disease. Using the HADS, participants' degrees of anxiety and depression were assessed at inception and at their final assessment 6 months after surgery. To calculate the MCID and the PASS, distribution and anchor approaches were employed. The MCID from inception to final assessment was 5.7 on the HADS, 3.8 on the HADS-A, and 3.3 on the HADS-D. A 5.7 amelioration on the HADS score, 3.8 on the HADS-A, and 3.3 on the HADS-D, from inception to final assessment, meant that patients had reached a clinically meaningful improvement in their symptom state. The PASS was 7 on the HADS, 3.5 on the HADS-A, and 3.5 on the HADS-D; therefore, for the majority of patients, a score of at least 7 on the HADS, 3.5 on the HADS-A, and 3.5 on the HADS-D at final evaluation was considered a satisfactory symptom state.
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Affiliation(s)
- Umile Giuseppe Longo
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
- Correspondence: ; Tel.: +39-06-225411613
| | - Rocco Papalia
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Sergio De Salvatore
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Andrea Marinozzi
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Ilaria Piergentili
- Laboratory of Measurement and Biomedical Instrumentation, Campus Bio-Medico University, Via Alvaro del Portillo 200, 00128 Rome, Italy
| | - Alberto Lalli
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Benedetta Bandini
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Edoardo Franceschetti
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | - Vincenzo Denaro
- Research Unit of Orthopaedic and Trauma Surgery, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Roma, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 21, 00128 Roma, Italy
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Freshman RD, Oeding JF, Anigwe C, Zhang AL, Feeley BT, Ma CB, Lansdown DA. Pre-existing Mental Health Diagnoses Are Associated With Higher Rates of Postoperative Complications, Readmissions, and Reoperations Following Arthroscopic Rotator Cuff Repair. Arthroscopy 2023; 39:185-195. [PMID: 35970453 DOI: 10.1016/j.arthro.2022.06.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/18/2022] [Accepted: 06/25/2022] [Indexed: 02/09/2023]
Abstract
PURPOSE To investigate the association between preoperative mental health disorders and postoperative complications, readmissions, and ipsilateral revision procedures among patients undergoing arthroscopic rotator cuff repair (RCR). METHODS A retrospective cohort study from 2010 to 2020 was performed using the PearlDiver database. Current Procedural Terminology and International Classification of Diseases codes were used to compare patients with and without mental health disorders who underwent arthroscopic RCR. Mental health disorders evaluated in this study include depressive disorder, major depressive disorder, major depressive affective disorder, bipolar disorder, dysthymic disorder, adjustment disorder, separation anxiety disorder, and posttraumatic stress disorder. Patients were matched at a 1:1 ratio based on age, sex, Charlson Comorbidity Index, body mass index, and tobacco use. Rates of complications and subsequent surgeries were compared between patients with and without a preoperative diagnosis of a mental health disorder. RESULTS The 1-year preoperative prevalence of a mental health disorder from 2010 to 2020 was 14.6%. After 1:1 matching, patients with a mental health disorder who underwent arthroscopic RCR were nearly twice as likely to undergo a revision procedure (odds ratio 1.94, 95% confidence interval 1.76-2.14, P < .001) and more than twice as likely to experience conversion to shoulder arthroplasty (odds ratio 2.29, 95% confidence interval 1.88-2.80, P < .001) within 2 years of initial arthroscopy when compared with patients without a mental disorder. Patients with a mental disorder also experienced increased risk for 90-day readmission (1.9% vs 0%, P < .001) as well as multiple postoperative medical complications. CONCLUSIONS Patients with pre-existing mental health diagnoses experience increased rates of 90-day postoperative complications and readmissions following arthroscopic RCR. In addition, patients with mental health diagnoses are more likely to undergo revision repair and conversion to shoulder arthroplasty within 2 years of the index procedure. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ryan D Freshman
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Jacob F Oeding
- NYU Grossman School of Medicine, New York, New York, U.S.A.
| | - Christopher Anigwe
- School of Medicine, University of California San Francisco, San Francisco, California, U.S.A
| | - Alan L Zhang
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Brian T Feeley
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - C Benjamin Ma
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
| | - Drew A Lansdown
- Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, U.S.A
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Karartı C, Basat HÇ, Özsoy İ, Özyurt F, Özsoy G, Kodak Mİ, Özüdoğru A, Uçar İ. Biopsychosocial Approach in Identifying Risk Factors of Kinesiophobia in Persons with Subacromial Pain Syndrome and Developing a Clinical Prediction Tool. Indian J Orthop 2023; 57:124-136. [PMID: 36660479 PMCID: PMC9789244 DOI: 10.1007/s43465-022-00781-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
Introduction Although the negative effects of kinesiophobia on functional status in subacromial pain syndrome (SAPS) patients are clearly demonstrated, no study examines the risk factors of kinesiophobia in individuals with SAPS from a biopsychosocial perspective. The present study aims to determine the risk factors of kinesiophobia in individuals with SAPS using a biopsychosocial approach. This study also aims to explore the compounding effects of multiple associative risk factors by developing a clinical prediction tool to identify SAPS patients at higher risk for kinesiophobia. Materials and methods This cross-sectional study included 549 patients who were diagnosed with SAPS. The Tampa-Scale of Kinesiophobia (TSK) was used to assess kinesiophobia. Visual analog scale (VAS), The Shoulder Pain and Disability Index (SPADI), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, the presence of metabolic syndrome, using any non-steroidal anti-inflammatory drugs, Pain Catastrophizing Scale (PCS), Illness Perception Questionnaire-revised (IPQ-R), Hospital Anxiety and Depression Scale (HADS), behavioral pattern of the patient, sociodemographic characteristics, and treatment expectancy were outcome measures. Results Thirteen significant risk factors of having kinesiophobia were: VASat rest (≥ 5.2), VASduring activity (≥ 7.1), DASH (≥ 72.1), presence of metabolic syndrome, PCShelplessness (≥ 16.1), IPQ-Rpersonal control (≤ 17.1), IPQ-Rtreatment control (≤ 16.3), HADSdepression (≥ 7.9), avoidance behavior type, being female, educational level (≤ high school), average hours of sleep (≤ 6.8), and treatment expectancy (≤ 6.6). The presence of seven or more risk factors increased the probability of having high level of kinesiophobia from 34.3 to 51%. Conclusions It seems necessary to address these factors, increase awareness of health practitioners and individuals. Level of evidence Level IV.
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Affiliation(s)
- Caner Karartı
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Hakkı Çağdaş Basat
- Department of Orthopedics and Traumatology, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İsmail Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Fatih Özyurt
- Department of Physiotherapy and Rehabilitation, Beykent University, Istanbul, Turkey
| | - Gülşah Özsoy
- Department of Physiotherapy and Rehabilitation, Selçuk University, Konya, Turkey
| | - Muhammed İhsan Kodak
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Anıl Özüdoğru
- Department of Physiotherapy and Rehabilitation, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - İlyas Uçar
- Department of Anatomy, Erciyes University, Kayseri, Turkey
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21
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Meta F, Khalil LS, Ziedas AC, Gulledge CM, Muh SJ, Moutzouros V, Makhni EC. Preoperative Opioid Use Is Associated With Inferior Patient-Reported Outcomes Measurement Information System Scores Following Rotator Cuff Repair. Arthroscopy 2022; 38:2787-2797. [PMID: 35398483 DOI: 10.1016/j.arthro.2022.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 03/20/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the influence of preoperative opioid use on Patient-Reported Outcomes Measurement Information System (PROMIS) scores pre- and postoperatively in patients undergoing arthroscopic rotator cuff repair (RCR). METHODS A retrospective review of all RCR patients aged >18 years old was performed. PROMIS pain interference ("PROMIS PI"), upper extremity function ("PROMIS UE"), and depression ("PROMIS D") scores, were reviewed. These measures were collected at preoperative, 6-month, and 1-year postoperative time points. A prescription drug-monitoring program was queried to track opioid prescriptions. Patients were categorized as chronic users, acute users, and nonusers based on prescriptions filled. Comparison of means were carried out using analysis of variance and least squares means. Effect sizes and 95% confidence intervals were calculated. RESULTS In total, 184 patients who underwent RCR were included. Preoperatively, nonusers (n = 92) had superior PROMIS UE (30.6 vs 28.9 vs 26.1; P < .05) and PI scores (61.5 vs 64.9 vs 65.3; P < .001) compared with acute users (n = 65) and chronic users (n = 27), respectively. At 6 months postoperatively; nonusers demonstrated significantly greater PROMIS UE (41.7 vs 35.6 vs. 33.5; P < .001), lower PROMIS D (41.6 vs 45.8 vs 51.1; P < .001), and lower PROMIS PI scores (50.7 vs 56.3 vs 58.1; P < .01) when compared with acute and chronic users, respectively. Nonusers had lower PROMIS PI (47.9 vs 54.3 vs 57.4; P < .0001) and PROMIS D (41.6 vs 48.3 vs 49.2; P = .0002) scores compared with acute and chronic users at 1-year postoperatively. Nonusers experienced a significantly greater magnitude of improvement in PROMIS D 6 months postoperatively compared with chronic opioid users (-5.9 vs 0.0; P < .01). CONCLUSIONS Patients undergoing RCR demonstrated superior PROMIS scores pre- and postoperatively if they did not use opioids within 3 months before surgery. LEVEL OF EVIDENCE III, retrospective comparative trial.
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Affiliation(s)
- Fabien Meta
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A..
| | - Lafi S Khalil
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | | | - Caleb M Gulledge
- Wayne State University School of Medicine, Detroit, Michigan, U.S.A
| | - Stephanie J Muh
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Vasilios Moutzouros
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Eric C Makhni
- Department of Orthopedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
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22
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Perioperative Management in Shoulder Arthroplasty: A Review of Current Practice. Orthop Clin North Am 2022; 53:483-490. [PMID: 36208890 DOI: 10.1016/j.ocl.2022.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Perioperative management for patients undergoing shoulder arthroplasty has evolved significantly over the years to reduce overt complications and improve patient outcomes. The groundwork for perioperative care encompasses initial patient selection and education strategies for achieving successful outcome. Multimodal pain management strategies have advanced patient care with the increased use of new regional/local anesthetics. In addition, complications resulting from blood loss and transfusions have been curtailed with the use of synthetic antifibrinolytic agents. It remains critical for shoulder arthroplasty surgeons to optimize patients during the perioperative period through various modalities to maximize functional progression, outcomes, and patient's satisfaction following shoulder arthroplasty.
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Johnson AH, York J, Lashgari CJ, Petre BM, Turcotte JJ, Redziniak DE. Effects of Preexisting Depression and Anxiety on Postoperative Outcomes following Arthroscopic Rotator Cuff Repair. JSES Int 2022; 6:984-988. [PMID: 36353422 PMCID: PMC9637647 DOI: 10.1016/j.jseint.2022.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Rotator cuff repairs (RCRs) are one of the most commonly performed shoulder surgeries in the United States. Psychological health has been shown to influence postoperative outcomes in orthopedic procedures. The purpose of this study is to evaluate the relationship between depression and anxiety (DA) and psychotropic medication and postoperative outcomes following RCR. Methods A single institution retrospective observational cohort study of 816 patients undergoing arthroscopic RCR from January 2014 to October 2020 was conducted. Univariate statistics were used to assess differences in demographics, operative characteristics, and postoperative outcomes; multivariate analysis was used to evaluate risk factors for postoperative complications. Results Patients with DA were more likely to have a higher first (3.60 vs. 3.00, P = .004) and last (1.23 vs. 0.96, P = .042) postoperative pain scores, lower first (18.67 vs. 21.85, P = .008) and last (61.87 vs. 64.71, P = .014) Upper Extremity Functional Score (UEFS), more likely to experience an emergency department visit postoperatively (9.1 vs. 5.0%, P = .028), have a symptomatic recurrent tear (8.2 vs. 3.3%, P = .003), and persistent pain (4.3 vs. 1.2%, P = .011). After controlling for age, sex, body mass index, American Society of Anesthesiologists score, diabetes, smoking, coronary artery disease, asthma, hypertension, psychotropic medication and DA, having DA at the time of surgery was independently predictive of any complication (odds ratio, 2.033; P = .028) and persistent pain (odds ratio, 8.232; P ≤ .001). Patients with and without DA showed significant improvement in postoperative pain and UEFS from the first to the last measurement (P < .001). Conclusion DA is not a deterrent for RCR but targeted interventions may be needed to decrease the occurrence of complications.
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24
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Brock L, Hightower B, Moore T, Nees D, Heigle B, Shepard S, Kee M, Ottwell R, Hartwell M, Vassar M. Reporting of Patient-Reported Outcome Measures in Randomized Controlled Trials on Shoulder Rotator Cuff Injuries Is Suboptimal and Requires Standardization. Arthrosc Sports Med Rehabil 2022; 4:e1429-e1436. [PMID: 36033194 PMCID: PMC9402470 DOI: 10.1016/j.asmr.2022.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/25/2022] [Indexed: 11/29/2022] Open
Abstract
Purpose Methods Results Conclusions Clinical Relevance
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Affiliation(s)
- Lydia Brock
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Address correspondence to Lydia Brock, Oklahoma State University Center for Health Sciences, 1111 W 17th St., Tulsa, OK 74107.
| | - Brooke Hightower
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Ty Moore
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Danya Nees
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Benjamin Heigle
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Samuel Shepard
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Micah Kee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Ryan Ottwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Department of Internal Medicine, University of Oklahoma, School of Community Medicine Tulsa, Oklahoma, U.S.A
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
- Department of Psychiatry and Behavioral Sciences, Oklahoma State University Center for Health Sciences Tulsa, Oklahoma, U.S.A
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25
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Massey PA, Sampognaro G, Fincher P, Vance S, Mody M, Barton RS. Earlier Return to Light Duty Is Associated With Successful Return to Full Duty of Workers’ Compensation Patients Treated With Shoulder Arthroscopic Surgery. Arthrosc Sports Med Rehabil 2022; 4:e927-e933. [PMID: 35747650 PMCID: PMC9210363 DOI: 10.1016/j.asmr.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/11/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate Workers’ Compensation (WC) patients who underwent arthroscopic shoulder surgery for workplace shoulder injuries and to determine whether there was an association between earlier return to light duty and earlier return to full duty. Methods After receiving institutional review board approval, we performed a retrospective chart review of all WC patients treated with shoulder arthroscopic surgery by 2 senior authors between 2011 and 2018. The patients were divided into 2 groups: Group 1 went back to light-duty work within the first 100 days after surgery, whereas group 2 performed light-duty work after 100 days or performed no light-duty work. The primary outcomes included the length of time from surgery to light-duty work and the length of time from surgery to return to the full-duty work level. Results A total of 59 patients met the inclusion criteria. There was a moderate correlation between the number of days at which the patients were released to light duty and the days they were able to be released to full duty (r = 0.35). In group 1 (light duty ≤ 100 days), 18 patients (75%) went back to full duty, whereas only 16 patients (46%) in group 2 were able to return to full-duty work (P = .025). Conclusions Earlier return to light duty is associated with earlier return to full duty after shoulder arthroscopic surgery in patients with a Workers’ Compensation claim. Additionally, WC patients who returned to early light duty in the first 100 days postoperatively had a higher rate of return to full duty than did patients who did not return to early light duty. Level of Evidence Level III, case-control study.
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Affiliation(s)
- Patrick A. Massey
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, Louisiana, U.S.A
- Address correspondence to Patrick A. Massey, M.D., Department of Orthopaedic Surgery, Louisiana State University, 1501 Kings Hwy, Shreveport, LA 71103, U.S.A.
| | - Gabriel Sampognaro
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, Louisiana, U.S.A
| | - Phillip Fincher
- School of Medicine, Louisiana State University, Shreveport, Louisiana, U.S.A
| | - Samantha Vance
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, Louisiana, U.S.A
| | - Milan Mody
- Willis-Knighton Health System, Shreveport, Louisiana, U.S.A
| | - R. Shane Barton
- Department of Orthopaedic Surgery, Louisiana State University, Shreveport, Louisiana, U.S.A
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Brindisino F, Silvestri E, Gallo C, Venturin D, Di Giacomo G, Peebles AM, Provencher MT, Innocenti T. Depression and Anxiety Are Associated With Worse Subjective and Functional Baseline Scores in Patients With Frozen Shoulder Contracture Syndrome: A Systematic Review. Arthrosc Sports Med Rehabil 2022; 4:e1219-e1234. [PMID: 35747628 PMCID: PMC9210488 DOI: 10.1016/j.asmr.2022.04.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/26/2022] [Accepted: 04/01/2022] [Indexed: 01/07/2023] Open
Abstract
Purpose To investigate whether psychological factors, such as avoidance behavior, fear, pain catastrophization, kinesiophobia, anxiety, depression, optimism, and expectation are associated with different subjective and functional baseline scores in patients with frozen shoulder contracture syndrome (FSCS). Methods Searches were conducted in MEDLINE, Cochrane Library (CENTRAL Database), PEDro, Pubpsych, and PsychNET.APA without restrictions applied to language, date, or status of publication. Two authors reviewed study titles, abstract, and full text based on the following inclusion criteria: adult population (≥ 30 < 70 years old) with FSCS. Results Seven hundred and seventy-six records were included by the search strategies. After title final screening, 6 studies were included for the qualitative synthesis. Psychological features investigated were anxiety, depression, pain-related fear, pain catastrophizing, and pain self-efficacy; reported outcomes included pain, function, disability, quality of life, and range of motion. Data suggest that anxiety and depression impact self-assessed function, pain, and quality of life. There is no consensus on the correlation between psychological variables and range of motion. Associations were suggested between pain-related fear, pain-related beliefs, and pain-related behavior and perceived arm function; pain-related conditions showed no significant correlation with range of motion and with perceived stiffness at baseline. Conclusion Scores traditionally thought to assess physical dimensions like shoulder pain, disability, and function seem to be influenced by psychological variables. In FSCS patients, depression and anxiety were associated with increased pain perception and decreased function and quality of life at baseline. Moreover, pain-related fear and catastrophizing seem to be associated with perceived arm function.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | | | | | - Giovanni Di Giacomo
- Department of Orthopaedic and Trauma Surgery, Concordia Hospital for Special Surgery, Rome, Italy
| | | | - Matthew T Provencher
- Steadman Clinic and Steadman Philippon Research Institute, Vail, Colorado, U.S.A
| | - Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, The Netherlands.,GIMBE Foundation, Bologna, Italy
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Mengi A, Akif Guler M. Nocturnal pain in patients with rotator cuff related shoulder pain: A prospective study. Musculoskelet Sci Pract 2022; 59:102536. [PMID: 35220021 DOI: 10.1016/j.msksp.2022.102536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 02/13/2022] [Accepted: 02/19/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Nocturnal pain is a common complaint in rotator cuff related shoulder pain (RCRSP), and there is no study in literature that has evaluated the relationship between nocturnal pain severity and other evaluation parameters in RCRSP. The objective of the study was to investigate the relationship between the severity of nighttime pain and demographic and clinical data including physical examination findings, magnetic resonance imaging (MRI) findings, disability, kinesiophobia, and quality of life scores in patients diagnosed with RCRSP. MATERIALS AND METHODS We assessed 61 patients (52.4% female) using the Visual Analog Scale (VAS) for nighttime and daytime, Shoulder Pain and Disability Questionnaire (SPADI), Tampa Scale of Kinesiophobia (TSK), and Short Form-36 (SF-36). Demographic and clinical data were recorded and rotator cuff specific examinations were performed and documented. RCRSP lesions were evaluated in terms of tendonitis and rupture by MRI. RESULTS The nighttime VAS score was positively correlated with SPADI disability and total scores, and daytime VAS score, and negatively correlated with SF-36 physical function subscale. The nighttime VAS score was associated with presence of calcific tendonitis in supraspinatus, infraspinatus tendinosis, and subscapularis tendinosis. On multivariate analysis with a linear regression model, presence of subscapularis tendinosis was an independent predictor of nighttime VAS score. In shoulder clinical tests, the nighttime VAS score correlated with only Neer test positivity. CONCLUSIONS Our results suggest that there is a relationship between nocturnal pain severity and disability. Presence of subscapularis tendinosis appears to be a predictor of nocturnal pain severity. Additionally, patients with positive Neer test may experience more nocturnal pain.
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Affiliation(s)
- Alper Mengi
- Istanbul University Cerrahpasa, Cerrahpasa Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Cerrahpasa, Istanbul, Turkey.
| | - Mehmet Akif Guler
- Gaziosmanpasa Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Gaziosmanpasa, Istanbul, Turkey.
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Dalton JF, Furdock R, Cluts L, Jilakara B, Mcdonald D, Calfee R, Cipriano C. Pre- and Post-Operative Patient-Reported Outcome Measurement Information System Scores in Patients Treated for Benign Versus Malignant Soft Tissue Tumors. Cureus 2022; 14:e25534. [PMID: 35800809 PMCID: PMC9246055 DOI: 10.7759/cureus.25534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
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Levin JM, Baker R, Goltz DE, Wickman J, Lentz TA, Cook C, George SZ, Klifto CS, Anakwenze OA. Heterogeneity of pain-related psychological distress in patients seeking care for shoulder pathology. J Shoulder Elbow Surg 2022; 31:681-687. [PMID: 34656777 DOI: 10.1016/j.jse.2021.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Psychological distress is associated with disability and quality of life for patients with shoulder pain. However, uncertainty around heterogeneity of psychological distress has limited the adoption of shoulder care models that address psychological characteristics. In a cohort of patients with shoulder pain, our study sought to (1) describe the prevalence of various subtypes of psychological distress; (2) evaluate associations between psychological distress and self-reported shoulder pain, disability, and function; and (3) determine differences in psychological distress profiles between patients receiving nonoperative vs. operative treatment. METHODS The sample included 277 patients who were evaluated in clinic by a shoulder surgeon and completed the Optimal Screening for Prediction of Referral and Outcome Yellow Flag Assessment Tool (OSPRO-YF) from 2019 to 2021. This tool categorizes maladaptive and adaptive psychological traits, and the number of yellow flags (YFs) ranges from 0 to 11, with higher YF counts indicating higher pain-related psychological distress. Operative and nonoperative cohorts were compared using χ2 test and Student t test. Linear regression was used to evaluate the association between pain, disability, and YFs, whereas Poisson regression evaluated the association between operative treatment and psychological distress. K-means cluster analysis was performed to propose potential psychological distress phenotypes. RESULTS Two hundred fifty-one patients (91%) had at least 1 YF on the OSPRO-YF tool, with a mean number of 6 ± 3.5 YFs. YFs in unhelpful coping (85%) and helpful coping domains (78%) were most prevalent. The number of YFs was significantly associated with baseline shoulder pain (P < .001), Single Assessment Numeric Evaluation (P < .001), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (P < .001) scores. Comparing operative and nonoperative cohorts, the operative cohort had a significantly higher mean number of YFs (6.5 vs. 5.6, P = .035), presence of any YF (94.3% vs. 85.7%, P = .015), and presence of YFs within the unhelpful coping domain (91.8% vs. 75.6%, P < .001). Three phenotypes were described, corresponding to low, moderate, and severe psychological distress (P < .001), with females (P = .037) and smokers (P = .018) associated with higher psychological distress phenotypes. CONCLUSIONS YFs, particularly within the unhelpful coping and helpful coping domains, were highly prevalent in a cohort of patients presenting to a shoulder surgeon's clinic. Additionally, operative patients were found to have a significantly higher rate of YFs across multiple dimensions of psychological distress. These findings stress the importance of routine attentiveness to multiple dimensions of pain-related psychological distress in shoulder populations, which can provide an opportunity to reinforce healthy interpretation of pain while minimizing distress in appropriately identified patients.
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Affiliation(s)
- Jay M Levin
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA.
| | - Rafeal Baker
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Daniel E Goltz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - John Wickman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Trevor A Lentz
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Chad Cook
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Steven Z George
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Christopher S Klifto
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | - Oke A Anakwenze
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Hoch C, Pire J, Scott DJ, Gross CE. The Influence of Pain and Resiliency on Foot and Ankle Surgery Outcomes. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221108137. [PMID: 35770145 PMCID: PMC9234850 DOI: 10.1177/24730114221108137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Resilience is the ability to recover after stressful events and has been shown to correlate with surgical outcomes. However, there has been minimal research on the impact of patient resiliency on foot and ankle surgical outcomes. This study aims to determine the predictive value of preoperative resiliency scores on surgical outcomes and investigate how this compares with the predictive value of pain scores. Methods: We conducted a retrospective review of adult patients who completed a preoperative Brief Resilience Scale (BRS) and underwent surgery between November 2019 and November 2020 with a fellowship-trained foot and ankle surgeon (N=184). Data included demographics, comorbidities, surgical details, complication and reoperation rates, pre- and postoperative opioid and benzodiazepine use, and additional patient-reported outcome measures (ie, visual analog scale [VAS], Pain Catastrophizing Scale [PCS], Pain Disability Index [PDI], Foot and Ankle Outcome Score [FAOS] pain subscale). Mean follow-up duration was 4.49 (range, 1.10-14.17) months. Results: BRS weakly correlated with decreased postoperative benzodiazepine use ( P=.007). PCS magnification ( P=.050) and helplessness ( P=.047) subscales weakly correlated with increased follow-up duration. PDI total score and most subscores significantly correlated with an increase in at least 1 of the following: follow-up duration, or postoperative opioid or benzodiazepine use. Neither the VAS nor FAOS pain subscore correlated with any outcome. PDI total score was the strongest predictor of postoperative opioid (β=0.334) and benzodiazepine (β=0.315) use. Preoperative opioid users had significantly higher PDI total score (user=39.3, nonuser=24.9; P=.012) and subscores (ie, social activity, sexual behavior, self-care, life-support activities). Conclusion: BRS is an unreliable tool for predicting outcomes in foot and ankle surgery, as it only weakly correlated with decreased benzodiazepine use. Rather, given the PDI’s strong associations with postoperative measures in this study, physicians should consider the value of preoperative PDI completion when predicting how foot and ankle surgery recipients will fare postoperatively. Level of Evidence: Level III, retrospective cohort study.
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Affiliation(s)
- Caroline Hoch
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jonathan Pire
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel J. Scott
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher E. Gross
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
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Aïm F, Chevallier R, Marion B, Klouche S, Bastard C, Bauer T. Psychological risk factors for the occurrence of frozen shoulder after rotator cuff repair. Orthop Traumatol Surg Res 2022; 108:103212. [PMID: 35077897 DOI: 10.1016/j.otsr.2022.103212] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/24/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Frozen shoulder is a dreaded complication after rotator cuff repair. HYPOTHESIS There are psychological determinants for this complication. MATERIALS AND METHODS We prospectively included 77 consecutive patients who underwent arthroscopic rotator cuff repair between May 2018 and April 2019. Along with a functional evaluation, we determined the Constant score, anxiety and depression levels based on the HADS, and kinesiophobia based on the Tampa Scale preoperatively and 6months after the surgery. RESULTS At the 6-month follow-up, 8 patients had been diagnosed with frozen shoulder (group A), 65 patients had satisfactory joint range of motion (group B) and 4 were lost to follow-up. In the frozen shoulder group, the preoperative anxiety rate was significantly higher than in group B (50% versus 17%, p=0.04). Furthermore, there were significantly more women (p=0.028) and more patients with an occupational disease in group A (75% versus 18%, p=0.027). At 6months postoperative, the Constant score was 55 in the group with a frozen shoulder versus 72 in group B (p=0.004). Neither depression nor kinesiophobia were risk factors for the development of frozen shoulder after rotator cuff repair. CONCLUSION Preoperative anxiety, the female sex and occupational disease are all risk factors for the occurrence of frozen shoulder after rotator cuff repair. Knowing these predisposing factors will help us better manage at-risk patients. LEVEL OF EVIDENCE III, prospective study.
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Affiliation(s)
- Florence Aïm
- Service de chirurgie orthopédique, centre de référence des infections ostéoarticulaires, groupe hospitalier Diaconnesses Croix Saint-Simon, Paris, France.
| | - Romain Chevallier
- Service de chirurgie orthopédique, hôpital Henri-Mondor, Créteil, France
| | - Blandine Marion
- Service de chirurgie orthopédique, centre de référence des infections ostéoarticulaires, groupe hospitalier Diaconnesses Croix Saint-Simon, Paris, France
| | | | - Claire Bastard
- Service de chirurgie orthopédique, hôpital Henri-Mondor, Créteil, France
| | - Thomas Bauer
- Service de chirurgie orthopédique, AP-HP, hôpital Ambroise-Paré, Boulogne-Billancourt, France
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Ihsan Kilic A, Hapa O, Ozmanevra R, Demirhan Demirkiran N, Gursan O. Biceps tenodesis combined with rotator cuff repair increases functional status and elbow strength. J Orthop Surg (Hong Kong) 2022; 29:23094990211056978. [PMID: 34898325 DOI: 10.1177/23094990211056978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The aim of the present study was to prospectively evaluate the elbow flexion and supination strengths and the functional outcomes of patients following arthroscopic rotator cuff repair combined with simultaneous biceps tenodesis. METHODS 19 patients who underwent arthroscopic rotator cuff repair and biceps tenodesis with at least 24 months of follow-up were included. Patients were evaluated using a visual analog scale (VAS) for bicipital groove pain, American Shoulder and Elbow Surgeons (ASES), and constant scores (CS), biceps apex distance (BAD), elbow flexion, and supination strengths. RESULTS The VAS for biceps groove measurement averages in the postoperative 6th, 12th, and 24th months was lower in comparison to preoperative data and was considered to be statistically significant (p < .05). The constant score, an average of all postoperative measurements and scores, was found to be higher than preoperative values and was considered to be statistically significant (p < .01). There was a significant difference in the operated and non-operated forearm supination and elbow flexion muscle strength measurements at the postoperative 3- and 6-month follow-ups (p < .01). CONCLUSION Arthroscopic biceps tenodesis into the anchors of the lateral row in combination with rotator cuff repair provides an increase in the strength of elbow flexion and forearm supination, while decreasing pain. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Ali Ihsan Kilic
- Department of Orthopaedics and Traumatology, Siirt State Hospital, Siirt, Turkey
| | - Onur Hapa
- Department of Orthopaedics and Traumatology, 064073University of Dokuz Eylül, Izmir, Turkey
| | - Ramadan Ozmanevra
- Department of Orthopaedics and Traumatology, 530180University of Kyrenia, Kyrenia, Turkish Republic of Northern Cyprus
| | - Nihat Demirhan Demirkiran
- Department of Orthopaedics and Traumatology, 552615Kütahya Health Sciences University School of Medicine, Kütahya, Turkey
| | - Onur Gursan
- Department of Orthopaedics and Traumatology, 064073University of Dokuz Eylül, Izmir, Turkey
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Şahinoğlu E, Ünver B, Yamak K. The associations of emotional health with pain, disability, and health-related quality of life in patients with rotator cuff disease. Musculoskeletal Care 2022; 20:121-127. [PMID: 33934491 DOI: 10.1002/msc.1560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Psychosocial factors have been associated with poor outcomes in patients with rotator cuff disease. Emotional health is one of these factors, and relationships between emotional health and outcome measures evaluated before and after physical therapy have not been reported. AIM To investigate the associations of baseline emotional health status with pre-treatment, post-treatment, and pre-to-post changes in pain, disability and health-related quality of life in patients with rotator cuff disease. METHODS Forty-one patients with rotator cuff disease were included. Emotional health was measured with the emotions domain of the Western Ontario Rotator Cuff Index (WORC). The outcomes were the WORC-total, the Shoulder Pain and Disability Index, and the numeric pain rating scale. All outcomes were measured at baseline and 6-week follow-up. RESULTS The baseline emotional health score and the outcomes scores were moderate to strong, and weak to moderate correlated at baseline and at follow-up, respectively. There was no correlation between the baseline emotional health score and the changes in the outcome measures from baseline to follow-up. CONCLUSIONS Lower baseline emotional health status was associated with worse outcomes in pain, disability and health-related quality of life at baseline and follow-up in patients with rotator cuff disease. However, the changes in these outcome measures from baseline to follow-up were not correlated with the baseline emotional health status. In clinical practice, an assessment of patients' emotional health status using standardised measures may help to predict post-treatment outcomes, and a multidisciplinary cooperation (e.g., among physical therapists and psychologists) may enhance outcomes.
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Affiliation(s)
- Ertan Şahinoğlu
- Graduate School of Health Sciences, Dokuz Eylül University, İzmir, Turkey
| | - Bayram Ünver
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Kamil Yamak
- University of Health Sciences, İzmir Bozyaka Education and Research Hospital, İzmir, Turkey
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Efficacy of automated electronic medical records (EMR) notification to promote provider intervention for severe depression. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hirschmann J, Kozato A, Sharma V, Villagra C, Wetmore J, Jandorf L, Pang JH, Reynolds M, Dodge L, Mejía S, Safer JD. An Analysis of Chaplains' Narrative Chart Notes Describing Spiritual Care Visits with Gender Affirmation Surgical Patients. Transgend Health 2022; 7:92-100. [PMID: 36644021 PMCID: PMC9829152 DOI: 10.1089/trgh.2020.0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose The benefit of spiritual care for patients is well described, but little is known about the role of spiritual care in transgender and nonbinary patients recovering from gender affirming surgeries (GASs). Methods A single-center retrospective chart review was performed on patients who underwent GAS in 2017. Demographic information, surgery type, and chaplains' narrative notes were examined. Results A total of 145 chaplain visits were identified in 103 inpatient stays among 98 patients at the Mount Sinai Center for Transgender Medicine and Surgery in New York. Analysis was performed on narrative notes authored by a single chaplain, which included 132 visits among 78 transfeminine and 11 transmasculine patients. Fifty-four patients (61%) expressed gratitude for the chaplain visit and/or hospital experience overall. Seven patients (8%) described movement between religious denominations over the course of their lives, and 7 (8%) described supportive belief systems. Fifty-seven patients (64%) had a family member or friend present during the perioperative process, 13 (15%) described support systems, and 9 (10%) described supportive practices, activities, and/or coping methods. Twenty-one patients (24%) expressed concerns about current symptoms or the recovery process, and 32 (36%) received a prayer or blessing from the chaplain. Fifty-two patients (58%) consented to a follow-up call. Conclusion Almost 50% of patients expressed gratitude for the chaplain's visit and more than half consented to a follow-up call from the chaplain, suggesting a chaplain can provide a welcome layer of support to postoperative GAS patients. The authors recommend integrating spiritual care into perioperative care.
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Affiliation(s)
- Jo Hirschmann
- Mount Sinai Center for Transgender Medicine and Surgery, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Address correspondence to: Jo Hirschmann, MAHL, Mount Sinai Center for Transgender Medicine and Surgery, Center for Spirituality and Health, Icahn School of Medicine at Mount Sinai, 10 Nathan D. Perlman Place, New York, NY 10003, USA,
| | - Aki Kozato
- Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Vansh Sharma
- Department of Psychiatry, Center for Spirituality and Health, Center for Stress, Resilience and Personal Growth, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Cristina Villagra
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Wetmore
- Mount Sinai Health System, New York, New York, USA
| | - Lina Jandorf
- Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - John Henry Pang
- Mount Sinai Center for Transgender Medicine and Surgery, Department of Surgery, Division of Plastic Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Leanne Dodge
- Department of Spiritual Care and Education, Mount Sinai Beth Israel, New York, New York, USA
| | - Silvia Mejía
- Department of Spiritual Care and Education, Mount Sinai Beth Israel, New York, New York, USA
| | - Joshua D. Safer
- Mount Sinai Center for Transgender Medicine and Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Treatment of partial rotator cuff lesions is associated with a higher frequency of post-operative shoulder stiffness. A prospective investigation on the role of surgery-related risk factors for this complication. Arch Orthop Trauma Surg 2022; 142:3379-3387. [PMID: 34905067 PMCID: PMC9522663 DOI: 10.1007/s00402-021-04285-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 11/27/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE Post-operative shoulder stiffness (SS) is a common complication after arthroscopic rotator cuff (RC) repair. The aim of this prospective study is to evaluate the role of surgical risk factors in the development of this complication, with special focus on the characteristics of the RC tears. METHODS Two-hundred and twenty patients who underwent arthroscopic RC repair for degenerative posterosuperior RC tears were included. Surgery-related risk factors for development of post-operative SS belonging to the following five categories were documented and analyzed: previous surgery, RC tear characteristics, hardware and repair type, concomitant procedures, time and duration of surgery. The incidence of post-operative SS was evaluated according to the criteria described by Brislin and colleagues. RESULTS The incidence of post-operative SS was 8.64%. The treatment of partial lesions by tear completion and repair technique was significantly associated with development of post-operative SS (p = 0.0083, pc = 0.04). A multivariate analysis revealed that treatment of partial lesions in patients younger than 60 years was associated to a higher risk of developing post-operative SS (p = 0.007). Previously known pre-operative risk factors such as female sex and younger age were confirmed. No other significant associations were documented. CONCLUSION The treatment of partial lesions of the RC may lead to a higher risk of post-operative SS than the treatment of complete lesions, in particular in patients younger than 60 years. Possible explanations of this finding are the increased release of pro-inflammatory cytokines caused by the additional surgical trauma needed to complete the lesion and the different pain perception of the subgroup of patients who require surgical treatment already for partial tears. EVIDENCE A higher risk of post-operative SS should be expected after tear completion and repair of partial lesions, especially in young patients. Appropriate pre-operative counseling and post-operative rehabilitation should be considered when approaching this subgroup of RC tears. LEVEL OF EVIDENCE Prognostic study, level II.
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Gulcu A. The effect of arthroscopic rotator cuff repair on sleep in degenerative full-thickness tears. Niger J Clin Pract 2022; 25:1344-1347. [DOI: 10.4103/njcp.njcp_219_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lakshminarasimhan A, Suresh Y. Effect of preoperative anxiety on postoperative pain in patients undergoing elective lower-segment cesarean section under spinal anesthesia: A cross-sectional study in South India. JOURNAL OF CURRENT RESEARCH IN SCIENTIFIC MEDICINE 2022. [DOI: 10.4103/jcrsm.jcrsm_39_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hessburg LT, Ziedas AC, Cross AG, Elhage K, Guo EW, Yedulla N, Koolmees D, Muh SJ, Moutzouros V, Makhni EC. Patients With Preoperative Clinical Depression Symptomology Experience Significant Improvements in Postoperative Pain, Function, and Depressive Symptoms Following Rotator Cuff Repair. Arthroscopy 2021; 37:3408-3413. [PMID: 34052382 DOI: 10.1016/j.arthro.2021.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 05/06/2021] [Accepted: 05/13/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the impact of clinical depression on outcomes after rotator cuff repair (RCR), as measured by Patient-Reported Outcomes Measurement Information System (PROMIS) Computer Adaptive Test (CAT) health domains. METHODS RCR patients were given PROMIS CAT assessments for physical function (PROMIS UE), pain interference (PROMIS PI), and depression (PROMIS D) during preoperative and postoperative clinic visits. PROMIS D scores ≥55 correlate with mild clinical depression; thus patients with PROMIS D scores ≥ 55 were placed in the clinical depression (CD) group, whereas patients with scores <55 were placed in the "no clinical depression" (NCD) group. Categorical variables were compared at preoperative and postoperative (6 months and ≥1 year) timepoints using χ2 tests. Continuous variables were compared using Student's t-tests. RESULTS Of the 340 RCR patients included in this study, 65 (19.1%) were found to have mild clinical depression preoperatively, with that number being reduced to 23 (6.8%) at 6 months and 19 (5.6%) at ≥1 year after surgery. Compared with preoperative PROMIS scores, CD patients had significant postoperative improvements at 6 months and ≥1 year in mean PROMIS UE (26.7 vs 35.5 vs 38.9; P < .001) and PROMIS PI (67.6 vs 56.7 vs 56.4; P < .001). NCD patients had similar postoperative improvements at 6 months and ≥1 year in mean PROMIS UE (30.8 vs 38.6 vs 46.9; P < .001) and PROMIS PI (61.7 vs 53.0 vs 47.6; P < .001). The improvement in PROMIS scores was similar for the CD and NCD groups in both PROMIS UE (12.2 vs 16.1, respectively) and PROMIS PI (-11.2 vs -14.1, respectively). CONCLUSION Despite starting with worse PROMIS UE and PROMIS PI scores, patients undergoing RCR with symptoms of CD experienced significant improvement in function, pain, and depressive symptoms. Preoperative depression should not be a contraindication to arthroscopic RCR in patients who are otherwise appropriate operative candidates. LEVEL OF EVIDENCE Level III, retrospective comparative trial.
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Affiliation(s)
- Luke T Hessburg
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Alexander C Ziedas
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Austin G Cross
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Kareem Elhage
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Eric W Guo
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Nikhil Yedulla
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Dylan Koolmees
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Stephanie J Muh
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A
| | - Eric C Makhni
- Department of Orthopaedic Surgery, Henry Ford Hospital, Detroit, Michigan, U.S.A..
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Lebe M, Burns SA, Falworth M, Higgs DS, Rudge WB, Majed A. Atraumatic shoulder instability: patient characteristics, comorbidities, and disability. JSES Int 2021; 5:955-959. [PMID: 34766069 PMCID: PMC8570950 DOI: 10.1016/j.jseint.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Atraumatic shoulder instability of the shoulder is well described, and numerous extrinsic factors have been identified as having a negative influence on long-term shoulder function, including age, sex, smoking, and workers' compensation status. Furthermore, physical factors such as acute or chronic pain, as well as psychological comorbidities such as depression and suicidal thoughts, are common in shoulder-related conditions. Methods Patients with atraumatic shoulder instability were recruited from a review of outpatient logbook and inpatient rehabilitation center admission records. Average and worst pain visual analogue scale rates were recorded for acute and chronic shoulder pain. Disability was measured using the “Disability of the Arm and Hand” score, as well as the Stanmore Percentage of Normal Shoulder Assessment (SPONSA). Depression was assessed using Becks Depression Inventory II, and further single psychological items were selected from other psychological assessment questionnaires. Results We included 64 patients, of which 51 (79.7%) were female. Mean visual analogue scale pain scores were in average 5.11 (standard deviation 2.24) and 5.58 (standard deviation 2.34) for acute and chronic shoulder pain, respectively. A stepwise, multiple linear regression revealed that only chronic shoulder pain remained significantly related to disability (F(1,61) = 46.13, P < .001). A second linear regression analysis was performed and showed a significant association between the overall Disability of the Arm, Shoulder and Hand score and overall Becks Depression Inventory score (F(1,62) = 12.78, P < .001). A further stepwise, multiple linear regression analysis indicated that chronic pain and depression remain independent variables in the prediction of disability. Conclusion In addition to sociodemographic factors, pain and psychological comorbidities were found to have a negative impact on patient's functional outcome. This study further supports the need for an multidisciplinary team, holistic approach in the management of atraumatic shoulder instability patients with particular emphasis on chronic pain management and psychological support.
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Affiliation(s)
- Moritz Lebe
- Royal London Hospital Rotation, London, England, UK
| | | | - Mark Falworth
- Shoulder and Elbow Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Deborah S Higgs
- Shoulder and Elbow Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Will Bj Rudge
- Shoulder and Elbow Unit, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Addie Majed
- Shoulder and Elbow Unit, Royal National Orthopaedic Hospital, Stanmore, UK
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Brindisino F, Salomon M, Giagio S, Pastore C, Innocenti T. Rotator cuff repair vs. nonoperative treatment: a systematic review with meta-analysis. J Shoulder Elbow Surg 2021; 30:2648-2659. [PMID: 34020002 DOI: 10.1016/j.jse.2021.04.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/21/2021] [Accepted: 04/25/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rotator cuff (RC) tears have been widely studied as many treatment strategies have been recommended. However, optimal management for patients with RC tears is still unclear. PURPOSE The main aim of this systematic review was to analyze randomized controlled trials using meta-analysis to compare repair to conservative treatments for patients with any type of RC tear. METHODS MEDLINE, Cochrane Library (CENTRAL database), PEDro, and Scopus databases were used. Two independent reviewers selected randomized controlled trials that compared surgical to conservative treatments for RC tear patients. The studies included were assessed using Cochrane Risk of Bias 2 tools, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was used to evaluate the certainty of evidence and to summarize the study conclusions. RESULTS Six trials were included. Pooled results showed improvement in function and pain perception in favor of the repair group at 6 months (mean difference 1.26, 95% CI -2.34, 4.85, P = .49; and -0.59, 95% CI -0.84, -0.33, P < .001, respectively), at 12 months (mean difference 5.25, 95% CI 1.55, 8.95, P = .005, for function; and -0.41, 95% CI -0.70, -0.12, P = .006, for pain) and at 24 months (mean difference 5.57, 95% CI 1.86, 9.29, P = .003, for function; and -0.92, 95% CI -1.31, -0.52, P < .001, for pain) in RC tear patients. However, these differences did not reach the minimum clinically important difference. The certainty of evidence ranged from low to moderate because of imprecision in the studies included. CONCLUSIONS Overall analysis showed that in patients with RC tear, repair compared with conservative treatment could result in increased pain reduction and functional improvement at 6, 12, and 24 months. Even if these effects were often statistically significant, their clinical relevance was limited. Moreover, the certainty of body of evidence ranged from low to moderate.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio," University of Molise, Campobasso, Italy; Faculty of Medicine, University "Tor Vergata", Rome, Italy.
| | - Mattia Salomon
- Faculty of Medicine, University "Tor Vergata", Rome, Italy
| | - Silvia Giagio
- Department of Biomedical and Neuromotor Science (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Chiara Pastore
- Centro Sanitario Riabilitativo FisicaMente, Predazzo, Trentino, Italy
| | - Tiziano Innocenti
- Department of Health Sciences, Faculty of Science, VU University, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Gibson E, LeBlanc J, Sabo MT. Prior mood disorder diagnoses do not relate to current mood disorder symptoms or patient-reported disease severity in rotator cuff patients. Shoulder Elbow 2021; 13:683-690. [PMID: 34804218 PMCID: PMC8600670 DOI: 10.1177/1758573220947025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 07/13/2020] [Accepted: 07/13/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Surgery for rotator cuff syndrome does not always produce symptom improvement. Biological factors may explain some symptoms, but mood disorder symptoms may also contribute. The purpose of this study is to examine the interaction between disease severity, prevalence of mood disorder diagnoses, and current mood disorder symptoms in preoperative rotator cuff patients. METHODS A prospective cohort of patients aged 35-75 years with unilateral rotator cuff disease awaiting surgery participated. Demographics, psychiatric history, the Hospital Anxiety & Depression Scale, and the Western Ontario Rotator Cuff index were collected. Descriptive and univariate statistical testing was performed. RESULTS Of 140 participants (75M:65W) aged 55 ± 8 years, 34 reported a prior diagnosis of a mood disorder. There was a moderate positive relationship between disease severity and current depression and anxiety scores. Women were more likely to carry a diagnosis of a mood disorder, but there were no differences in current symptom levels between genders. No differences were found in patient-reported outcome measure scores between patients with and without a mood disorder diagnosis. DISCUSSION Current mood disorder symptoms were associated with greater disease severity, whereas the presence of a past mood disorder diagnosis was not. Awareness of this relationship may reduce bias about past mood disorder diagnoses during decision-making.
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Affiliation(s)
- Eric Gibson
- Sport Injury Prevention Research Centre,
University of Calgary, Calgary, Canada,South Campus Research Unit for Bone and
Soft Tissue, University of Calgary, Calgary, Canada,Eric Gibson, Sport Injury Prevention
Research Centre, 2500 University Drive NW, Calgary, Alberta, Canada T2N 1N4.
| | - Justin LeBlanc
- South Campus Research Unit for Bone and
Soft Tissue, University of Calgary, Calgary, Canada,Section of Orthopaedic Surgery, Cumming
School of Medicine, University of Calgary, Calgary, Canada
| | - Marlis T Sabo
- South Campus Research Unit for Bone and
Soft Tissue, University of Calgary, Calgary, Canada,Section of Orthopaedic Surgery, Cumming
School of Medicine, University of Calgary, Calgary, Canada
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Debeer P, Commeyne O, De Cupere I, Tijskens D, Verhaegen F, Dankaerts W, Claes L, Kiekens G. The outcome of hydrodilation in frozen shoulder patients and the relationship with kinesiophobia, depression, and anxiety. J Exp Orthop 2021; 8:85. [PMID: 34591188 PMCID: PMC8484410 DOI: 10.1186/s40634-021-00394-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 08/19/2021] [Indexed: 02/08/2023] Open
Abstract
Purpose The aims of this study were to (1) investigate the effect of hydrodilatation in frozen shoulder patients on objective indices of shoulder functionality and subjective outcomes of pain, mobility, kinesiophobia, depression, and anxiety, and (2) progress knowledge about the reciprocal temporal relationship between psychological parameters at baseline and objective and subjective outcomes at 3-month follow-up. Methods We evaluated the clinical and psychological status of 72 patients with a frozen shoulder before and after hydrodilatation, using the Constant Murley score, the Visual Analogue score, the Tampa Scale for Kinesiophobia, the Hospital Anxiety and Depression Scale, and the Shoulder Pain And Disability Index. Results We noted a significant improvement in functionality, pain and disability (p < .001). Depression and anxiety improved significantly (p < .001) between baseline and 3-month follow-up. Prospective analyses demonstrated that psychological factors are more likely to predict outcomes of hydrodilatation than vice versa. Conclusion Hydrodilatation followed by physiotherapy is an excellent way to treat patients with recalcitrant frozen shoulder, resulting in a continuous improvement of ROM and pain. Physiotherapists and physicians should be aware that psychological factors might have an impact on the treatment outcome.
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Affiliation(s)
- Philippe Debeer
- Orthopedics, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium. .,Department of Development and Regeneration, KU Leuven, Leuven, Belgium. .,Institute for Orthopaedic Research and Training, Leuven, Belgium.
| | - Olivia Commeyne
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Ianthe De Cupere
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Dorien Tijskens
- Orthopedics, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Institute for Orthopaedic Research and Training, Leuven, Belgium
| | - Filip Verhaegen
- Orthopedics, University Hospitals Leuven, Herestraat 49, B-3000, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium.,Institute for Orthopaedic Research and Training, Leuven, Belgium
| | - Wim Dankaerts
- Musculoskeletal Research Unit, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Glenn Kiekens
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Department of Neurosciences, Center for Contextual Psychiatry, KU Leuven, Leuven, Belgium
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Lemaster NG, Hettrich CM, Jacobs CA, Heebner N, Westgate PM, Mair S, Montgomery JR, Uhl TL. Which Risk Factors Are Associated with Pain and Patient-reported Function in Patients with a Rotator Cuff Tear? Clin Orthop Relat Res 2021; 479:1982-1992. [PMID: 33835100 PMCID: PMC8373537 DOI: 10.1097/corr.0000000000001750] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 03/08/2021] [Indexed: 01/31/2023]
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.
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Affiliation(s)
- Nicole G. Lemaster
- Department of Rehabilitation Science, University of Kentucky, Lexington, KY, USA
| | | | - Cale A. Jacobs
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | - Nick Heebner
- Department of Rehabilitation Science, University of Kentucky, Lexington, KY, USA
| | | | - Scott Mair
- Department of Orthopedic Surgery and Sports Medicine, University of Kentucky, Lexington, KY, USA
| | | | - Tim L. Uhl
- Department of Physical Therapy, University of Kentucky, Lexington, KY, USA
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Panattoni N, Longo UG, De Salvatore S, Castaneda NSC, Risi Ambrogioni L, Piredda M, De Marinis MG, Denaro V. The influence of psychosocial factors on patient-reported outcome measures in rotator cuff tears pre- and post-surgery: a systematic review. Qual Life Res 2021; 31:91-116. [PMID: 34216351 DOI: 10.1007/s11136-021-02921-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2021] [Indexed: 01/21/2023]
Abstract
PURPOSE Recent research shows that major levels of psychological distress correlate with higher pain and reduced function in patients with shoulder and rotator cuff pathology. A systematic review updating a review published in 2016 was conducted to determine the degree of consistency and the strength of association between psychosocial factors and patient-reported outcomes (PROMs) in patients with rotator cuff repair (RCR) with new high-quality literature. METHODS The bibliographic searches were conducted from May to June 2020 within the following databases: MEDLINE/PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Web of Science. The articles included should discuss the association between psychosocial factors and outcomes in patients with documented or diagnosed rotator cuff tears through clinical and/or radiological examination. The Methodological Index for Non-Randomized Studies (MINORS) tool was used to assess the methodological quality. RESULTS Fifteen articles were included. Negative psychosocial factors were found consistently associated with worse function and disability in the pre- and post-operative period. In particular, psychosocial factors regarding emotional or mental health were associated with a weak to a substantial degree with preoperative and postoperative function/disability and pain intensity in patients undergoing RCR. CONCLUSION In patients undergoing repair of the rotator cuff tear, there was a correlation between poor psychological function before surgery and worsening post-surgical outcomes, such as persistence of postoperative pain intensity and worse levels of function/disability.
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Affiliation(s)
- Nicolò Panattoni
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133, Rome, Italy
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Zhu M, Chen JY, Yeo NEM, Koo K, Rikhraj IS. Health-related quality-of-life improvement after hallux valgus corrective surgery. Foot Ankle Surg 2021; 27:539-542. [PMID: 32694077 DOI: 10.1016/j.fas.2020.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/13/2020] [Accepted: 07/05/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Hallux valgus is a common forefoot deformity that affects function of foot and quality of life (QoL). This study aims to identify factors associated with clinically important improvements in QoL after hallux valgus corrective surgery. METHODS A retrospective analysis on 591 cases of hallux valgus corrective surgery performed between 2007 and 2013 was conducted. Patients' preoperative and 2-year postoperative Physical Component Score (PCS) and Mental Component Score (MCS) were compared to identify the presence of clinically significant improvements in patient-reported QoL. A multiple logistic regression model was developed through a stepwise variable-selection model building approach. Age, BMI, preoperative patient reported outcome score, PCS, MCS, pain score, gender, side of surgery, type of surgery, and presence of lesser toe deformities or metatarsalgia were considered. RESULTS Median PCS significantly improved from 49 to 53 (p < 0.001), and median MCS remained at 56 (p = 0.724). Age, preoperative MCS and PCS were independent predictors for significant improvements of PCS at 2-year postoperatively. CONCLUSION Three groups of patients were more likely to have significant QoL improvements after hallux valgus corrective surgery. These were the younger patients, those with better preoperative mental health or those with poorer preoperative physical health. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Meng Zhu
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | | | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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47
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Zhang C, Wu J, Li X, Wang Z, Lu WW, Wong TM. Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair. Front Bioeng Biotechnol 2021; 9:657584. [PMID: 34178957 PMCID: PMC8226184 DOI: 10.3389/fbioe.2021.657584] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Rotator cuff tear is one of the most common shoulder problems encountered by orthopedic surgeons. Due to the slow healing process and high retear rate, rotator cuff tear has distressed millions of people all around the world every year, especially for the elderly and active athletes. This disease significantly impairs patients' motor ability and reduces their quality of life. Besides conservative treatment, open and arthroscopic surgery contributes a lot to accelerate the healing process of rotator cuff tear. Currently, there are many emerging novel treatment methods to promote rotator cuff repair. A variety of biological stimulus has been utilized in clinical practice. Among them, platelet-rich plasma, growth factors, stem cells, and exosomes are the most popular biologics in laboratory research and clinical trials. This review will focus on the biologics of bioaugmentation methods for rotator cuff repair and tendon healing, including platelet-rich plasma, growth factors, exosomes and stem cells, etc. Relevant studies are summarized in this review and future research perspectives are introduced.
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Affiliation(s)
- Cheng Zhang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jun Wu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiang Li
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zejin Wang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Weijia William Lu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Center for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology (CAS), Shenzhen, China
| | - Tak-Man Wong
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Gunasingha RMKD, Niloy IL, Wetstein BB, Learn PA, Turza LC. Keeping tabs: Reducing postoperative opioid prescriptions for patients after breast surgical procedures. Surgery 2021; 169:1316-1322. [PMID: 33413919 DOI: 10.1016/j.surg.2020.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/11/2020] [Accepted: 11/19/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND As the opioid crisis continues, it is critical that health care providers ensure they are not overprescribing opioid medications. At our institution (Walter Reed National Military Medical Center, Bethesda, MD), postoperative patients after breast surgeries are discharged with variable amounts of opioid medications. However, many patients report minimal opioid use. The objectives of this study were to characterize postoperative opioid usage and prescribing practices for patients undergoing various breast surgeries and to recommend the number of opioid pills for discharge for each procedure. METHODS This was a prospective, single-institution study of all patients undergoing breast surgery from October 2018 to 2019. All patients were enrolled in our institution's enhanced recovery after surgery protocol. Patients were given questionnaires at their 2-week postoperative clinic appointment that evaluated perioperative pain and use of pain medications. The electronic medical record was reviewed to obtain additional information. Appropriate parametric and nonparametric tests were used for analysis. RESULTS A total of 190 breast surgery patients completed the survey. We observed no significant differences in pain scores except between re-excision and mastectomy. Of these patients, 99% were prescribed opioids; however, only 53% of patients used them. Of those patients who were prescribed opioids, on average, all were prescribed more pills than were used. CONCLUSION Our study demonstrates that it is possible to discharge all breast surgery patients with fewer than 10 opioid pills, except for special circumstances. This is the first study to provide a set of specific recommended discharge medications. Utilization of an enhanced recovery after surgery protocol with standardized discharge opioids can be used successfully to reduce the number of opioids prescribed to patients.
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Affiliation(s)
- Rathnayaka M K D Gunasingha
- Breast Care Center, Murtha Cancer Center, General Surgery, Walter Reed National Military Medical Center, Bethesda, MD.
| | - Injamamul L Niloy
- Department of Oral Maxillofacial Surgery, Walter Reed National Military Medical Center, Bethesda, MD
| | - Berish B Wetstein
- School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Peter A Learn
- Breast Care Center, Murtha Cancer Center, General Surgery, Walter Reed National Military Medical Center, Bethesda, MD; School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Lauren C Turza
- Breast Care Center, Murtha Cancer Center, General Surgery, Walter Reed National Military Medical Center, Bethesda, MD
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Zangrilli J, Szukics P, Austin L, Horneff JG. Perioperative Pain Management in Ambulatory and Inpatient Shoulder Surgery. JBJS Rev 2021; 9:e20.00191. [PMID: 33999881 DOI: 10.2106/jbjs.rvw.20.00191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
» Acetaminophen is an effective addition to a multimodal pain regimen; however, evidence to support intravenous versus oral administration requires further evaluation. » While nonsteroidal anti-inflammatory drugs are a valuable addition to a multimodal pain strategy, concerns regarding their effect on healing after certain procedures (i.e., rotator cuff repair) in select patients may preclude their use. » The use of perioperative gabapentinoids have varied results for pain control, and additional research is warranted to support their use after certain shoulder procedures. » Opioid-prescribing should be limited and reserved for severe postoperative pain. When prescribed, opioids should be taken at the lowest possible dose and for the shortest period. » Centrally acting analgesics such as tramadol have been shown to be as effective as opioids and have a lower risk of complications. » Nerve blocks are an excellent addition to multimodal pain management strategies. Longer-lasting formulations of perioperative single-shot injections and indwelling catheters may reduce rebound pain.
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Affiliation(s)
- Julian Zangrilli
- Department of Orthopaedic Surgery, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Patrick Szukics
- Department of Orthopaedic Surgery, Rowan School of Osteopathic Medicine, Stratford, New Jersey
| | - Luke Austin
- Rothman Institute of Orthopaedics at Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
| | - John G Horneff
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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Bingöl İ, Biçici V. How does rerupture affect sleep and quality of life in patients undergoing arthroscopic rotator cuff repair? Turk J Med Sci 2021; 51:181-187. [PMID: 33576587 PMCID: PMC7991867 DOI: 10.3906/sag-2012-169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/11/2021] [Indexed: 11/08/2022] Open
Abstract
Background/aim Sleep disturbance and related improvement in quality of life as a result of arthroscopic repair in rotator cuff tear (RCT) patients can be considered as an important parameter. The aim of our study is to evaluate the rotator cuff by ultrasonography (USG) in the first postoperative year and to examine whether there is a difference between sleep disturbance and quality of life between cases of rupture and healthy patients. In addition, we aim to compare the preoperative and at least the first postoperative year’s sleep disturbances and quality of life among patients who underwent arthroscopic RCT repair and to examine the effects of factors affecting this situation. Materials and methods We retrospectively reviewed the records of patients who were operated on for RCT. In this process, 257 patients were examined and 76 patients who met the inclusion criteria were included in the study. The Pittsburgh sleep quality index (PSQI), Constant–Murley shoulder score (CSS), and Oxford shoulder score (OSS) were used to evaluate the results preoperatively and at the last control visit of each patient. In the USG performed in the postoperative first year, the rotor cuff was evaluated in terms of rerupture. Results It was observed that 14 (18.4%) patients’ rotor cuffs were reruptured and those of 62 (81.6%) patients were intact. The preoperative PSQI, CSS, and OSS values of the patients were calculated as an average of 10.79 ± 3.58, 35.61 ± 8.88, and 17.61 ± 4.20 and the mean postoperative values were calculated as 5.45 ± 1.68, 81.55 ± 5.27, and 38.05 ± 3.06, respectively. The postoperative PSQI value was statistically significantly lower in patients with tears of <1 cm (PSQI: 4.29 ± 0.73) than in those with tears of 1–3 cm (PSQI: 5.50 ± 2.17) and 3–5 cm (PSQI: 5.88 ± 1.25) (P < 0.001). The mean CSS and OSS values were significantly higher in postoperative measurements for all tear types. According to the size of the tear, postoperative CSS and OSS values were statistically significantly lower in patients with tears of 3–5 cm (CSS: 78.59 ± 4.50 and OSS: 36.18 ± 2.47) than those with <1 cm (CSS: 85.43 ± 2.14 and OSS: 40.57 ± 1.55) and 1–3 cm (CSS: 83.21 ± 5.35 and OSS: 39.07 ± 2.94) tears (P < 0.001). Conclusion In the USG performed in the postoperative first year, it was determined that the patients with healthy rotator cuffs recovered better than those with rerupture.
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Affiliation(s)
- İzzet Bingöl
- Department of Orthopaedics and Traumatology, 29 Mayıs Goverment Hospital, Ankara, Turkey
| | - Vedat Biçici
- Department of Orthopaedics and Traumatology, Ankara City Hospital, Ankara, Turkey
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