Complete Rotator Cuff Tear: An Evidence-Based Conservative Management Approach

Abdulwahab, Taiceer; Murrell, William; Jenio, Frank Z.; NavneetBhangra,; Malanga, Gerard A.; Stafford, Michael; Jain, Nitin B.; Verborgt, Olivier

doi:10.5772/intechopen.70270

Cited by 2 publications

(2 citation statements)

References 93 publications

(115 reference statements)

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“…Other relevant factors that were not included but may have had an impact on this study's results include smoking history, hand dominance, comorbidities, alcohol use, obesity, sleep status, occupational factors, socioeconomic background, and genetics. Relationships between these factors and shoulder outcomes have already been studied [1,9,16,51,59]. Furthermore, we did not include muscle strength because it is a well-established clinical factor associated with pain and function [23,34,41,43], but we recognize that the inclusion of strength in our multivariable models may have increased the explained variance.…”

Section: Limitationsmentioning

confidence: 99%

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

Lemaster

Hettrich

Jacobs

et al. 2021

Clin Orthop Relat Res

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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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Section: Limitationsmentioning

confidence: 99%

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

Lemaster

Hettrich

Jacobs

et al. 2021

Clin Orthop Relat Res

View full text Add to dashboard Cite

show abstract

“…People with partial tears of the rotator cuffs or those with rotator cuffs that appear to be intact but inflamed are likely to benefit from surgical intervention [7]. According to the results of the imaging of the shoulder, depending on the accuracy of the diagnosis of the extent of the rotator cuff tear, as well as whether the decision to proceed with conservative management or to undergo surgery will be made, the results of the imaging could have clinical implications [8]. It is imperative to make the right diagnosis at the right time before making an informed decision regarding the therapeutic options available to you.…”

Section: Introductionmentioning

confidence: 99%