Outcome analysis of surgery for disorders of the rotator cuff

Abstract

A consecutive series of 372 patients who underwent surgery for disorders of the rotator cuff involving arthroscopic subacromial decompression and open or arthroscopic repairs of the cuff were prospectively investigated as to the comparability of subjective and objective assessment scores of shoulder function. Assessments were made before operation and at 3, 6, 12, 18 and 24 months after surgery using the Disabilities of the Arm, Shoulder, and Hand score, the Oxford shoulder score and the Constant-Murley score, which was used as a reference. All scores were standardised to a scale of 0 to 100 for comparison. Statistical analysis compared the post-operative course and the mean score for the subjective Disabilities to the Arm, Shoulder and Hand score and Oxford shoulder score, with the objective Constant score at each interval. A strong correlation was evident between both subjective scores and the Constant score. We concluded that both the subjective scores would be useful substitutes for the Constant score, obviating the need for a trained investigator and the specialist equipment required to perform the Constant score.

The Munich Shoulder Questionnaire (MSQ): development and validation of an effective patient-reported tool for outcome measurement and patient safety in shoulder surgery

“…This is confirmed by other authors who recommend combining subjective rating instruments like the SPADI or DASH score with a questionnaire assessing the objective function or a physical examination [1,12,16]. For this reason, both aspects were integrated in the MSQ.…”

“…While the CMS mainly evaluates the objective function, and the SPADI and DASH solely address the subjective function of the shoulder, the MSQ captures both [16]. Objective and subjective function, however, have recently been controversially discussed as the objective function of a shoulder alone correlates poorly with the outcome and the quality of life experienced by the patients [16,23,24]. …”

“…Certainly, the objective function alone does not necessarily reflect the outcome of a therapy but still provides important information when evaluating the effectiveness of a therapy [16]. Especially for comparison of conservative and surgical therapies it is important to gather information on the range of motion and on the power of the affected arm irrespectively from the final rating.…”

“…The validity, reliability and responsiveness for most of these instruments were demonstrated in several studies. Hence, these test-systems are widely accepted for outcome measurement in shoulder surgery [1,7,16-18]. However, routine measurement of outcome in shoulder surgery is substantially jeopardized by three major disadvantages of these instruments: i) physical presence of the patient is mandatory if the objective function (e.g.…”

“…As a result, performing clinical studies is time consuming, expensive and a logistical challenge, especially when physical presence of the patient is required [3-5,16,19]. In addition, many procedures are performed on outpatients in centers far away from the home of the patients.…”