Prevalence and Risk Factors of Neuropathic Pain in Patients with a Rotator Cuff Tear

Abstract

Background: Until now, few studies had investigated the neuropathic pain component in patients with a rotator cuff tear (RCT). Objectives: The aim of the study was to identify the neuropathic pain component in patients with RCT and to determine the factors correlated with neuropathic pain in patients with RCT. Study Design: Prospective, cohort, prognostic study. Setting: Study patients who required arthroscopic rotator cuff repair were analyzed in a hospital setting. Methods: We prospectively studied 101 patients who were less than 60 years old with fullthickness tears requiring arthroscopic rotator cuff repair and met the inclusion and exclusion criteria. Multiple regression analysis was performed to identify variables that independently affected neuropathic pain in patients with a RCT. We use Douleur neuropathique 4 questionnaire (DN4) to assess neuropathic pain, which was ≥ 4 points of the DN4 questionaire. The visual analog scale (VAS) for the most severe pain within 4 weeks before admission and mean pain level during the last 4 weeks were checked. The atrophy grades of the rotator cuff muscles were classified on magnetic resonance images according to the Goutallier classification. The size and medial retraction of the RCT were measured during arthroscopic repair for RCT. Results: Sixteen (15.8%) of the 101 patients had neuropathic pain according to the cutoff values on the DN4 questionnaire for diagnosing neuropathic pain. The neuropathic pain group had significantly higher prevalence of smoking (P = 0.042), more mean VAS during last 4 weeks (P = 0.008), larger cuff tear (P = 0.003), more medial retraction of cuff (P = 0.016), and severe fatty degeneration of rotator cuff muscles (supraspinatus, P < 0.001; subscapularis, P < 0.001; and infraspinatus, P = 0.003) than the nonneuropathic pain group. The multiple logistic regression analyses showed that more mean VAS during the last 4 weeks and tear size of a rotator cuff were independent of other factors for the neuropathic pain of the patients with a full-thickness RCT. Limitations: Small sample size is the first limitation of this study. Conclusions: The prevalence of neuropathic pain in patients with a full-thickness RCT requiring arthroscopic rotator cuff repair was 15.8 % according to the DN4 questionnaire. The neuropathic pain component was more relevant to the severity of pain and tear size in the patients with a full-thickness RCT. It is important to be aware of the existence of neuropathic pain when treating a patient presenting with pain due to a RCT because accompanying neuropathy with a RCT could have a worse effect on repair of a RCT. IRB approval and clinical trial registration number: CR-15-045 Key words: Shoulder, rotator cuff tear, arthroscopic rotator cuff repair, neuropathic pain

Prevalence of Neuropathic Pain Symptoms in Foot and Ankle Patients

“…In this study, we prospectively collected data assessing the presence of NP symptoms in patients with foot and ankle pathologies. The overall rate of NP symptoms was lower than previously published for hip, 1 knee, 8,14,16 and lower back, 15 and similar to other reports of NP in carpal tunnel 18 and rotator cuff 9 pathologies. We did find a much lower rate of NP symptoms compared to a recent study following ORIF of ankle fracture.…”

“…1 Ko et al found smoking to be related to NP. 9 Although diabetes itself is a risk factor for development of peripheral neuropathy in about 50% of the patients with diabetes and up to 26% for painful peripheral neuropathy, 19 we did not find higher prevalence of NP symptoms in this group of patients. This finding can be explained to some degree by our patient selection and management of patients with uncontrolled diabetes or documented neuropathy.…”

“…A recent general-population health survey done in the United States found that as high as 15.7% of the patients reporting to have pain and 10% of all the responders had a probable NP with a higher tendency in certain ethnic groups (blacks and Hispanic). 2 The study of NP in orthopedic conditions has started with focusing mainly in osteoarthrosis (OA) of the knee 1,5,7,14,16 and spinal pathologies 15,23 but has now progressed to evaluate the prevalence and the implications of NP in other common orthopedic conditions including hip lesions, 13 rotator cuff tear, 9 carpal tunnel syndrome, 18 etc. These studies have found up to 34% of the patients with knee OA have NP, 10.5% of the patients with carpal tunnel syndrome, 15.8% with rotator cuff tears, and as high as 53% of patients with chronic back pain.…”

A comparison of ice wrap and subacromial injection for postoperative pain and edema control following arthroscopic rotator cuff repair

“…Ravindra et al [28] stated that physicosocial factors have stronger associations with postoperative pain after ARCR than structural factors do. Ko et al [29] pointed out that neuropathic pain can occur after rotator cuff tears, and this can result in severe postoperative pain, especially if there is a high preoperative VAS score or a heavy smoking habit [23]. Preoperative opioid consumption was found to be another nonstructural factor that affects postoperative pain in a study based on 35,155 patient records, which is not consistent with our findings [22].…”

Vascular endothelial growth factor enhances tendon‐bone healing by activating Yes‐associated protein for angiogenesis induction and rotator cuff reconstruction in rats

“…Rotator cuff tear is a very common orthopedic injury that causes repeated pain and dysfunction. 1,2 Currently, rotator cuff reconstruction is the gold standard for the treatment of rotator cuff tears. 3 Complete rotator cuff reconstruction has been reported to greatly improve the shoulder function of patients with rotator cuff tears.…”