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

Area of Science:

• Orthopedics
• Rehabilitation Medicine
• Psychology

Background:

• Patient-reported outcome measures are vital for clinical decision-making in rotator cuff tear management.
• Previous research has often examined psychological and physical factors independently, limiting a comprehensive understanding of their combined impact.
• The interplay between psychological distress, scapular motion, and shoulder function outcomes in rotator cuff tears requires simultaneous investigation.

Purpose of the Study:

• To identify physical and psychological factors associated with improved American Shoulder and Elbow Surgeons (ASES) function, pain, and total scores in patients with rotator cuff tears.
• To control for confounding variables when assessing these associations.
• To determine the predictive value of biopsychosocial factors on shoulder outcome scores.

Main Methods:

• A cross-sectional study involving 50 patients with confirmed rotator cuff tears (partial or full-thickness) without prior shoulder surgery.
• Evaluation of demographics, rotator cuff tear size, arm flexion, and scapular motion using standardized procedures.
• Patients completed the ASES questionnaire and the Optimal Screening for Prediction of Referral and Outcomes-Yellow Flag assessment for psychological distress; stepwise multiple linear regression was used for analysis.

Main Results:

• ASES function scores were associated with older age, increased arm flexion, greater scapular external rotation, and higher acceptance of chronic pain (adjusted r² = 0.67).
• ASES pain scores were linked to increased scapular external rotation and lower fear-avoidance beliefs (adjusted r² = 0.36).
• Total ASES scores correlated with increased arm flexion, upward and external scapular rotation, and decreased fear-avoidance beliefs (adjusted r² = 0.65).

Conclusions:

• A comprehensive biopsychological assessment, including humeral/scapular motion and psychological factors like fear-avoidance and pain coping, is recommended for rotator cuff tear patients.
• These physical and psychological variables are significantly associated with ASES scores and should be considered in clinical assessments.
• Simultaneous examination and targeted treatment plans incorporating these biopsychosocial factors can optimize patient outcomes for rotator cuff tears.