More than pain and physical limitation: the declined cognitive performance associated with rotator cuff injuries

Rotator cuff (RC) injuries often lead to shoulder pain, physical limitations, sleep disturbances, and emotional distress. However, the relationship between these symptoms and cognitive decline remains unclear.

We recruited 150 patients with RC injury, who completed the Visual Analog Scale (VAS) for pain, the American Shoulder and Elbow Surgeons scale (ASES), the Pittsburgh Sleep Quality Index (PSQI), the Beck Depression Inventory II (BDI-II), and the State-Trait Anxiety Inventory (STAI). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA), Digit Symbol Substitution Test (DSST), Trail Making Test (TMT), and Digit Span.

High prevalence rates of potential MCI (54% based on MoCA) and sleep disturbance (64.7%) were found. Depressive and anxiety symptoms were present in 18% and 28-30%, respectively. Multiple regressions indicated that older age, lower education, poorer sleep quality, and higher state anxiety were significant predictors across various cognitive tests, but not the pain intensity. Instead, logistic regression confirmed that older age (OR = 1.08, 95% CI: 1.04-1.12) and lower shoulder function (OR = 0.97, 95% CI: 0.95-0.99) significantly increased MCI risk.

This study highlights that while pain intensity itself was not a predictor of cognitive decline, other associated symptoms like sleep disturbances and emotional distress contribute to poor cognitive function. Furthermore, the physical limitations resulting from RC injuries increase the risk of mild cognitive impairment (MCI). Management of RC injuries should thus address cognitive factors alongside physical and psychological symptoms.