Are Psychologic Factors Associated With Shoulder Scores After Rotator Cuff Surgery? What factors are predictors of emotional health in patients with full-thickness rotator cuff tears? Patient outcome following rehabilitation for rotator cuff repair surgery: the impact of selected medical comorbidities. The duration of symptoms does not correlate with rotator cuff tear severity or other patient-related features: a cross-sectional study of patients with atraumatic, full-thickness rotator cuff tears. Plasma rich in growth factors in arthroscopic rotator cuff repair: a randomized, double-blind, controlled clinical trial. Surgical versus Non-surgical Management of Rotator Cuff Tears: Predictors of Treatment Allocation Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears. Does Rotator Cuff Repair Improve Psychologic Status and Quality of Life in Patients With Rotator Cuff Tear? Longitudinal Changes in Psychosocial Factors and Their Association With Knee Pain and Function After Anterior Cruciate Ligament Reconstruction Prospective analysis of arthroscopic rotator cuff repair: prognostic factors affecting clinical and ultrasound outcome. Psychological Distress Negatively Affects Self-assessment of Shoulder Function in Patients With Rotator Cuff Tears Comparison of clinical and patient-based measures to assess medium-term outcomes following shoulder surgery for disorders of the rotator cuff. Shoulder Activity Level Is Not Associated With the Severity of Symptomatic, Atraumatic Rotator Cuff Tears in Patients Electing Nonoperative Treatment Effectiveness of physical therapy in treating atraumatic full-thickness rotator cuff tears: a multicenter prospective cohort study. A multicenter randomized controlled trial comparing single-row with double-row fixation in arthroscopic rotator cuff repair. Sleep Quality in Patients With Rotator Cuff Disease Prospective Evaluation of the Effect of Rotator Cuff Integrity on the Outcome of Open Rotator Cuff Repairs
Background Psychologic factors are associated with pain and disability in patients with chronic shoulder pain . Recent research regarding the association of affective psychologic factors ( emotions ) with patients ’ pain and disability outcome after surgery disagrees ; and the relationship between cognitive psychologic factors ( thoughts and beliefs ) and outcome after surgery is unknown . Questions / purpose s ( 1 ) Are there identifiable clusters ( based on psychologic functioning measures ) in patients undergoing shoulder surgery  ? ( 2 ) Is poorer psychologic functioning associated with worse outcome ( American Shoulder and Elbow Surgeons [ ASES ] score ) after shoulder surgery ? Methods This prospect i ve cohort study investigated patients undergoing shoulder surgery for rotator cuff-related shoulder pain or rotator cuff tear by one of six surgeons between January 2014 and July 2015 . Inclusion criteria were patients undergoing surgery for rotator cuff repair with or without subacromial decompression and arthroscopic subacromial decompression only . Of 153 patients who were recruited and consented to participate in the study , 16 withdrew before data collection , leaving 137 who underwent surgery and were included in analyses . Of these , 124 ( 46 of 124 [ 37 % ] female ; median age , 54 years [ range , 21 - 79 years ] ) had a complete set of four psychologic measures before surgery  : Depression , Anxiety and Stress Scale ; Pain Catastrophizing Scale ; Pain Self-Efficacy Question naire ; and Tampa Scale for Kinesiophobia . The existence of clusters of people with different profiles of affective and cognitive factors was investigated using latent class analysis , which grouped people according to their pattern of scores on the four psychologic measures . Result ant clusters were profiled on potential confounding variables . The ASES score was measured before surgery and 3 and 12 months after surgery . Linear mixed models assessed the association between psychologic cluster membership before surgery and trajectories of ASES score over time adjusting for potential confounding variables . Results Two clusters were identified : one cluster ( 84 of 124 [ 68 % ] ) had lower scores indicating better psychologic functioning and a second cluster ( 40 of 124 [ 32 % ] ) had higher scores indicating poorer psychologic functioning . Accounting for all variables , the cluster with poorer psychologic functioning was found to be independently associated with worse ASES score at all time points ( regression coefficient for ASES : before surgery -9 [ 95 % confidence interval { CI } , -16 to -2 ] , p = 0.011 ) ; 3 months after surgery -15 [ 95 % CI , -23 to -8 ] , p < 0.001 ) ; and 12 months after surgery -9 [ 95 % CI , -17 to -1 ] , p = 0.023 ) . However , both clusters showed improvement in ASES score from before to 12 months after surgery , and there was no difference in the amount of improvement between clusters ( regression coefficient for ASES : cluster with poorer psychologic function 31 [ 95 % CI , 26 - 36 ] , p < 0.001 ) ; cluster with better psychologic function 31 [ 95 % CI , 23 - 39 ] , p < 0.001 ) . Conclusions Patients who scored poorly on a range of psychologic measures before shoulder surgery displayed worse ASES scores at 3 and 12 months after surgery . Screening of psychologic factors before surgery is recommended to identify patients with poor psychologic function . Such patients may warrant additional behavioral or psychologic management before proceeding to surgery . However , further research is needed to determine the optimal management for patients with poorer psychologic function to improve pain and disability levels before and after surgery . Level of Evidence Level II , therapeutic study BACKGROUND The importance of emotional and psychological factors in treatment of patients with rotator cuff disease has been recently emphasized . Our goal was to establish factors most predictive of poor emotional health in patients with full-thickness rotator cuff tears ( FT RCTs ) . METHODS In 2007 , we began to prospect ively collect data on patients with symptomatic , atraumatic FT RCTs . All patients completed a question naire collecting data on demographics , symptom characteristics , comorbidities , willingness to undergo surgery , and patient-related outcomes ( 12-Item Short Form Health Survey , American Shoulder and Elbow Surgeons score , Western Ontario Rotator Cuff Index [ WORC ] , Single Assessment Numeric Evaluation score , Shoulder Activity Scale ) . Physicians recorded physical examination and imaging data . To evaluate the predictors of lower WORC emotion scores , a linear multiple regression model was fit . RESULTS Baseline data for 452 patients were used for analysis . In patients with symptomatic FT RCTs , the factors most predictive of worse WORC emotion scores were higher levels of pain ( interquartile range odds ratio , -18.9 ; 95 % confidence interval , -20.2 to -11.6 ; P < .0001 ) and lower Single Assessment Numeric Evaluation scores ( rating of percentage normal that patients perceive their shoulder to be ; interquartile range odds ratio , 6.2 ; 95 % confidence interval , 2.5 - 9.95 ; P = .0012 ) . Higher education ( P = .006 ) and unemployment status ( P = .0025 ) were associated with higher WORC emotion scores . CONCLUSIONS Education level , employment status , pain levels , and patient perception of percentage of shoulder normalcy were most predictive of emotional health in patients with FT RCTs . Structural data , such astendon tear size , were not . Those with poor emotional health may perceive their shoulder to be worse than others and experience more pain . This may allow us to better optimize patient outcomes with nonoperative and operative treatment of rotator cuff tears STUDY DESIGN Prospect i ve , multicenter research design . OBJECTIVES To assess functional and health status outcomes in patients following a physical therapy program after rotator cuff repair surgery , and to determine the impact of selected patient medical comorbidities on rehabilitation outcomes . BACKGROUND While authors have studied the influence of multiple factors on patient outcomes after rotator cuff repair surgery , little research has been done on the impact of comorbidities , particularly as it relates to establishing an accurate patient prognosis . eighteen patients who had recently undergone a rotator cuff repair surgical procedure were recruited at 1 of 30 Physiotherapy Associates , Inc outpatient clinics located in 13 states . A rehabilitation protocol was implemented and included the following interventions , as indicated : therapeutic exercise , manual therapy , electrotherapeutic modalities , and physical agents . Patient health history factors were documented during the initial examination , including age , race , body mass index , smoking , rotator cuff tear size , type of surgical procedure , and selected medications and comorbidities . The Disabilities of the Arm , Shoulder , and H and ( DASH ) and the Short-Form-36 ( SF-36 ) were completed prior to rehabilitation , at discharge , and at 6 months postdischarg RESULTS DASH and most SF-36 domain mean scores obtained postrehabilitation were significantly improved from pretherapy scores . Most health status outcomes were maintained at 6-month follow-up , with slight further improvement noted in SF-36 physical dimensions and DASH scores . Having a greater number of comorbidities was associated with worse postrehabilitation SF-36 scores , but not with the DASH shoulder function scores . The mean change scores ( difference between prerehabilitation and postrehabilitation status ) for the DASH and SF-36 were not significantly different for patients with 0 to 1 , 2 , or at least 3 or more comorbidities ( except for emotional role ) . In regression analyses a model with baseline physical function score ( P = .0001 ) , age ( P = .03 ) , and number of comorbidities ( P = .003 ) fitted the data well and explained 38 % of the variance in the physical function score at discharge . CONCLUSIONS A higher number of comorbidities had a negative effect on general health status outcomes but not on shoulder function outcomes at the time of patient discharge following rehabilitation . Despite a negative effect of more comorbidities on health status outcomes , the specific number of medical comorbidities did not affect the overall level of improvement prerehabilitation to postrehabilitation in function and health status . The findings describing the influence of comorbidities on rehabilitation outcomes may assist therapists in establishing accurate patient prognosis HYPOTHESIS The purpose of this cross-sectional study is to determine whether the duration of symptoms influences the features seen in patients with atraumatic , full-thickness rotator cuff tears . Our hypothesis is that an increasing duration of symptoms will correlate with more advanced findings of rotator cuff tear severity on magnetic resonance imaging , worse shoulder outcome scores , more pain , decreased range of motion , and less strength . METHODS We enrolled 450 patients with full-thickness rotator cuff tears in a prospect i ve cohort study to assess the effectiveness of nonoperative treatment and factors predictive of success . The duration of patient symptoms was divided into 4 groups : 3 months or less , 4 to 6 months , 7 to 12 months , and greater than 12 months . Data collected at patient entry into the study included ( 1 ) demographic data , ( 2 ) history and physical examination data , ( 3 ) radiographic imaging data , and ( 4 ) vali date d patient-reported measures of shoulder status . Statistical analysis included a univariate analysis with the Kruskal-Wallis test and Pearson test to identify statistically significant differences in these features for different duration s of symptoms . RESULTS A longer duration of symptoms does not correlate with more severe rotator cuff disease . The duration of symptoms was not related to weakness , limited range of motion , tear size , fatty atrophy , or vali date d patient-reported outcome measures . CONCLUSIONS There is only a weak relationship between the duration of symptoms and features associated with rotator cuff disease PURPOSE The aim of this study was to determine whether addition of plasma rich in growth factors ( PRGF ) improves functional and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears . METHODS The study design was independent ( investigator-sponsored ) , r and omized in parallel groups , double-blind , and controlled with a conventional surgical technique clinical trial . Sixty-nine patients with rotator cuff tears were included . Subsequently , 6 patients in whom less than 50 % footprint coverage of the repair was possible were excluded . Before arthroscopic repair , patients were r and omly assigned to receive PRGF at the end of arthroscopy ( injected first in the repaired area and then spread over the tendon suture ) or only conventional surgery .  Efficacy was evaluated 1 year after surgery using functional ( UCLA score ) and structural ( arthro-MRI ) assessment s. RESULTS The baseline UCLA scores of the PRGF ( 14.9 ; 95 % confidence interval [ CI ] : 13.7 to 16.12 ) and control ( 13.2 ; 95 % CI : 13.3 to 16.3 ) groups were similar . After surgery , both groups showed an improvement in UCLA score , without significant differences between groups ( 23.2 ; CI 95 % : 20.8 to 25.7 , and 23.8 ; 95 % CI : 21.0 to 26.7 , respectively ) . Furthermore , no significant differences were observed in satisfaction 1 year after surgery . Tendon healing evaluated with arthro-magnetic resonance imaging showed total healing in 40 % of cases , partial healing in 30 % , and lack of healing in 30 % , again with no significant differences between groups . No adverse events were recorded . CONCLUSIONS The present clinical trial does not support the use of plasma rich in growth factors in the arthroscopic repair of rotator cuff tears because no differences in rotator cuff healing or improvements in function were observed in the 1-year postsurgical clinical and radiological follow-up assessment s. LEVEL OF EVIDENCE Level I , r and omized , double-blind , controlled clinical trial Objectives : Rotator cuff tears are a common shoulder disorder result ing in significant disability to patients and strain on the health care system . While both surgical and non-surgical management are accepted treatment options , little data exist to guide the surgeon in treatment allocation . Defining variables to guide treatment allocation may be important for patient education and counseling , as well as to deliver the most efficient care plan at the time of presentation . The objective of this study was to identify patient characteristics at the time of initial clinical presentation that are associated with allocation to surgical versus non-surgical management for patients with known full-thickness rotator cuff tears . Methods : 185 consecutive adult patients with known full-thickness rotator cuff tears were enrolled into a prospect i ve cohort study . Robust data were collected for each subject at baseline , including age , gender , body mass index ( BMI ) , shoulder activity score , smoking status , size of cuff tear , duration of symptoms , functional comorbidity index , treating surgeon , the American Shoulder and Elbow Society ( ASES ) score , the Western Ontario Rotator Cuff Index ( WORC ) , and the Veterans R and 12 Item Health Survey ( VR-12 ) . Logistic regression was performed in order to identity variables associated with treatment allocation , and the corresponding odds ratios were calculated . Results : Of the 185 subject enrolled , 100 underwent surgical intervention and 85 non-operative management . While controlling for co-variates , significant baseline patient characteristics predictive of eventual allocation to surgical treatment included the following : non-smoking status [ OR .039 ( 0.005 , 0.300 ) p=0.002 ] , lower functional comorbidity index [ OR 0.739 ( 0.518 , 1.055 ) p=0.096 ] , younger age [ OR 0.872 ( 0.820 , 0.927 ) p<0.001 ] , lower BMI [ OR 0.895 ( 0.826 , 0.970 ) p=0.007 ] , and symptoms present for fewer than 4 months [ OR 3.258 ( 1.070 , 9.921 ) p=0.038 ] . Factors that were not associated with treatment allocation included gender , tear size , diabetes , treating surgeon , or any of the patient derived outcome scores at presentation ( ASES , WORC , VR-12 , shoulder activity score ) . Conclusion : This prospect i ve cohort study suggests that the factors predictive of treatment allocation are related more to patient demographics at presentation than patient derived outcome scores or intrinsic characteristics of the rotator cuff such as tear size . Further study is warranted to help define appropriate indications for treatment allocation in patients with rotator cuff tears BACKGROUND Patient-reported outcome measures have increasingly accompanied objective examination findings in the evaluation of orthopaedic interventions . Our objective was to determine whether a vali date d measure of mental health ( Short Form-36 Mental Component Summary [ SF-36 MCS ] ) or measures of tear severity on magnetic resonance imaging were more strongly associated with self-assessed shoulder pain and function in patients with symptomatic full-thickness rotator cuff tears . METHODS One hundred and sixty-nine patients with full-thickness rotator cuff tears were prospect ively enrolled . Patients completed the Short Form-36 , visual analog scales for shoulder pain  and function , the Simple Shoulder Test ( SST ) , and the American Shoulder and Elbow Surgeons ( ASES ) instrument at the time of diagnosis . Shoulder magnetic resonance imaging examinations were review ed to document the number of tendons involved , tear size , tendon retraction , and tear surface area . Age , sex , body mass index , number of medical comorbidities , smoking status , and Workers ' Compensation status were recorded . Bivariate correlations and multivariate regression models were calculated to identify associations with baseline shoulder scores . RESULTS The SF-36 MCS had the strongest correlation with the visual analog scale for shoulder pain ( Pearson correlation coefficient , -0.48 ; p < 0.001 ) , the visual analog scale for shoulder function ( Pearson correlation coefficient , -0.33 ; p < 0.001 ) , the SST ( Pearson correlation coefficient , 0.37 ; p < 0.001 ) , and the ASES score ( Pearson correlation coefficient , 0.51 ; p < 0.001 ) . Tear severity only correlated with the visual analog scale for shoulder function ; the Pearson correlation coefficient was 0.19 for tear size ( p = 0.018 ) , 0.18 for tendon retraction ( p = 0.025 ) , 0.18 for tear area ( p = 0.022 ) , and 0.20 for the number of tendons involved ( p = 0.011 ) . Tear severity did not correlate with other scores in bivariate correlations ( all p > 0.05 ) . In all multivariate models , the SF-36 MCS had the strongest association with the visual analog scale for shoulder pain , the visual analog scale for shoulder function , the SST , and the ASES score ( all p < 0.001 ) . CONCLUSIONS Patient mental health may play an influential role in patient-reported pain and function in patients with full-thickness rotator cuff tears . Further studies are needed to determine its effect on the outcome of the treatment of rotator cuff disease Background Recently , psychological status , patient-centered outcomes , and health-related quality of life ( HRQoL ) in patients with scheduled or who underwent orthopaedic surgeries have been emphasized . The relationship between preoperative psychological status and postoperative clinical outcome in patients with rotator cuff repair has not yet been investigated . Questions / purpose sThe primary objective of this study was to investigate changes in psychological status ( depression , anxiety , insomnia ) and HRQoL after rotator cuff repair . The secondary objective was to assess whether preoperative depression , anxiety , and insomnia predict clinical outcome after rotator cuff repair . Methods Forty-seven patients who underwent rotator cuff repair prospect ively completed the  visual analog scale ( VAS ) pain score , the UCLA Scale , the  American Shoulder and Elbow Surgeons ’ Scale ( ASES ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Pittsburgh Sleep Quality Index ( PSQI ) , and the World Health Organization Quality -of-life Scale Abbreviated Version ( WHOQOL-BREF ) before surgery and at 3 , 6 , and 12 months after surgery . Repeated- measures analysis of variance was used to evaluate the serial changes in psychological parameters and outcome measurements . The chi-square test was also used to compare preoperative and postoperative prevalence of depression , anxiety , and insomnia . Finally , multiple regression analysis was applied to determine the relationship between preoperative psychological status and postoperative clinical outcome . Results With surgery , depression , anxiety , and insomnia decreased , whereas quality of life increased . The mean HADS-D and HADS-A scores and the mean PSQI score decreased from 3.7 ± 3.3 , 4.3 ± 4.3 , and 6.6 ± 3.6 , respectively , before surgery to 2.1 ± 2.3 , 1.4 ± 2.4 , and 4.2 ± 3.3 , respectively , at 12 months after surgery ( HADS-D mean difference 1.6 [ 95 % confidence interval { CI } , 0.6–2.6 ] , p = 0.003 ; HADS-A mean difference 2.9 [ 1.5–4.4 ] , p < 0.001 ; PSQI mean difference 2.4 [ 1.3–3.4 ] , p < 0.001 ) . The mean WHOQOL-BREF score increased from 60.4 ± 11.0 before surgery to 67.4 ± 11.8 at 12 months after surgery ( mean difference −7.0 [ 95 % CI , −10.7 to −3.4 ] , p < 0.001 ) . At 12 months after surgery , there were decreases in the prevalence of depression ( six of 47 [ 22.8 % ] versus three of 47 [ 6.4 % ] , p = 0.002 ) , anxiety ( 11 of 47 [ 23.4 % ] versus two of 47 [ 4.3 % ] , p = 0.016 ) , and insomnia ( 33 of 47 [ 70.2 % ] versus 20 of 47 [ 42.6 % ] , p = 0.022 ) . Preoperative HADS-depression , HADS-anxiety , and PSQI scores did not correlate with the VAS pain score , UCLA , or ASES scores at 12 months after surgery . Conclusions Psychological status and HRQoL improved with decreasing pain and increasing functional ability from 3 months after surgery . Preoperative depression , anxiety , and insomnia did not predict poor outcome after rotator cuff repair . Our findings suggest that successful rotator cuff repair may improve psychological status and HRQoL.Level of Evidence Level II , prospect i ve study Background Evidence in the musculoskeletal rehabilitation literature suggests that psychosocial factors can influence pain levels and functional outcome . Objective The purpose of this study was to examine changes in select psychosocial factors and their association with knee pain and function over 12 weeks after anterior cruciate ligament ( ACL ) reconstruction . Design This was a prospect i ve , longitudinal , observational study . Methods Patients with ACL reconstruction completed self-report question naires for average knee pain intensity ( numeric rating scale [ NRS ] ) , knee function ( International Knee Documentation Committee Subjective Knee Form [ IKDC-SKF ] ) , and psychosocial factors ( pain catastrophizing [ Pain Catastrophizing Scale ] , fear of movement or reinjury [ shortened version of the Tampa Scale for Kinesiophobia ( TSK-11 ) ] , and self-efficacy for rehabilitation tasks [ modified Self-Efficacy for Rehabilitation Outcome Scale ( SER ) ] ) . Data were collected at 4 time points after surgery ( baseline and 4 , 8 , and 12 weeks ) . Repeated- measures analyses of variance determined changes in question naire scores across time . Hierarchical linear regression models were used to examine the association of psychosocial factors with knee pain and function . Results Seventy-seven participants completed the study . All question naire scores changed across 12 weeks . Baseline psychosocial factors did not predict the 12-week NRS or IKDC-SKF score . The 12-week change in modified SER score predicted the 12-week change in NRS score ( r2=.061 ) , and the 12-week change in modified SER and TSK-11 scores predicted the 12-week change in IKDC-SKF score ( r2=.120 ) . Limitations The psychometric properties of the psychosocial factor question naires are unknown in people with ACL reconstruction . The study focused on short-term outcomes using only self-report measures . Conclusions Psychosocial factors are potentially modifiable early after ACL reconstruction . Baseline psychosocial factor levels did not predict knee pain or function 12 weeks postoperatively . Interventions that increase self-efficacy for rehabilitation tasks or decrease fear of movement or reinjury may have potential to improve short-term outcomes for knee pain and function The purpose of this study was to identify potential predictors of function and tendon healing after  arthroscopic rotator cuff repair  that will enable the orthopaedic surgeon to determine which patients can expect a successful outcome . Between 2003 and 2005 , the Arthroscopic Rotator Cuff Registry was established to collect demographic , intraoperative , functional outcome , and ultrasound data prospect ively on all patients who underwent primary arthroscopic rotator cuff repair . At total of 193 patients met the study criteria , and 127 ( 65.8 % ) completed the 2-year follow-up . The most significant independent factors affecting  ultrasound outcome were age ( odds ratio [ OR ] , 1.08 ; 95 % confidence interval [ CI ] , 1.02 - 1.14 ; P = .006 ) and tear size ( OR , 2.29 ; 95 % CI , 1.55 - 3.38 ; P < .001 ) . After adjustment for age and tear size , the intraoperative factors found to be significantly associated with a tendon defect were concomitant biceps procedures ( OR , 11.39 ; 95 % CI , 2.90 - 44.69 ; P < .001 ) and acromioclavicular joint procedures ( OR , 3.85 ; 95 % CI , 1.46 - 10.12 ; P = .006 ) . In contrast to the ultrasound data , the functional outcome variables , such as satisfaction ( OR , 3.92 ; 95 % CI , 2.00 - 7.68 ; P < .001 ) and strength ( OR , 10.05 ; 95 % CI , 1.61 - 62.77 ; P = .01 ) , had a greater role in predicting an American Shoulder and Elbow Surgeons score greater than 90 . The progression from a single-tendon rotator cuff tear to a multiple-tendon tear with associated pathology increased the likelihood of tendon defect by at least 9 times , and therefore , earlier surgical intervention for isolated , single-tendon rotator cuff tears could optimize the likelihood of ultrasound healing and an excellent functional outcome Background In many areas of orthopaedics , patients with greater levels of psychological distress report inferior self- assessment s of pain and function . This effect can lead to lower-than-expected baseline scores on common patient-reported outcome scales , even those not traditionally considered to have a psychological component . Questions / purpose sThis study attempts to answer the following questions : ( 1 ) Are higher levels of psychological distress associated with clinical ly important differences in baseline scores on the VAS for pain , the Simple Shoulder Test , and the American Shoulder and Elbow Surgeons score in patients undergoing arthroscopic rotator cuff repair ? ( 2 ) Does psychological distress remain a negative predictor of baseline shoulder scores when other clinical variables are controlled ? Methods Eighty-five patients with full-thickness rotator cuff tears were prospect ively enrolled . Psychological distress was quantified using the Distress Risk Assessment Method question naire . Patients completed baseline self- assessment s including the  VAS for pain ,  the  Simple Shoulder Test  , and the  American Shoulder and Elbow Surgeons score . Age , sex , BMI , smoking status , American Society of Anesthesiologists classification , tear size , and tear retraction were recorded for each patient . Bivariate correlations and multivariate regression models were used to assess the effect of psychological distress on patient self- assessment of shoulder pain and function . Results Distressed patients reported higher baseline VAS scores ( 6.7 [ 95 % CI , 4.4–9.0 ] versus 2.9 [ 95 % CI , 2.3–3.6 ] , p = 0.001 ) and lower baseline Simple Shoulder Test ( 3.7 [ 95 % CI , 2.9–4.5 ] versus 5.7 [ 95 % CI 5.0–6.4 ] , p = 0.001 ) and American Shoulder and Elbow Surgeons scores ( 39 [ 95 % CI , 34–45 ] versus 58 [ 95 % CI , 53–63 ] , p < 0.001 ) . Distress remained associated with higher VAS scores ( p = 0.001 ) and lower Simple Shoulder Test ( p < 0.001 ) and American Shoulder and Elbow Surgeons scores ( p < 0.001 ) when age , sex , BMI , American Society of Anesthesiologists classification , smoking status , tear size , and tear retraction were controlled . Conclusions Higher levels of psychological distress are associated with inferior baseline patient self- assessment of shoulder pain and function using the VAS , the Simple Shoulder Test , and the American Shoulder and Elbow Surgeons score . Longitudinal followup is warranted to clarify the relationship between distress and self-perceived disability and the effect of distress on postoperative outcomes  after arthroscopic rotator cuff repair .  Level of Evidence Level I , prognostic study . See the Instructions for Authors for a complete description of levels of evidence OBJECTIVE To compare different assessment s following  shoulder surgery for impingement syndrome with or without rotator cuff tear or repair . METHODS A prospect i ve study of 93 patients was conducted . St and ard assessment s were performed before , at 6 months , and at 4 years following shoulder surgery using the patient-based Oxford Shoulder Score ( OSS ) , the Medical Outcomes Study Short Form-36 ( SF-36 ) question naire , and a surgeon-assessed Constant Shoulder Score . Patients were categorized according to the surgery received in relation to the presence of cuff tears : full repair , partial repair , cuff tear/no repair , no tear/no repair . RESULTS Most patients ( 57 % ) received subacromial decompression for impingement with no cuff tear . This group had the fewest pre- and postoperative symptoms . The category of patients who received only partial repair of a cuff tear had worse scores on all outcome assessment s compared with other groups . Patient-based measures were more stable over time than the Constant . CONCLUSION The shoulder-specific measures had greater sensitivity than the SF-36 in registering significant differences in outcomes between comparison groups at 6 months and 4 years Background : Patient activity level  may be an important prognostic variable relating to outcomes in patients with shoulder disorders . Little is known about the predictors of activity level in patients with shoulder disorders . Hypothesis : Tear size and patient variables would be predictive of shoulder activity level in a cohort of patients who have selected initial nonoperative treatment for a symptomatic , atraumatic rotator cuff tear on magnetic resonance imaging ( MRI ) .  Study Design : Cross-sectional study ; Level of evidence , 3 . Methods : Patients with an atraumatic rotator cuff tear on MRI were prospect ively enrolled in the Multicenter Orthopaedic Outcomes Network ( MOON ) shoulder study of nonoperative treatment . As part of routine data collection , these patients were asked to complete a previously vali date d  shoulder activity scale . A regression analysis was performed to assess the association of shoulder activity level to rotator cuff tear characteristics , including tendon involvement and retraction , and patient factors such as age , sex , smoking , and occupation . Results : A total of 434 patients ( 220 male , 214 female ) with a mean age of 62.7 years ( range , 31 - 90 years ) completed the activity scale . Shoulder activity was not associated with severity of the rotator cuff tear , but it was negatively associated with age ( P = .0001 ) and female sex ( P = .001 ) . The only other factor associated with shoulder activity level in this cohort was occupation ( P = .0006 ) . Conclusion : Shoulder activity level in patients with an atraumatic rotator cuff tear confirmed on MRI is not associated with severity of the tear but is affected by age , sex , and occupation PURPOSE To assess the effectiveness of a specific nonoperative physical therapy program in treating atraumatic full-thickness rotator cuff tears using a multicenter prospect i ve cohort study design . MATERIAL S AND METHODS Patients with atraumatic full-thickness rotator cuff tears who consented to enroll provided data via question naire on demographics , symptom characteristics , comorbidities , willingness to undergo surgery , and patient-related outcome assessment s ( Short Form 12 score , American Shoulder and Elbow Surgeons score , Western Ontario Rotator Cuff score , Single Assessment Numeric Evaluation score , and Shoulder Activity Scale )  . Physicians recorded physical examination and imaging data . Patients began a physical therapy program developed from a systematic review of the literature and returned for evaluation at 6 and 12 weeks . At those visits , patients could choose 1 of 3 courses : ( 1 ) cured ( no formal follow-up scheduled ) , ( 2 ) improved ( continue therapy with scheduled re assessment in 6 weeks ) , or ( 3 ) no better ( surgery offered ) . Patients were contacted by telephone at 1 and 2 years to determine whether they had undergone surgery since their last visit . A Wilcoxon signed rank test with continuity correction was used to compare initial , 6-week , and 12-week outcome scores . RESULTS The cohort consists of 452 patients .  Patient-reported outcomes improved significantly at 6 and 12 weeks . Patients elected to undergo surgery less than 25 % of the time . Patients who decided to have surgery generally did so between 6 and 12 weeks , and few had surgery between 3 and 24 months . CONCLUSION Nonoperative treatment using this physical therapy protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75 % of patients followed up for 2 years BACKGROUND Controversy exists regarding the optimal technique for arthroscopic rotator cuff repair . The purpose of this multicenter , r and omized , double-blind controlled study was to compare the functional outcomes and healing rates after use of single-row and double-row suture techniques for repair of the rotator cuff . METHODS Ninety patients undergoing arthroscopic rotator cuff repair  were r and omized to receive either a single-row or a double-row repair . The primary objective was to compare the Western Ontario rotator cuff index ( WORC ) score at twenty-four months . Secondary objectives included comparison of the constant and american shoulder and elbow surgeons ( ASES ) scores and strength between groups . Anatomical outcomes were assessed with magnetic resonance imaging ( MRI ) or ultrasonography to determine the postoperative healing rates . RESULTS Baseline demographic data including age ( p = 0.29 ) , sex ( p = 0.68 ) , affected side ( p = 0.39 ) , and rotator cuff tear size ( p = 0.28 ) did not differ between groups . The WORC score did not differ significantly between groups at any time point ( p = 0.48 at baseline , p = 0.089 at three months , p = 0.52 at six months , p = 0.83 at twelve months , and p = 0.60 at twenty-four months ) . The WORC score at each postoperative time point was significantly better than the baseline value . The Constant score , ASES score , and strength did not differ significantly between groups at any time point . Logistic regression analysis demonstrated that a smaller initial tear size and double-row fixation were associated with higher healing rates . CONCLUSIONS No significant differences in functional or quality -of-life outcomes were identified between single-row and double-row fixation techniques . A smaller initial tear size and a double-row fixation technique were associated with higher healing rates as assessed with ultrasonography or MRI . LEVEL OF EVIDENCE Therapeutic level I. See Instructions for Authors for a complete description of levels of evidence Background : Little is known about the influence of rotator cuff pathology on sleep . The purpose of this study was to determine which patient-reported factors correlate with sleep disturbance in patients with rotator cuff disease . Methods : A nonr and omized , cross-sectional cohort study was performed to evaluate the effects of rotator cuff disease on sleep quality . Data collected at time zero ( before any treatment ) included the  Single Assessment Numeric Evaluation rating  , the  American Shoulder  and Elbow  Surgeons score , the  Pittsburgh Sleep Quality Index  , patient demographics , and medical comorbidities . Statistical analysis included the Pearson correlation and multiple regression analysis to determine which patient-reported factors were associated with sleep disturbance . Results : Nocturnal pain was reported by 91 % of the 391 participants ( 274 with tendinitis and 117 with rotator cuff tears ) . Participants had a mean age of 57 years . Pearson correlation coefficients determined that poor sleep quality in one group or both the tendinitis and the rotator cuff tear groups was associated with higher pain visual analog scale scores ( 0.27 and 0.31 ; P = 0.004 and P < 0.0001 , respectively ) , depression ( 0.27 and 0.30 ; P < 0.01 ) , female sex ( 0.24 and 0.27 ; P < 0.001 ) , presence of low back pain ( 0.25 and 0.27 ; P < 0.01 ) , diabetes mellitus ( 0.24 in the rotator cuff tear group ; P < 0.01 ) , and increased body mass index ( 0.22 and 0.27 ; P = 0.02 ) . Discussion : The status of the rotator cuff did not correlate with increasing symptoms of shoulder pain or with worse sleep quality as measured by the Pittsburgh Sleep Quality Index . These results support the theory that worsening symptoms of shoulder pain may not be clearly associated with rotator cuff disease severity . Conclusion : Worse sleep quality scores in patients with rotator cuff disease are associated with pain , depression , female sex , low back pain , diabetes mellitus , and high body mass index . Overall , sleep quality did not differ among patients with varying rotator cuff disease severity . Only hypertension ( in patients with rotator cuff tears ) and concurrent cervical pathology ( in patients with tendinitis ) were uniquely related to the disease classification . Further investigation is needed to better define how these factors interact and influence nocturnal shoulder pain and sleep quality in patients with rotator cuff disease . Level of Evidence : Level III prognostic cohort Background Open rotator cuff repairs have led to excellent clinical results ; however , several studies have linked postoperative structural integrity to patient outcomes . The purpose of this study is to prospect ively assess postoperative cuff integrity after  open rotator cuff repair  and assess its relationship to clinical outcome . Hypothesis Preoperative rotator cuff tear size and postoperative rotator cuff integrity are important factors in overall clinical outcomes . Study Design Prospect i ve nonr and omized clinical outcomes study . Methods Forty-seven consecutive patients undergoing repair of full-thickness rotator cuff tears by a single surgeon were enrolled in this prospect i ve study . A st and ardized evaluation was performed preoperatively and postoperatively at annual intervals . All patients underwent  postoperative magnetic resonance imaging at least 1 year after surgery . Statistical evaluation was performed using paired and unpaired 2-tailed t tests for comparison . Results Thirty-two patients were available for evaluation . Overall , the patients experienced a significant ( P < .05 ) improvement in their American Shoulder and Elbow Surgeons survey ( 40 - 85 ) and Constant ( 53 - 80 ) scores . The overall retear rate was 31 % . Although patients with large tears preoperatively and retears postoperatively had lower overall outcomes scores , this was not significant . Conclusion These data support open rotator cuff repair as an effective technique that restores excellent shoulder function . The authors did not find postoperative cuff integrity to have a significant effect on outcomes when compared with those with an intact cuff . In fact , those with a retear still had a significant improvement in all clinical areas assessed , including strength
Results Weak to moderate cross-sectional associations were found for emotional or mental health with function or disability and pain in multiple studies .
Lower emotional or mental health function was associated with greater pain or disability or lower physical function at initial evaluation .
Conclusions At the initial evaluation of patients with rotator cuff tear , there was an association between self-reported function and pain and emotional or mental health .
However , these factors were not associated with patient-reported outcomes after intervention .
Preoperative patient expectation is an important predictor of patient-reported outcomes in patients after rotator cuff surgery and may be a modifiable target for enhancing recovery .
Background Psychosocial factors are key determinants of health and can influence patient-reported outcomes after rotator cuff tears .
However , to our knowledge , a systematic review of published studies has not been conducted to determine the degree of consistency and strength of the relationship between psychosocial factors and patient-reported outcomes in this patient population .
Questions / purpose s ( 1 ) Are psychosocial factors associated with patient-reported measures at initial clinical presentation in patients with rotator cuff tears ? (
2 ) Are psychosocial factors associated with patient-reported outcomes after treatment in patients with rotator cuff tears ?