Assessment of function in patients with rotator cuff tears: Functional test versus self-reported questionnaire (original) (raw)
2014, International journal of shoulder surgery
The rotator cuff tears (RCT) are a well-known cause of shoulder pain and loss of upper extremity function. The purpose of this study was to evaluate the upper extremity function using two different methods in patients with RCT and to determine the parameters that influence the upper extremity function. A sample of 38 patients (27-76 years; 10 men and 28 women) who were diagnosed with a chronic full-thickness RCT, confirmed by magnetic resonance imaging (MRI), was studied. Upper extremity function was determined using Western Ontario Rotator Cuff Index (WORC) and 9 Hole Peg Test (9PEG). Other assessments included active range of motion (ROM), muscle strength, shoulder pain, and scapular dyskinesis. There was a weak association between WORC scores and 9PEG. A statistically significant, negative relationship was found between 9PEG and ROM in supination, as well as muscle strength of shoulder extensors, adductors, internal and external rotators. In addition to the weak association betwe...
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2019
Clinical outcomes and upper extremity functions are deteriorated over time in degenerative rotator cuff tear (dRCT). Therefore, evaluation of the radiological and clinical parameters in cases with dRCT will guide to choose a proper treatment. This article is a case-control study which investigates the effects of age related changes on degree of anatomic abnormalities in individuals with dRCT and the influence of these parameters on upper extremity functions (UEF). 20 healthy participants and 43 symptomatic patients with dRCT participated in this study. The healthy group and patient group were divided into 2 categories based on their ages and degree of abnormalities. UEF was determined with Western Ontario Rotator Cuff Index (WORC) and 9 Hole Peg Test (9PEG). Number of tendons, tear size, humeral head migration>7mm (Mig>7mm), humeral cysts, presence of retraction (PR) and muscle atrophy (MA) were evaluated with MRI. Mean age of the patients with severe radiological parameters w...
Background: The purpose of the present study was to validate the Functional Shoulder Score (FSS), a new patientreported outcome score specifically designed to evaluate patients with rotator cuff disorders. Methods: One hundred and nineteen patients were assessed using two shoulder scoring systems [the FSS and the Constant-Murley Score (CMS)] at 3 weeks pre-and 6 months post-arthroscopic rotator cuff surgery. The reliability, validity, responsiveness and interpretability of the FSS were evaluated. Results: Reliability analysis (test-retest) showed an intraclass correlation coefficient value of 0.96 [95% confidence interval (CI) ¼ 0.92 to 0.98]. Internal consistency analysis revealed a Cronbach's alpha coefficient of 0.93. The Pearson correlation coefficient FSS-CMS was 0.782 pre-operatively and 0.737 postoperatively (p < 0.0005). There was a statistically significant increase in FSS scores postoperatively, an effect size of 3.06 and standardized response mean of 2.80. The value for minimal detectable change was AE8.38 scale points (based on a 90% CI) and the minimal clinically important difference for improvement was 24.7 AE 5.4 points. Conclusions: The FSS is a patient-reported outcome measure that can easily be incorporated into clinical practice, providing a quick, reliable, valid and practical measure for rotator cuff problems. The questionnaire is highly sensitive to clinical change.
Asymptomatic rotator cuff tears: Patient demographics and baseline shoulder function
Journal of Shoulder and Elbow Surgery, 2010
Background-The purpose of this study is to characterize the demographic features and physical function of subjects with asymptomatic rotator cuff tears and to compare their shoulder function to controls with an intact rotator cuff. Materials and Methods-196 subjects with an asymptomatic rotator cuff tear and 54 subjects with an intact rotator cuff presenting with a painful rotator cuff tear in the contralateral shoulder were enrolled. Various demographic features, shoulder function (ASES score and SST score), range of motion and strength were compared. Results-The demographic features of the study and control groups were similar. Hand dominance was associated with the presence of shoulder pain (p < .05). Subjects with an intact rotator cuff had greater but clinically insignificant ASES (p < .05) and SST scores (p < .05) than those with an asymptomatic tear. No differences in functional scores, range of motion or strength were seen between partial (n=61) and full-thickness tears (n=135). Of the full-thickness tears, 36 (27%) were classified as small, 85 (63%) as medium and 14 (10%) as large tears. No differences were seen in functional scores between full-thickness tears of various sizes. Conclusions-When asymptomatic, a rotator cuff tear is associated with a clinically insignificant loss of shoulder function compared to those with an intact rotator cuff. Therefore, a clinically detectable decline in shoulder function may indicate an "at-risk" asymptomatic tear. The presence of pain is important in cuff deficient shoulders for creating a measurable loss of shoulder function. Hand dominance appears to be an important risk factor for pain.
Journal of Shoulder and Elbow Surgery, 2005
Patients with rotator cuff tears have varying degrees of symptom expression. Our purpose was to evaluate the differential firing patterns of the rotator cuff, deltoid, and scapular stabilizer muscle groups in normal control subjects and in patients with symptomatic and asymptomatic 2-tendon rotator cuff tears. Eighteen subjects were evaluated: six normal subjects and twelve with 2-tendon cuff tears (six asymptomatic and six symptomatic). All cuff tear patients had magnetic resonance imaging (MRI) scans documenting superoposterior tear configurations involving the supraspinatus and infraspinatus tendons; all normal subjects had an ultrasound examination confirming the absence of cuff pathology. Subjects were grouped based on shoulder examination and outcomes questionnaires. Asymptomatic patients had minimal pain (Ͻ3 on the visual analog scale and no loss of active range of motion compared with the contralateral side); symptomatic patients had pain greater than 3 on the visual analog scale and decreased range of motion compared with the contralateral side (Ͼ10°of motion loss). Electromyographic activity from 12 muscles and kinematic data were collected simultaneously during 10 functional tasks. Both symptomatic and asymptomatic cuff subjects demonstrated a trend toward increased muscle activation during all tasks compared with normal subjects. During the internal rotation tasks, asymptomatic patients had significantly greater (P Ͻ .05) subscapularis activity than symptomatic patients (65% maximal voluntary contraction [MVC] vs 42% MVC). During the carrying task, asymptomatic patients dem-onstrated significantly less (P Ͻ .03) upper trapezius muscle activation than symptomatic patients (16% MVC vs 50% MVC). During shoulder elevation tasks, symptomatic patients had significantly greater supraspinatus (52% MVC vs 28% MVC, P Ͻ .03), infraspinatus (32% MVC vs 16% MVC, P Ͻ .05), and upper trapezius (39% MVC vs 20% MVC, P Ͻ .04) muscle activation compared with asymptomatic patients. During heavy elevation , asymptomatic patients showed a trend toward increased activation (P Ͻ .06) of the subscapularis compared with symptomatic patients (34% MVC vs 21% MVC). Differential shoulder muscle firing patterns in patients with rotator cuff pathology may play a role in the presence or absence of symptoms. Asymptomatic subjects demonstrated increased firing of the intact subscapularis, whereas symptomatic subjects continued to rely on torn rotator cuff tendons and periscapular muscle substitution, resulting in compromised function. (J Shoulder Elbow Surg 2005;14:165-171.)
JSES International, 2021
Background: Altered scapular motion is thought to be one of the factors associated with the development of symptomatic rotator cuff tears. However, the differences in kinematics and muscle activities of scapular upward/downward rotation between patients with symptomatic and asymptomatic tears are unclear. The purpose of this study was to compare the differences in kinematics and muscle activities of scapular rotation among patients with symptomatic and asymptomatic tears, and healthy individuals. Methods: Twenty-three patients with rotator cuff tears and 9 healthy individuals (healthy group) participated in this study. Based on a visual analog scale (VAS, 0-100 mm), the patients were divided into symptomatic (13 patients; VAS !20 mm) and asymptomatic (10 patients; VAS <20 mm) groups. Scapular upward rotation was measured with a digital inclinometer. Elasticities of the upper trapezius, levator scapulae, and rhomboid major were assessed by using ultrasound real-time tissue elastography to quantify their muscle activities. All measurements were performed at 0 , 60 , 90 , and 120 of active arm elevation in the scapular plane. Results: Scapular upward rotation was significantly less in the symptomatic group (9.4 ± 5.6) compared with the asymptomatic group (15.7 ± 6.0 ; P ¼ .022) at 90 of arm elevation. The activity of the levator scapulae was significantly higher in the symptomatic group compared with the asymptomatic and healthy groups (P ¼ .013 and P ¼ .005, respectively) at 90 of arm elevation. The activity of the upper trapezius was significantly higher in the symptomatic group compared with the healthy group (P ¼ .015) at 120 of arm elevation. Conclusion: Patients with symptomatic rotator cuff tears showed less scapular upward rotation and higher activity of the levator scapulae at 90 of arm elevation compared to patients with asymptomatic rotator cuff tears.
2007
Background: Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons. Methods: Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function.
Rotator cuff tears: functional outcomes of open surgery
Background: The aim of the present study was to evaluate the clinical and radiological outcomes of the patients who underwent open surgical repair with the diagnosis of rotator cuff rupture. Methods: Twenty-eight rotator cuff tear patients refractory to conservative treatment and underwent open rotator cuff repair between April 2012 and April 2017 were retrospectively included in the study. Patients were assessed radiologically and clinically before and after surgery. Patients' age, gender, duration of complaints, the type of the rupture, the data obtained during operation (rupture size, shape, affected tendon, the presence of retraction if any), postoperative complications were recorded. Functional assessments of the patients were performed at 6th and 12th months preoperatively and postoperatively with objective assessments using Constant and UCLA scoring. All patients' operated shoulders were evaluated with MRI during their recent follow-up. Results: The mean postoperative...
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