Effect of anxiety and depression on early pain and range of motion after rotator cuff repair - measured by HADS (Hospital Anxiety and Depression Scale) -

Objectives: According to previous studies, the prevalence of anxiety and depression was approximately 25% in patients with rotator cuff tear, and psychological status may be an important predictor for clinical outcomes after rotator cuff repair. Considering continuous steady rehabilitation is essential for recovery of postoperative pain and range of motion (ROM), the anxiety or depression would affect this process. The aim of this study was to evaluate the effect of anxiety and depression measured by HADS (Hospital Anxiety and Depression Scale) on early pain and ROM after rotator cuff repair. Methods: Consecutive 156 patients who underwent arthroscopic rotator cuff repair were prospectively enrolled, and divided into two groups defined by HADS scores; Group I with normal psychological status (n = 105, anxiety ≤ 7 and depression ≤ 7), Group II with psychological distress (n = 51, anxiety ≥ 8 or depression ≥ 8). Same rehabilitation protocols were applied to all patients: 4 ˜ 6 weeks of brace according to tear size, and then ROM exercises. Clinical outcomes were measured with pain VAS and ROM at 3, 6 months and 1 year after surgery. Results: There were no significant differences in age, cuff tear size, preoperative external and internal rotation angle between two groups, but more female patients, higher preoperative pain VAS, and lower range of preoperative forward flexion in Group II (all p < 0.05). At 3 months after surgery, the average of pain VAS was 2.2 ± 1.3 in Group I, which was statistically lower than 3.5 ± 2.0 in Group II. The average forward flexion was 145.4° ± 23.4° in Group I, and 122.5° ± 30.3° in Group II. The average external rotation was 42.3° ± 16.1° in Group I, and 34.7° ± 17.6° in Group II. The mean level of internal rotation at back was T11.6 ± 2.8 in Group I, and L1.9 ± 2.4 in Group II (all p < 0.05). At 6 months after surgery, there was no significant difference in forward flexion (148.9° ± 23.2° in Group I compared with 144.9° ± 25.2° in Group II) and external rotation (59.5° ± 13.4° in Group I compared with 54.5° ± 17.5° in Group II). The mean level of internal rotation at back was T9.4 ± 1.8 in Group I, and T10.0 ± 1.5 in Group II (p < 0.05). The average of pain VAS was 0.8 ± 1.6 in Group I, which was statistically lower than 1.6 ± 2.0 in Group II (p < 0.05). However, there was no significant difference in ROM and pain VAS at 1 year after surgery. Conclusion: The recovery of pain and ROM was faster in patients with normal psychological status after arthroscopic rotator cuff repair. Therefore, psychologic intervention including medication should be collaborated to improve early clinical outcomes after rotator cuff repair through the encouragement of rehabilitation, as well as mitigation of anxiety and depression moods. [Figure: see text]

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Effects of Anxiety and Depression Measured via the Hospital Anxiety and Depression Scale on Early Pain and Range of Motion After Rotator Cuff Repair

The American Journal of Sports Medicine ◽

10.1177/0363546520976574 ◽

2021 ◽

Vol 49 (2) ◽

pp. 314-320

Author(s):

Joo Hyun Park ◽

Sung-Min Rhee ◽

Hyong Suk Kim ◽

Joo Han Oh

Keyword(s):

Rotator Cuff ◽

Clinical Outcomes ◽

Rotator Cuff Repair ◽

Preoperative Anxiety ◽

Arthroscopic Rotator Cuff Repair ◽

Psychological Status ◽

Anxiety And Depression ◽

Group B ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Preoperative anxiety and depression are independent predictors of clinical outcomes after arthroscopic rotator cuff repair. However, few studies have evaluated correlations between outcomes such as pain and range of motion (ROM) after arthroscopic rotator cuff repair and preoperative anxiety and depression. Purpose: To evaluate the effects of preoperative anxiety and depression, measured using the Hospital Anxiety and Depression Scale (HADS), on early pain and ROM after rotator cuff repair. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 144 consecutive patients who underwent arthroscopic rotator cuff repair were enrolled and divided into 2 groups according to HADS scores: group A, those with a healthy psychological status (n = 103; anxiety ≤7 and depression ≤7), and group B, those with psychological distress (n = 41; anxiety ≥8 or depression ≥8). Clinical outcomes were assessed using the visual analog scale for pain (pVAS) and ROM at 3 and 6 months postoperatively and annually. Results: There were no significant preoperative differences in age, sex, tear size, pVAS scores, and ROM. However, at 3 months postoperatively, group A showed significantly lower mean pVAS scores (2.2 ± 1.3 vs 3.4 ± 1.8, respectively; P = .001) and significantly higher mean forward flexion (146.4°± 23.0° vs 124.1°± 28.2°, respectively; P < .001) than group B, as well as significantly higher mean levels of internal rotation at the back (T11.5 ± 2.8 vs L1.9 ± 2.5, respectively; P < .001) and significantly higher mean external rotation (42.4°± 15.9° vs 35.2°± 16.8°, respectively; P = .019). At 6 months postoperatively, the mean pVAS score was still significantly lower in group A than in group B (0.8 ± 1.6 vs 1.8 ± 2.1, respectively; P = .016), but other ROM measurements had no significant differences. There was also no significant difference in clinical and functional outcomes at the final follow-up. Conclusion: Anxiety and depression negatively affected clinical outcomes after rotator cuff repair. Recovery from pain and of ROM after arthroscopic rotator cuff repair occurred more quickly in patients with a healthy psychological status. Therefore, assessments of preoperative psychological status should be emphasized to improve early clinical outcomes after arthroscopic rotator cuff repair.

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Does the Use of Injectable Atelocollagen during Arthroscopic Rotator Cuff Repair Improve Clinical and Structural Outcomes?

Clinics in Shoulder and Elbow ◽

10.5397/cise.2019.22.4.183 ◽

2019 ◽

Vol 22 (4) ◽

pp. 183-189

Author(s):

In Bo Kim ◽

Eun Yeol Kim ◽

Kuk Pil Lim ◽

Ki Seong Heo

Keyword(s):

Rotator Cuff ◽

Clinical Outcomes ◽

Rotator Cuff Repair ◽

Arthroscopic Rotator Cuff Repair ◽

Rotator Cuff Tears ◽

Group I ◽

Significant Difference ◽

Group Ii ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

Background: Since the establishment of biological augmentation to improve the treatment of rotator cuff tears, it is imperative to explore newer techniques to reduce the retear rate and improve long-term shoulder function after rotator cuff repair. This study was undertaken to determine the consequences of a gel-type atelocollagen injection during arthroscopic rotator cuff repair on clinical outcomes, and evaluate its effect on structural integrity.Methods: Between January 2014 and June 2015, 121 patients with full thickness rotator cuff tears underwent arthroscopic rotator cuff repair. Of these, 61 patients were subjected to arthroscopic rotator cuff repair in combination with an atelocollagen injection (group I), and 60 patients underwent arthroscopic rotator cuff repair alone (group II). The visual analogue scale (VAS) for pain and the Korean Shoulder Society (KSS) scores were evaluated preoperatively and postoperatively. Magnetic resonance imaging (MRI) was performed at 6 months postoperatively, to assess the integrity of the repair.Results: VAS scores were significantly lower in group I than in group II at 3, 7, and 14 days after surgery. KSS scores showed no significant difference between groups in the 24 months period of follow-up. No significant difference was obtained in the healing rate of the rotator cuff tear at 6 months postoperatively (<i>p</i>=0.529).Conclusions: Although a gel-type atelocollagen injection results in reduced pain in patients at 2 weeks after surgery, our study does not substantiate the administration of atelocollagen during rotator cuff repair to improve the clinical outcomes and healing of the rotator cuff.

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Short-term Comparison of Supervised Rehabilitation and Home-based Rehabilitation for Earlier Recovery of Shoulder Motion, Pain, and Function after Rotator Cuff Repair

Clinics in Shoulder and Elbow ◽

10.5397/cise.2018.21.1.15 ◽

2018 ◽

Vol 21 (1) ◽

pp. 15-21

Author(s):

Si Jung Song ◽

Tae Ho Jeong ◽

Jung Wha Moon ◽

Han Vit Park ◽

Si Yung Lee ◽

...

Keyword(s):

Rotator Cuff ◽

Internal Rotation ◽

Rotator Cuff Repair ◽

External Rotation ◽

Exercise Group ◽

Short Term ◽

Forward Flexion ◽

Supervised Exercise ◽

Arthroscopic Rotator Cuff ◽

Cuff Repair

BACKGROUND: This study was undertaken to compare the outcome of supervised and home exercises with respect to range of motion (ROM), pain, and Single Assessment Numeric Evaluation (SANE). We further correlated the ROM recovery and pain reduction as well.METHODS: The study included 49 patients who underwent arthroscopic rotator cuff repair. Rehabilitation was initiated after 4 weeks of immobilization. A total of 29 patients performed supervised exercise 3 times a week. Standardized education and brochures for review were provided to the remaining 20 patients who insisted on home rehabilitation. Statistical analysis was performed for comparing pain Numerical Rating Scale (NRS), SANE, and ROM. In addition, we also evaluated the correlation between pain and ROM.RESULTS: Comparison of the two groups revealed no significant differences in forward flexion, internal rotation, abduction, and pain NRS. However, SANE at the 9th week (63.8 vs. 55.0, p=0.038) and improvement of external rotation from the 5th to the 9th week (17.6 vs. 9.3, p=0.018) were significantly higher in the supervised exercise group as compared to the home exercise group. Correlation of pain NRS with forward flexion, external rotation, internal rotation and abduction were statistically not significant (correlation coefficient=0.032 [p=0.828], ?0.255 [p=0.077], 0.068 [p=0.642], and ?0.188 [p=0.196], respectively).CONCLUSIONS: The supervised rehabilitation after arthroscopic rotator cuff repair showed better improvement in external rotation and higher SANE score after 4 weeks of rehabilitation exercise. However, no statistically significant correlation was observed between the recovery of ROM and short-term pain relief.

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Delayed Rehabilitation Protocol after Rotator Cuff Repair

Osteology ◽

10.3390/osteology1010003 ◽

2020 ◽

Vol 1 (1) ◽

pp. 29-38

Author(s):

Alessandra Berton ◽

Sergio De Salvatore ◽

Vincenzo Candela ◽

Gabriele Cortina ◽

Daniela Lo Presti ◽

...

Keyword(s):

Rotator Cuff ◽

Muscle Strength ◽

Internal Rotation ◽

Outcome Measures ◽

Rotator Cuff Repair ◽

External Rotation ◽

Shoulder Function ◽

Rehabilitation Protocol ◽

Patient Reported ◽

Cuff Repair

Rotator cuff tears are a frequent cause of shoulder pain that often require arthroscopic repair. After surgery an intense and well-studied rehabilitation protocol is needed to obtain the complete recovery of shoulder function. Fifty patients, who sustained arthroscopic rotator cuff repair for symptomatic, atraumatic and full-thickness supraspinatus tendon tear, were involved. According to our rehabilitation protocol, during the first four postoperative weeks, the arm was supported with an abduction sling pillow, and pendulum exercises, table slide and active elbow extension and flexion were conceded. Outcome measures (Oxford shoulder score (OSS), simple shoulder test (SST), patient-reported satisfaction), shoulder function (range of motion (ROM) and muscle strength), and MRI examination were evaluated. The mean OSS score and SST score increased from 16 to 30.2 and from 5.3 to 11.4, respectively. Patient-reported satisfaction was 96%. At 12 months, patients improved ROM and muscle strength. Postoperative passive anterior elevation was 176; external rotation averaged 47; internal rotation was 90. Postoperative muscle strength during anterior elevation was 8.3 ± 2.2 kg, internal rotation 6.8 ± 3 kg, external rotation 5.5 ± 2.3 kg. Five out of seven patients with recurrent tears evaluated their results as satisfactory. They reported improvements in terms of OSS and SST mean scores despite recurrent tears; therefore, they did not undergo revision surgery. The delayed postoperative physical therapy protocol was associated with improvements in the outcome measures and shoulder function compared to the preoperatory state and rotator cuff healing demonstrated by MRI.

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