Predictors of pain and function in patients with symptomatic, atraumatic full-thickness rotator cuff tears: a time-zero analysis of a prospective patient cohort enrolled in a structured physical therapy program

Joshua D Harris, Angela Pedroza, Grant L Jones, MOON (Multicenter Orthopedic Outcomes Network) Shoulder Group, Keith M Baumgarten, Julie Y Bishop, Robert H Brophy, James L Carey, Warren R Dunn, G Brian Holloway, John E Kuhn, C Benjamin Ma, Robert G Marx, Eric C McCarty, Sourav K Poddar, Matthew V Smith, Edwin E Spencer, Armando F Vidal, Brian R Wolf, Rick W Wright, Joshua D Harris, Angela Pedroza, Grant L Jones, MOON (Multicenter Orthopedic Outcomes Network) Shoulder Group, Keith M Baumgarten, Julie Y Bishop, Robert H Brophy, James L Carey, Warren R Dunn, G Brian Holloway, John E Kuhn, C Benjamin Ma, Robert G Marx, Eric C McCarty, Sourav K Poddar, Matthew V Smith, Edwin E Spencer, Armando F Vidal, Brian R Wolf, Rick W Wright

Abstract

Background: Although the prevalence of full-thickness rotator cuff tears increases with age, many patients are asymptomatic and may not require surgical repair. The factors associated with pain and loss of function in patients with rotator cuff tears are not well defined.

Purpose: To determine which factors correlate with pain and loss of function in patients with symptomatic, atraumatic full-thickness rotator cuff tears who are enrolled in a structured physical therapy program.

Study design: Cross-sectional study; Level of evidence, 3.

Methods: A multicenter group enrolled patients with symptomatic, atraumatic rotator cuff tears in a prospective, nonrandomized cohort study evaluating the effects of a structured physical therapy program. Time-zero patient data were reviewed to test which factors correlated with Western Ontario Rotator Cuff (WORC) index and American Shoulder and Elbow Surgeons (ASES) scores.

Results: A total of 389 patients were enrolled. Mean ASES score was 53.9; mean WORC score was 46.9. The following variables were associated with higher WORC and ASES scores: female sex (P = .001), education level (higher education, higher score; P < .001), active abduction (degrees; P = .021), and strength in forward elevation (P = .002) and abduction (P = .007). The following variables were associated with lower WORC and ASES scores: male sex (P = .001), atrophy of the supraspinatus (P = .04) and infraspinatus (P = .003), and presence of scapulothoracic dyskinesia (P < .001). Tear size was not a significant predictor (WORC) unless comparing isolated supraspinatus tears to supraspinatus, infraspinatus, and subscapularis tears (P = .004). Age, tear retraction, duration of symptoms, and humeral head migration were not statistically significant.

Conclusion: Nonsurgically modifiable factors, such as scapulothoracic dyskinesia, active abduction, and strength in forward elevation and abduction, were identified that could be addressed nonoperatively with therapy. Therefore, physical therapy for patients with symptomatic rotator cuff tears should target these modifiable factors associated with pain and loss of function.

Figures

Figure 1
Figure 1
Flowchart illustrating application of study inclusion and exclusion criteria. RA, rheumatoid arthritis.
Figure 2
Figure 2
Predicted Western Ontario Rotator Cuff (WORC) index score based on sex. Across all degrees of active abduction range of motion (ROM), women had a significantly higher WORC index score.
Figure 3
Figure 3
Predicted Western Ontario Rotator Cuff (WORC) index score based on presence or absence of scapulothoracic dyskinesis. At low active abduction range of motion (ROM), the presence or absence of scapulothoracic (ST) dyskinesis has an imperceptible effect on WORC index score. However, at higher degrees of ROM, the presence of ST leads to a lower WORC index score.

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