RESUMO
BACKGROUND: Work-related rotator cuff injuries are a common cause of disability and employee time loss. PURPOSE: To examine the effectiveness of expedited rotator cuff surgery in injured workers who underwent rotator cuff decompression or repair and to explore the impact of demographic, clinical, and psychosocial factors in predicting the outcome of surgery. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Injured workers who were seen at a shoulder specialty program and who underwent expedited arthroscopic rotator cuff decompression or repair were observed for a period of 6 to 12 months based on their type of surgery and recovery trajectory. The primary outcome measure was the American Shoulder and Elbow Surgeons (ASES) Standardized Shoulder Assessment Form. The impact of surgery was assessed by whether the change in the ASES score exceeded the minimal clinically important difference (MCID) of 17 points. Secondary outcomes were range of motion (ROM), medication consumption, and work status. RESULTS: One hundred forty-six patients (43 women [29%], 103 men [71%]; mean age, 52 years; SD, 8 years) completed the study. Sixty-seven (46%) patients underwent rotator cuff repair. The mean time between the date the patient consented to have surgery and the date of surgery was 82 (SD, 44) days. There was a statistically significant improvement in ASES score and ROM and work status (52 returned to regular duties and 59 to modified duties) (P < .0001). Eighty-four percent (n = 122) of patients exceeded the MCID of 17 points. Individual factors that affected patient overall disability were preoperative ASES, work status prior to surgery, access to care, and autonomy at work. Achieving a minimal clinically meaningful change was influenced by perceived access to care, autonomy and stress at work, and overall satisfaction with the job. CONCLUSION: Expedited rotator cuff surgery improved disability, ROM, and work status in injured workers. Successful recovery after work-related shoulder injuries may further be facilitated by improving the psychosocial work environment and increasing access to care.
RESUMO
PURPOSE: Despite the popularity of the Constant-Murley score (CMS), a combined patient-report and objective (health professional administered) shoulder outcome measure, minimal information exists on its reliability or validity. The purpose of this study was to examine (1) internal consistency and convergent validity of the CMS and (2) the degree to which other shoulder measures explain variation in range of motion and strength components of the CMS. METHODS: In this cross-sectional study of outcome measures, 45 patients undergoing conservative or surgical treatment for rotator cuff disease participated. Two disease-specific outcome measures, one shoulder-specific measure, and one upper extremity outcome measure were compared to the CMS. RESULTS: Correlations between competing measures and relative total CMS were moderate (0.56 to 0.75). The American Shoulder & Elbow Score, the Upper Extremity Functional Index, the Western Ontario Rotator Cuff Index, and the Rotator Cuff Quality of Life index explained 38%, 28%, 26%, and 10% of variance of the objective component of the CMS respectively. CONCLUSIONS: The patient-report component of the CMS measures a multidimensional concept. The strength component had moderate correlations with isometric strength measures of the shoulder external rotators and abductors. The total CMS appears to measure a construct that is not totally captured by competing measures. The unexplained variance may be due, in part, to the lack of importance of the patient's physical impairment to symptoms or activity limitations as measured by other instruments.