Wednesday, April 24, 2013

Rotator cuff repair and depression / anxiety

The impact of depression and anxiety on self-assessed pain, disability, and quality of life in patients scheduled for rotator cuff repair

This important article investigated the prevalence of psychological distress and its effect on self-assessed pain, disability, and health-related quality of life in 107 patients scheduled for rotator cuff repair. Essentially 1 out of 4 patients had depression and 1 out of 4 had anxiety. The depression score positively correlated with a visual analog scale pain score and negatively correlated with self-assessed function. On multivariate analysis with a linear regression model, the depression score was an independent predictor of self-assessed function.

The bottom line is that both depression and rotator cuff tears are common entities. These authors have shown that in patients with cuff tears, self assessed comfort and function is worse when depression is present.

The authors state, "Our study is the first to show that depression and anxiety are contributing factors to the magnitude of preoperative self-assessed pain, functional disability, and HRQOL in patients undergoing rotator cuff repair." The question is, have they shown causation or association? See this.

The message is that while we cannot be sure of the cause and effect relationships, we need to be alert to the presence of depression in our patients along with its possible role in the comfort and function of the shoulder. We cannot assume that fixing a cuff tear will resolve the mood issue.

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