Thursday, December 6, 2018

Does arthroscopic rotator cuff repair improve patients’ activity levels?

Does arthroscopic rotator cuff repair improve patients’ activity levels?

These authors used the Shoulder Activity Level outcomes survey to measure patients' shoulder-specific activity level before and at a minimum of two years after 281 arthroscopic rotator cuff repairs. 

The postoperative median Shoulder Activity Level score decreased compared with the preoperative score (12 vs. 11;P < .0001).

The median values for the other shoulder scores were improved at a minimum of two years after surgery: Simple Shoulder Test (4 vs. 11), Western Ontario Rotator Cuff Index (42 vs. 94), American Shoulder and Elbow Surgeons (41 vs. 95), and Single Assessment Numeric Evaluation (30 vs. 95), scores were statistically significantly improved compared with preoperative scores (P < .0001). 

As shown below, there was no relationship between the Shoulder Activity Level score and the standard patient reported outcome scores.

Comment: This study reveals that the  Shoulder Activity Level measures something quite different than, say, the Simple Shoulder Test (SST). The SST scores for all three groups in the chart above showed highly clinically significant improvement, even in the group with decreased Shoulder Activity Level scores. The reasons become apparent when looking at the individual elements of the Shoulder Activity Level (see the first chart above). Patients having cuff repair surgery may have lower Shoulder Activity Level because they want to protect their shoulder from repeat rotator cuff injury by avoiding such activities as carrying objects 8 lbs or heavier by hand, handling objects overhead, swinging a bat or club, lifting objects 25 lbs or heavier,  American football, rugby, soccer, basketball, wrestling, boxing, lacrosse, martial arts, baseball, cricket, or quarterback in American football, overhead serving in tennis or volleyball  or lap/distance swimming - any of these abstentions would lower the Shoulder Activity Level.

Different measures produce different measurements.

We have a new set of shoulder youtubes about the shoulder, check them out at this link.

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