Monday, May 3, 2021

What determines the preoperative comfort and function of patients coming for shoulder arthroplasty?

Associations of preoperative patient mental health status and sociodemographic and clinical characteristics with baseline pain, function, and satisfaction in patients undergoing primary shoulder arthroplasty

These authors hypothesized that worse mental health status assessed by the Veterans RAND 12-Item Health Survey (VR-12) mental component score (MCS), glenoid bone loss, and increasing rotator cuff tear severity would be associated with lower values for the preoperative shoulder comfort and function as reflected by the Penn Shoulder Score in 788 patients having shoulder arthroplasty. 

They found that the following factors were statistically significantly associated with lower total scores for preoperative comfort and function: a lower VR-12 MCS, fewer years of eduction, female sex, and preoperative opiod use. Interestingly, shoulder characteristics, such as prior surgery, glenoid bone loss, and rotator cuff status did not have statistically significant associations with preoperative comfort and function in either omnibus tests or in Bonferroni-Holm adjusted pair-wise comparisons for trichotomous variables.

Comment: The lack of significant relationship between the severity of shoulder pathoanatomy and preoperative comfort and function was also noted by another recent article Prearthroplasty glenohumeral pathoanatomy and its relationship to patient’s sex, age, diagnosis, and self-assessed shoulder comfort and function in which the individuals with higher grades of shoulder pathology had better preoperative comfort and function (see below).

It appears that patient factors rather than shoulder factors are the primary determinants of preoperative shoulder comfort and function.

It seems likely that the same patient factors (lower VR-12 MCS, fewer years of eduction, female sex, and preoperative opiod use) may have strong effects on the comfort and function after shoulder arthroplasty. 

Here are some videos that are of shoulder interest
Shoulder arthritis - what you need to know (see this link).
How to x-ray the shoulder (see this link).
The ream and run procedure (see this link).
The total shoulder arthroplasty (see this link).
The cuff tear arthropathy arthroplasty (see this link).
The reverse total shoulder arthroplasty (see this link).
The smooth and move procedure for irreparable rotator cuff tears (see this link).
Shoulder rehabilitation exercises (see this link).