Rotator Cuff Tendinopathy: Magnitude of Incapability is Associated with Greater Symptoms of Depression Rather than Pathology Severity

These authors point out that most people develop rotator cuff tendinopathy during their lifetime, that it is often well accommodated by the patient without major functional loss, and that there is limited correspondence between symptom intensity and pathology severity. Furthermore they note mounting evidence that the ability to adapt to painful pathology, measured as symptom severity and magnitude of capability using patient reported outcome measures (PROMs), has notable inverse associations with unhelpful thoughts and distress (worry and despair) regarding symptoms.

They analyzed a retrospective cohort of 71 adults seeking specialty care for symptoms of rotator cuff tendinopathy, that had a recent Magnetic Resonance Imaging (MRI) of the shoulder, and completed the following questionnaires: PROMIS Global Health (a measure of symptom intensity and magnitude of capability, consisting of the mental and physical Health subscores), the Generalized Anxiety Disorder (symptoms of anxiety), and the Patient Health Questionnaire (symptoms of depression).

They measured the sagittal length of the rotator cuff defect and tendon retraction in millimeters on MRI (excellent reliability) and rated the rotator cuff muscle atrophy and fat infiltration (more limited reliability) and we used the average of measurement or rating for each patient.

They found that lower scores on the PROMIS Global Health total score and physical health subscale were independently associated with greater symptoms of depression but not with measures of tendon pathology.

Comment: The observation that the global health and physical health scores among people seeking care for symptoms from rotator cuff pathology is inversely associated with symptoms of depression but not with measures of the severity of the rotator cuff pathology is important because impaired global heath and physical health are often used both (1) as a major component of the indications for rotator cuff surgery and (2) as tools for evaluating the efficacy of treatment. If depression is a major driver of these metrics, the presence and severity of depression will confound analyses of treatment indications and outcomes.

An important implication of this study is that individuals with good mental health may be better able to maintain the functional capability of their shoulders in spite of the natural age-related deterioration in their rotator cuff tissue.

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