The symptoms experienced by patients with rotator cuff pathology vary widely, ranging from asymptomatic to disabling (see Asymptomatic Rotator Cuff Tears). In A prospective multipractice investigation of patients with full-thickness rotator cuff tears: the importance of comorbidities, practice, and other covariables on self-assessed shoulder function and health status the authors found that shoulder function of patients with cuff tears was correlated with medical and social comorbidities.

In a study of 191 patients with full thickness cuff tears, the authors of A prospective, multipractice study of shoulder function and health status in patients with documented rotator cuff tears found that shoulder function was significantly correlated with patient sex, involvement of the infraspinatus tendon and workers’ compensation claims.

The authors of Patient self-assessed shoulder comfort and function and active motion are not closely related to surgically documented rotator cuff tear integrity found that the extent of the cuff tear was poorly associated with the shoulder's comfort or function.

A systematic review, Are Psychosocial Factors Associated With Patient-reported Outcome Measures in Patients With Rotator Cuff Tears? found that lower emotional and mental health function was associated with greater pain, disability and lower physical function in patients with cuff tears.

The authors of Psychological distress negatively affects self-assessment of shoulder function in patients with rotator cuff tears found that higher levels of psychological distress are associated with inferior patient self-assessment of shoulder pain and function using the VAS, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score.

Depression may drive patients to have evaluation and treatment for cuff disorders as suggested by the authors of Depression increases the risk of rotator cuff tear and rotator cuff repair surgery: a nationwide population-based study. who found that a diagnosis of cuff tear and the incidence of rotator cuff repair surgery was greater in patients with depression. Depressed patients also had a significantly increased risk of subsequent rotator cuff repair surgery.

Recently, the authors of Rotator cuff tendinopathy: magnitude of incapability is associated with greater symptoms of depression rather than pathology severity again pointed out that while rotator cuff tendinopathy develops in most persons during their lifetimes, it is often accommodated, and that there is limited correspondence between symptom intensity and pathology severity.

They studied the relative association of functional capability with symptoms of anxiety or depression and with quantifications of rotator cuff pathology such as defect size, degree of retraction, and muscle atrophy among 71 adults seeking specialty care for symptoms of rotator cuff tendinopathy who had a recent shoulder MRI and completed the following questionnaires:

1.Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health questionnaire (a measure of symptom intensity and magnitude of

capability, consisting of mental and physical health subscores),

2. Generalized Anxiety Disorder (GAD) questionnaire (measuring symptoms of anxiety), and

3. Patient Health Questionnaire (PHQ) (measuring symptoms of depression).

Muscle atrophy was assessed based on oblique-sagittal plane MRI images medial to

the coracoid process according to the system of Warner et al with conversion to a 4-point numeric scale. Grade 0 (no atrophy) was assigned when the muscle completely filled its fossa and there was a convex extension out of the fossa; grade 1 (mild atrophy), when the muscle filled the fossa and the outer contour was flat with respect to the fossa; grade 2 (moderate atrophy), when the muscle was concave with respect to the fossa; and grade 3 (severe atrophy), when the muscle was barely apparent in the fossa.

They found the magnitude of incapability among patients seeking care for rotator cuff pathology was associated with symptoms of depression but not with the severity of the rotator cuff pathology.

Comment: Taken together these studies suggest that the symptoms and degree of disability experienced by patients with rotator cuff tears is strongly influenced by factors other than the magnitude of the cuff pathology. Such factors may include coverage by workers' compensation insurance, patient sex, social well being and mental health. These same factors may influence the tipping point for rotator cuff repair surgery and may have negative effects on the outcome of this procedure as well.

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