As surgeons it is tempting for us to believe that the outcome of cuff repair is determined by our technical skill (see Rotator cuff repair - does the repair method matter?).
However, it is becoming increasing evident that the result realized by the patient is strongly influenced by factors that are not directly related to the shoulder or the procedure performed. For example a recent post (What determines the outcome of rotator cuff repair?) pointed to the strong relationship between social determinants of health and cuff repair outcomes. A prior post ("Resiliency" - how does it correlate with clinical outcomes of shoulder surgery?) demonstrated that a patient's resiliency after surgery is correlated with the postoperative Simple Shoulder Test and ASES scores. They used the "LOT-R" questions:
In uncertain times, I usually expect the best.
If something can go wrong for me, it will.
I'm always optimistic about my future.
I hardly ever expect things to go my way.
I rarely count on good things happening to me.
Overall, I expect more good things to happen to me than bad.
Postoperative LOT-R scores exhibited a significant correlation with ASES and SST scores.
Recently the authors of Low resilience is associated with decreased patient reported outcomes following arthroscopic rotator cuff repair sought to evaluate the relationship between preoperative resiliency and outcomes following arthroscopic rotator cuff repair in 81 patients. Preoperative evaluation included range of motion, and the following patient-reported outcomes: visual analog scale pain, the American Shoulder and Elbow Surgeons, Veterans RAND 12- Item Health Survey, and the Single Assessment Numeric Evaluation tests and a Brief Resilience Scale.
Low resiliency was defined as a score of less than 20.8, high resiliency was a score greater than 28.8.
There were potentially important differences in patient and shoulder characteristics that did not achieve statistical significance due to the small numbers in the low and high resiliency groups.
Despite similar baseline characteristics and postoperative range of motion and VAS scores, patients with low resiliency had poorer two year postoperative ASES scores and satisfaction compared to patients with high resiliency. Preoperative low resilience was associated with 20-point lower postoperative ASES scores following ARCR. On regression analysis, the final ASES score increased 1.6 points for every 1-point increase in the BRS.
Comment: The relationship of surgical outcomes to resiliency applies not only to cuff repair as shown in Is resilience a predictor of the outcomes of total shoulder arthroplasty?.
These studies bring up some important questions:
(1) what causes lower resiliency?
(2) can these causes be effectively addressed in clinical practice?
(3) how should surgeons use resiliency questionnaires (and other instruments to detect mental health status)?
(4) if low resiliency is detected, how does the surgeon use this information in conversations with the patient and in decision making ("I'm not going to operate on you because you're not resilient." or "I'll operate, but your surgery is less likely to be effective")?
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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).
