The Journal of Bone and Joint Surgery (American) 85:690-696 (2003)
© 2003 The Journal of Bone and Joint Surgery, Inc.
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
Douglas T. Harryman, II, MD,
Carolyn M. Hettrich, BS,
Kevin L. Smith, MD,
Barry Campbell, MS,
John A. Sidles, PhD and
Frederick A. Matsen, III, MD
Investigation performed at the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle, Washington
Douglas T. Harryman II, MD (deceased)
Carolyn M. Hettrich, BS
Kevin L. Smith, MD
Barry Campbell, MS
John A. Sidles, PhD
Frederick A. Matsen III, MD
Department of Orthopaedics and Sports Medicine, University of Washington, Box 356500, 1959 Northeast Pacific Street, Seattle, WA 98195-6500. E-mail address for F.A. Matsen III: matsen{at}u.washington.edu
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the Orthopaedic Research and Education Foundation. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. A commercial entity (Douglas T. Harryman II/DePuy Endowed Chair for Shoulder Research) paid or directed, or agreed to pay or direct, benefits to a research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Background: Rotator cuff tears are among the most common conditions of the shoulder. One of the major difficulties in studying patients with rotator cuff tears is that the clinical expression of these tears varies widely and different practices may have substantially different patient populations. The goals of the present prospective multipractice study were to use patient self-assessment questionnaires (1) to identify some of the characteristics of patients with rotator cuff tears, other than the size of the cuff tear, that are correlated with shoulder function, and (2) to determine whether there are significant differences in these characteristics among patients from the practices of different surgeons.
Methods: Ten surgeons enrolled a total of 333 patients with a full-thickness tear of the supraspinatus tendon into this prospective study. Each patient completed self-assessment questionnaires that included items regarding demographic characteristics, prior treatment, medical and social comorbidities, general health status, and shoulder function.
Results: As expected, patients who had an infraspinatus tendon tear as well as a supraspinatus tendon tear had significantly worse ability to use the arm overhead compared with those who had a supraspinatus tear alone (p < 0.005). However, shoulder function and health status were correlated with patient characteristics other than the size of the rotator cuff tear. The number of shoulder functions that were performable was correlated with the subscales of the Short Form-36 and was inversely associated with medical and social comorbidities. The patients from the ten different surgeon practices showed significant differences in almost every parameter, including age, gender, method of tear documentation, tear size, prior treatment, medical and social comorbidities, general health status, and shoulder function.
Conclusions: Clinical studies on the natural history of rotator cuff tears and the effectiveness of treatment must control for a wide range of variables, many of which do not pertain directly to the shoulder. Patients from the practices of different surgeons cannot be assumed to be similar with respect to these variables. Patient self-assessment questionnaires appear to offer a practical method of uniform assessment across different practices.
Level of Evidence: Prognostic study, Level I-1 (prospective study). See Instructions to Authors for a complete description of levels of evidence.
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