The Journal of Bone and Joint Surgery (American). 2006;88:536-540.
doi:10.2106/JBJS.E.00418
© 2006 The Journal of Bone and Joint Surgery, Inc.
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Effect of Medical Comorbidity on Self-Assessed Pain, Function, and General Health Status After Rotator Cuff Repair

Robert Z. Tashjian, MD1, R. Frank Henn, MD2, Lana Kang, MD2 and Andrew Green, MD3

1 Department of Orthopaedic Surgery, Rhode Island Hospital, 2 Dudley Street, COOP 1st Floor, Providence, RI 02905
2 The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
3 University Orthopedics, 2 Dudley Street, Suite 200, Providence, RI 02905. E-mail address: agshoulder{at}aol.com

Investigation performed at the Department of Orthopaedic Surgery, Rhode Island Hospital, Providence, Rhode Island

The authors did not receive grants or outside funding in support of their research for or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

Background: In a previous study, we found that medical comorbidities have a negative effect on preoperative pain, function, and general health status in patients with a chronic rotator cuff tear. In this study, we evaluated the relationship between medical comorbidities and the postoperative outcome of rotator cuff repair.

Methods: One hundred and twenty-five patients were evaluated on the basis of a history (including medical comorbidities) and use of outcome tools preoperatively and at one year after rotator cuff repair. Outcome was evaluated with the Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire, the Simple Shoulder Test (SST), visual analog scales (pain, function, and quality of life), and the Short Form-36 (SF-36).

Results: The mean number of medical comorbidities was 1.91 (range, zero to six). At one year after rotator cuff repair, there were no significant correlations between comorbidities and pain, shoulder function, or quality of life as determined with the SST, DASH, and visual analog scales (p > 0.05). A greater number of comorbidities was associated with a worse postoperative general health status (SF-36 role emotional [p = 0.045], SF-36 bodily pain [p = 0.032], SF-36 general health [p = 0.001], and SF-36 vitality [p = 0.033]). Nevertheless, a greater number of comorbidities was associated with greater improvement, compared with the preoperative status, in the pain score on the visual analog scale (p = 0.009), function as assessed with the visual analog scale (p = 0.022) and the DASH (p = 0.044), and quality of life as assessed with the visual analog scale (p = 0.041).

Conclusions: Patients with more medical comorbidities have a worse general health status after rotator cuff repair. Interestingly, it also appears that these patients have greater improvement in overall shoulder pain, function, and quality-of-life scores compared with preoperative scores. Therefore, despite a negative effect of comorbidities on outcomes, patients with more comorbidities have greater improvement after the repair, to the point where postoperative shoulder function and pain are not significantly influenced by medical comorbidities. Consequently, a higher number of medical comorbidities should not be considered a negative factor in determining whether a patient should undergo rotator cuff repair.

Level of Evidence: Therapeutic Level III. See Instructions to Authors for a complete description of levels of evidence.


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R. F. Henn III, L. Kang, R. Z. Tashjian, and A. Green
Patients' Preoperative Expectations Predict the Outcome of Rotator Cuff Repair
J. Bone Joint Surg. Am., September 1, 2007; 89(9): 1913 - 1919.
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