Association of Rotator Cuff Injuries with Upper Limb Dysfunction in Security Guards

Influence of dominant- as compared with nondominant-side symptoms on Disabilities of the Arm, Shoulder and Hand and Western Ontario Rotator Cuff scores in patients with rotator cuff tendinopathy

Background: Despite advances in surgical techniques, the use of maximal repair to treat large or massive rotator cuff tears results in a high retear rate postoperatively. Currently, no randomized controlled trials have compared the outcomes of maximal repair with interposition dermal allograft bridging reconstruction. Hypothesis: We hypothesized that large or massive rotator cuff tendon tears reconstructed using bridging dermal allograft would have better clinical outcomes 2 years postoperatively, as measured using the Western Ontario Rotator Cuff (WORC) index, than would those receiving the current gold standard treatment of debridement and maximal repair alone. We also expected that patients treated via bridging reconstruction using dermal allograft would have fewer postoperative failures as assessed using postoperative magnetic resonance imaging scans. Study Design: Randomized controlled trial; Level of evidence 1. Methods: A sample size of 30 patients (determined using a priori sample size calculation) with massive, retracted rotator cuff tears were randomly allocated to 1 of 2 groups: maximal repair or bridging reconstruction using dermal allograft. All patients completed questionnaires (WORC and Disabilities of the Arm, Shoulder and Hand [DASH]) preoperatively and postoperatively at 3 months, 6 months, 1 year, and 2 years. The primary outcome of this study was the WORC index at 2 years. Secondary outcomes included healing rate, progression of rotator cuff arthropathy, and postoperative acromiohumeral distance in both groups. Results: Patients treated via bridging reconstruction using dermal allograft had better postoperative WORC and DASH scores (23.93 ± 24.55 and 15.77 ± 19.27, respectively) compared with patients who received maximal repair alone (53.36 ± 31.93 and 34.32 ± 23.31, respectively). We also noted increased progression to rotator cuff arthropathy in the maximal repair group with an increased retear rate when compared with the reconstruction group (87% and 21%, respectively; P < .001). The acromiohumeral distance was maintained in the reconstruction group but significantly decreased in the maximal repair group. Conclusion: Rotator cuff bridging reconstruction using a dermal allograft demonstrated improved patient-reported outcomes as measured using the WORC index 2 years postoperatively. This technique also showed favorable structural healing rates and decreased progression to arthropathy compared with maximal repair. Trial Registration: ClinicalTrials.gov (NCT01987973)

Cross-cultural adaptation, reliability, and validity of the Italian version of the Western Ontario Rotator Cuff (WORC) Index in subjects with rotator cuff diseases.

No Functional Difference Between Three and Six Weeks of Immobilization After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Non-Inferiority Trial

To examine functional outcomes and radiographic shoulder findings at mid-term after superior capsular reconstruction for irreparable rotator cuff ruptures using a porcine dermal graft. Clinical results for patients not older than 70 years of age with a chronic irreparable superior or posterosuperior tendon defect, which included either a total defect of the supraspinatus tendon or a larger defect, including both the supraspinatus and infraspinatus tendons, treated with a xenograft superior capsular reconstruction technique during a 5-year period between October 2015 and January 2020. Patients were evaluated using the Constant score and Western Ontario Rotator Cuff (WORC) index over a minimum 5-year follow-up. All operated shoulders had magnetic resonance imaging of the injured shoulder after 1 year and after 5 years or later with a qualitative radiographic evaluation of graft integrity. Preoperative x-rays and x-rays at mid-term were classified according to the Hamada classification. Twenty-three patients were operated on. Twenty-one patients completed a mid-term follow-up (range, 60-101 months; mean, 71 months). Mean age was 57 years at the time of surgery. No correlation was found between functional outcome scores, graft durability, and Hamada grade. There was no correlation between functional outcome and any progression of radiographic rotator cuff arthropathy. Patients with a single-tendon defect or patients with no prior rotator cuff operation had better outcomes than patients with a 2-tendon defect and patients with a prior operation. At final follow-up for 21 patients, the mean Constant score improved from an average of 26 points to 68 points (P < .001). The mean WORC index increased from a percentage average of 29% to 76% (P < .001). Twenty-one of 21 patients exceeded recognized minimal clinically important difference (MCID) levels for their Constant scores, and 20 of 21 patients exceeded MCID levels for their WORC indices. At mid-term follow-up, no further complications in terms of graft tears, infections, or revisions were registered. The clinical failure rate was 1 patient out of 21. At the time of completed mid-term follow-up, a substantial number of patients (95%) achieved the MCID for the Constant scores and WORC indices, with no deterioration in functional improvement. No correlations between functional outcomes and radiographic shoulder findings at mid-term were identified. Level IV, retrospective case series.

Comparison of Self-Report and Interview Administration Methods Based on the Brazilian Versions of the Western Ontario Rotator Cuff Index and Disabilities of the Arm, Shoulder and Hand Questionnaire in Patients with Rotator Cuff Disorders

Treatments for rotator cuff tendinopathy include rotator cuff muscle strengthening to promote better muscle recruitment in order to minimize subacromial narrowing during active movement. Glenohumeral adductor recruitment has also been shown to prevent such narrowing in asymptomatic individuals; therefore, adding glenohumeral adductor coactivation during rotator cuff strengthening could enhance the efficacy of rotator cuff strengthening. However, no study has explored its benefits. To compare the short-term efficacy of adding glenohumeral adductor coactivation to a rotator cuff-strengthening program to improve function, reduce symptoms, and increase acromiohumeral distance in adults with rotator cuff tendinopathy. In this single-blind randomized controlled trial, 42 participants with rotator cuff tendinopathy were randomly assigned to 2 groups, one that received strengthening of the scapular and rotator cuff muscles or one that received rotator cuff strengthening plus coactivation with pectoralis major and latissimus dorsi recruitment. The daily programs were performed at home for 6 weeks, with supervised training and follow-up sessions. Functional limitations/symptoms (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire as the primary outcome, and the Western Ontario Rotator Cuff index), pain (visual analog scale), and acromiohumeral distance were measured at baseline, 3 weeks, and 6 weeks. Data were analyzed using a mixed-model analysis of variance. No significant group-by-time interaction was observed for the Disabilities of the Arm, Shoulder and Hand questionnaire, Western Ontario Rotator Cuff index, visual analog scale, and acromiohumeral distance (P≥.055). Significant time effects were obtained for the Western Ontario Rotator Cuff index and visual analog scale for pain with movement (P<.001). The present findings show that adding glenohumeral adductor coactivation to a rotator cuff-strengthening program does not result in improved short-term efficacy in any of the measured outcomes. This study was registered with ClinicalTrials.gov (NCT02837848). Therapy, level 1b. J Orthop Sports Phys Ther 2019;49(3):126-135. Epub 30 Nov 2018. doi:10.2519/jospt.2019.8240.

A questionnaire found disease-specific WORC index is not more responsive than SPADI and OSS in rotator cuff disease

Purpose We aimed to translate and cross-culturally adapt the Western Ontario Rotator Cuff index into Greek (WORC-GR) and evaluate its reliability and validity in a Greek speaking population with rotator cuff (RC) disorders. Materials and methods Translation and cross-cultural adaptation process followed published guidelines. Content and face validity were assessed by 9 experts and 16 patients with RC pathologies, respectively. Internal structure, reliability, measurement error, and convergent validity (correlation with the Disability of the Arm, Shoulder and Hand – DASH, Shoulder Pain and Disability Index – SPADI, and Short Form-36) of the index were evaluated in 104 participants (44.2% women, mean age ± SD: 44.9 ± 15.01 years) with RC related pain. Results The WORC-GR showed excellent item and scale content validity index (0.875–1.00 and 0.975, respectively), internal consistency (Cronbach’s alpha range 0.749 − 0.903) and test-retest reliability (intraclass correlation coefficient: 0.942, 95% CI: 0.913–0.961). Factorial validity testing revealed a 4-factor structure explaining 69.7% of the total variance. High positive correlations were found with DASH (r = 0.806) and SPADI (r = 0.852). Conclusions WORC-GR is a reliable and valid instrument to assess symptoms in patients with RC disorders. Further research on the content validity, internal structure, and responsiveness of the tool is required. Implications for rehabilitation The Greek version of WORC (WORC-GR) is a clear and comprehensible patient reported outcome measure. WORC-GR has excellent internal consistency, test-retest reliability and with no floor and ceiling effects. WORC-GR is a valid outcome measure for patients with rotator cuff disorders.

Although rotator cuff injures are often associated with a limited range of motion and muscle weakness, being able to conduct pain-free and efficient performances of the activities as part of daily living seems to be more important for patients. The aim of this study was to investigate the correlation between two questionnaires—the disease-specific, subjective questionnaire termed the Western Ontario Rotator Cuff Index (WORC), and the shoulder-specific, subjective-objective questionnaire Constant–Murley score (CMS), with the objective assessment of external rotator muscle strength, and the subjective assessment of pain according to the visual analog scale (VAS) in patients after arthroscopic rotator cuff repair. The study was carried out among 47 patients twice—6 and 12 months after surgery, respectively. All patients completed the WORC, the CMS, and the VAS. Isokinetic evaluation of the external rotators was performed using the Biodex 4 ProSystem. The correlations of all assessed muscle strength parameters with both the CMS and the WORC were found to be statistically significant, being mostly average during the 1st examination and mostly strong during the 2nd examination. There was a significant improvement in all assessed tools as a result of the undertaken rehabilitation. There were weak correlations present between changes in the WORC and changes in the external rotator muscle strength, with correlations between WORC-Sport and EXT900-AVERAGE-POWER and PEAK-TORQUE also being found statistically significant. Correlations of changes in the CMS scale with changes in the external rotator muscle strength were weak and statistically insignificant. It seems that the WORC questionnaire can be recommended more for the population after rotator cuff repair, which allows for a reliable assessment of patients’ ability to function and its changes in various areas of life, and at the same time does not require a direct assessment by a clinician or researcher.

Introduction: The Western Ontario Rotator Cuff (WORC) Index is a self-assessment instrument that has been developed to measure the quality of life of patients with rotator cuff disease. The WORC index was developed by Kirkley et al., 2003 to evaluate the diseasespecific quality of life of patients with rotator cuff disease. Aim: To translate the WORC index into Punjabi language (P-WORC) and to evaluate its adaptation, validation and reliability among patients with Rotator Cuff tendinopathy. Materials and Methods: Beaton’s guidelines have been followed for the translation process after obtaining approval from the original developer, then forward and backward translations by two independent translators will be performed.Cultural adaptation was achieved through feedback from 30 outpatient participants regarding the scale’s clarity. Content validation was conducted using the Delphi method, involving a panel of 10 experts with more than five years of experience.Experts evaluated each item for relevance and consistency, deeming it valid if at least 80% rated it as "valid." Reliability testing was performed on a sample of 51 patients. Ethical approval was granted by the Institutional Ethics Committees (IEC-2995) in June 2024, and the study was registered with the Clinical Trials Registry of India (CTRI/2024/08/072815) on August 21, 2024.

Comparison of computerized and paper versions of the Western Ontario Rotator Cuff (WORC) Index

To adapt the Western Ontario Rotator Cuff (WORC) index for use in Turkey and to investigate its reliability and validity; the Turkish version of the WORC was developed according to the guidelines in the literature. Seventy-two patients with rotator cuff disease were administered the questionnaire and were also evaluated by using the University of California Los Angeles (UCLA) shoulder rating scale, Constant score, and Short Form (SF)-36 to test validity. The WORC questionnaire was repeated in 35 patients after a mean interval of 2.9 days (range 2-7 days) to evaluate test-retest reliability. Cronbach's alpha was calculated as 0.92 for the total questionnaire. The intraclass correlation coefficients were very high and ranged between 0.96 and 0.98 for each section. There was a significant negative correlation between the Turkish version of WORC and UCLA (r = -0.598, P < 0.01), Constant score (r = -0.630, P < 0.01), and all subscales of SF-36 (P < 0.01). The Turkish version of the WORC index is a reliable and valid instrument for use in clinical trials in patients with rotator cuff disorders.

Single Assessment Numeric Evaluation (SANE) correlates with American Shoulder and Elbow Surgeons score and Western Ontario Rotator Cuff index in patients undergoing arthroscopic rotator cuff repair

BackgroundThe smallest worthwhile effect (SWE) is the minimum benefit required in addition to that from a comparator for an intervention to be considered worthwhile by patients. We aimed to estimate the SWE for rotator cuff repair (with decompression and debridement) compared to either decompression and debridement alone or to non-surgical treatment for people with atraumatic shoulder pain.MethodsBenefit-harm trade-off study. We recruited English-speaking adults aged 45–75 years with shoulder pain of intensity ≥ 4 (on a 0–10 scale) for ≥ 6 months to our online survey through paid advertising on Facebook. Participants must have sought care in the past 6 months and could not have had recent shoulder surgery or significant recent shoulder trauma. Participants were explained three treatments: rotator cuff repair (with subacromial decompression and debridement), subacromial decompression and debridement alone, and non-surgical treatment. Participants completed the benefit-harm trade-off survey to determine the SWE of improvements in pain and function for rotator cuff repair compared to the other treatments and again after one week to assess reliability. We used univariable linear regression to estimate associations between baseline characteristics and SWE.ResultsWe recruited 56 participants. The mean ± standard deviation age was 58.4 ± 6.7 years, and 39 (70%) were female. For rotator cuff repair to be worthwhile compared to decompression and debridement alone, participants needed to see at least a median 40% (interquartile range (IQR) 20–62.5) between-group improvement in pain and function. Compared to non-surgical treatment, the SWE was a median 40% (IQR 30–60). On the Western Ontario Rotator Cuff (WORC) Index, the SWE values equate to a between-group improvement of 28/100 points (533/2100 on the raw WORC score). Female sex was associated with larger SWEs for both comparisons. Reliability analyses were underpowered, 25/56 (45%) provided follow-up data. The intraclass correlation coefficient estimates ranged from 0.60 to 0.77.ConclusionsThis SWE indicates the benefit required by people with shoulder pain to consider the costs and risks of surgical rotator cuff repair worthwhile is larger than previously estimated minimum clinically important differences (13.5–28/100 on the WORC Index). This SWE may be used to inform the design or interpret the findings of trials of these comparisons.Trial registrationOpen Science Framework (osf.io/crj9p). Registered retrospectively on 11/06/2024.