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)

Background:Rotator cuff tears are common injuries that are reliably treated witharthroscopic repair, producing good to excellent results. The WesternOntario Rotator Cuff (WORC) index is a validated disease-specific instrumentused to assess patient outcomes; however, no study to date has correlatedWORC index with treatment failure.Purpose:To evaluate the WORC index as a predictor for successful treatment inarthroscopic rotator cuff repair. An additional purpose was to identifypatient and tear characteristics associated with risk of treatmentfailure.Study Design:Case-control study; Level of evidence, 3.Methods:This study reviewed a total of 500 patients who underwent arthroscopicrotator cuff repair with a minimum of 2-year follow-up. Patient charts werereviewed for treatment failures, defined as persistent or recurrent shoulderpain or weakness, leading to further workup and identification of a failureto heal or recurrent tear by magnetic resonance imaging. Patient demographicand comorbidity data were gathered and correlated with risk of failure. Allpatients completed WORC questionnaires, and scores were correlated with riskof treatment failure.Results:There were 28 (5.6%) treatment failures at a median 28 weeks (SD, 42 weeks)postoperatively. Patients claiming workers’ compensation were 3.21 timesmore likely (odds ratio; P = .018) to fail treatment.Posterior interval tears (those including infraspinatus) were 3.14 timesmore likely (P = .01) to fail than anterior interval tears.Tear size was associated with treatment failure; the odds of failure was3.24 for a 2-tendon tear and 5.83 for a 3-tendon tear (P =.03). Tears involving the nondominant arm were associated with an increasedrisk of failure by a factor of 3.04 (95% CI, 1.01-9.11; P =.047). A WORC score ≥80 was associated with a 95% probability of treatmentsuccess at 1 year.Conclusion:After arthroscopic rotator cuff repair, patients with WORC scores ≥80 at 1year have a 95% probability of successful treatment and likely do notbenefit from continued follow-up visits. Furthermore, several risk factorswere identified that may influence outcomes after rotator cuff repair,including workers’ compensation, location of tear, tear size, and handdominance.

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

Patient-reported outcome measures (PROMs) are essential clinical instruments used for assessing patient function and assisting in clinical decision making. The Western Ontario Rotator Cuff (WORC) index is the PROM for shoulder pathology with the most psychometric properties but is very time consuming. The Single Assessment Numeric Evaluation (SANE) method is a PROM that takes less time to answer and to analyze. The aim of the study is to evaluate the intra- class correlation between these two outcome scores in establishing shoulder function in patients with non-traumatic rotator cuff pathologies. Fifty five subjects of both genders and different ages presenting with non-traumatic shoulder pain for more than 12 weeks had a physical examination and ultrasound as well as MRI arthrogram scan findings that were consistent of a non-traumatic rotator cuff (RC) based pathology. On the same moment a WORC index and a SANE score questionnaire were filled in by the subject. The intra class correlation of both PROMs was statistically analyzed. The WORC index score and the SANE score show a moderate correlation with an Intra Class Coefficient (ICC) of r = 0.60 (95% CI:0.40-0.75). This study demonstrates a moderate correlation between the WORC index score and the SANE score in rating the disability of patients with atraumatic RC disease. The SANE score is applicable in research and clinical practice and is for the patient and the researcher an almost no time consuming PROM.

The shoulder terrible triad (STT) is a traumatic anterior shoulder dislocation, associated with rotator cuff (RC) tear and nerve injury from the brachial plexus. This study aimed to describe the functional results and prognostic factors of surgery in patients with STT. Thirty consecutive patients with acute STT were included at the same institution. All patients were examined with x-rays, MRI, and electromyography. Surgical treatment in the acute setting was indicated to address an RC injury or a displaced greater tuberosity fracture. Variables registered on the day of surgery were preoperative Constant and Western Ontario Rotator Cuff (WORC) scores and injury pattern. At final discharge, Constant, American Shoulder and Elbow Surgeons (ASES), WORC, and subjective shoulder value scores were recorded by an independent evaluator. Twenty-seven patients underwent a complete follow-up. The dominant arm was affected in 50% of cases. The mean follow-up was 27 (12 to 43) months. The mean WORC and Constant scores improved from 1,543 to 1,093 (P = 0.015) and 31 to 54 (P = 0.003), respectively. The ASES and subjective shoulder value scores at the end of the follow-up were 60 and 56 points, respectively. RC tears and nerve injuries that did not involve the axillary or suprascapular nerves were associated to better results than greater tuberosity fractures and injuries to the axillary or suprascapular nerves, respectively, in WORC (P = 0.028), Constant (P = 0.024), and ASES scores (P = 0.035). Preoperative WORC and Constant scores were independent prognostic factors. The most frequent patterns include complete RC tears, anterior capsular injuries, and an axillary nerve injury. Patients had improved functional scores at the end of follow-up after surgery. Better functional results were correlated to RC tears, injuries to nerves with innervation distal to the shoulder, and higher preoperative Constant and WORC scores.

Background/aimHealth-related quality of life (HRQoL) is increasingly assessed within orthopaedic research. For those patients presenting with glenoid labral pathologies, there is little information on how baseline comorbidities affect long-term outcomes...

Background:Rotator cuff tendinopathy (RCT) is a common musculoskeletal disease that causes pain and functional limitation of the shoulder, thereby impacting patients’ quality of life. In a post hoc analysis of...

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

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.

Does statin-treated hyperlipidemia affect rotator cuff healing or muscle fatty infiltration after rotator cuff repair?

Background: Although the prevalence of full-thickness rotator cuff tears increases with age, many patients are asymptomatic and may not require surgical repair. The factors associated with pain and loss of function in patients with rotator cuff tears are not well defined. Purpose: To determine which factors correlate with pain and loss of function in patients with symptomatic, atraumatic full-thickness rotator cuff tears who are enrolled in a structured physical therapy program. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A multicenter group enrolled patients with symptomatic, atraumatic rotator cuff tears in a prospective, nonrandomized cohort study evaluating the effects of a structured physical therapy program. Time-zero patient data were reviewed to test which factors correlated with Western Ontario Rotator Cuff (WORC) index and American Shoulder and Elbow Surgeons (ASES) scores. Results: A total of 389 patients were enrolled. Mean ASES score was 53.9; mean WORC score was 46.9. The following variables were associated with higher WORC and ASES scores: female sex (P = .001), education level (higher education, higher score; P < .001), active abduction (degrees; P = .021), and strength in forward elevation (P = .002) and abduction (P = .007). The following variables were associated with lower WORC and ASES scores: male sex (P = .001), atrophy of the supraspinatus (P = .04) and infraspinatus (P = .003), and presence of scapulothoracic dyskinesia (P < .001). Tear size was not a significant predictor (WORC) unless comparing isolated supraspinatus tears to supraspinatus, infraspinatus, and subscapularis tears (P = .004). Age, tear retraction, duration of symptoms, and humeral head migration were not statistically significant. Conclusion: Nonsurgically modifiable factors, such as scapulothoracic dyskinesia, active abduction, and strength in forward elevation and abduction, were identified that could be addressed nonoperatively with therapy. Therefore, physical therapy for patients with symptomatic rotator cuff tears should target these modifiable factors associated with pain and loss of function.

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

Introduction: Partial rotator cuff injuries are a major cause of shoulder pain and significant functional impairment. Conservative therapy with physiotherapy and steroid injections is commonly used but has limitations in long-term effectiveness. Platelet Rich Plasma (PRP) has emerged as an alternative therapy with the potential to accelerate healing through regenerative and anti-inflammatory mechanisms. However, the effectiveness of PRP in improving shoulder function and Transforming Growth Factor-β (TGF-β) levels in patients with partial rotator cuff injuries still needs further investigation. This study aims to determine the differences in the Western Ontario Rotator Cuff Index (WORC) score and TGF-β levels in patients with partial rotator cuff injuries who receive conservative physiotherapy with and without PRP injections. Material &amp; Methods: This study is an observational analytic study with a prospective cohort design. Data were obtained from the medical records of patients with partial rotator cuff injuries who underwent conservative therapy with or without PRP injections. WORC scores and TGF-β levels were measured before therapy and three months after treatment. Statistical analysis was performed to evaluate differences between the two groups. Results: The study results indicate a more significant decrease in WORC scores in the group receiving PRP injections compared to the physiotherapy group without PRP. Additionally, TGF-β levels increased more in the PRP group than in the conservative therapy group, suggesting a better regenerative effect than standard conservative therapy. Conclusion: The administration of PRP injections in patients with partial rotator cuff injuries yields better outcomes in reducing WORC scores and increasing TGF-β levels compared to conservative physiotherapy. These findings support the potential of PRP as an adjunct therapy in the conservative management of partial rotator cuff injuries. Keywords: Conservative Therapy, Partial Rotator Cuff, Platelet Rich Plasma, Transforming Growth Factor-β, Western Ontario Rotator Cuff Index

To compare responsiveness for the two region specific questionnaires Shoulder Disability Questionnaire (SDQ) and Shoulder Pain Disability Index (SPADI) and the disease specific Western Ontario Rotator Cuff (WORC) index in subacromial impingement syndrome (SIS) receiving physical therapy or subacromial corticosteroid injection. Sixty-four patients with SIS diagnosed participated in this study. All the patients were provided either physical therapy or subacromial corticosteroid injection treatment. The SDQ, the SPADI and WORC index were assessed both at the beginning and after the 3rd month of treatment. The responsiveness of the three questionnaires was compared by using the effect size (ES), the standardized responsiveness mean (SRM) and Guyatt's method. For both treatment groups there was no statistical difference observed between the pre- and post treatment measurement results versus improvement differences (p> 0.05). SDQ (ES=0.94; SRM=1.14; Guyatt value=0.95), SPADI (ES=1.55; SRM=2.14; Guyatt value=1.08), WORC index (ES=1.37; SRM=1.70; Guyatt value=1.15) were highly responsive for SIS. The SDQ, the SPADI and the WORC index are suitable for measuring changes in patients with SIS. Of these three indices, the SDQ and the SPADI are more suitable for a rapid assessment whereas the WORC index is better in cases where a more detailed assessment including the psychological impact created by the functional status needs to be assessed.

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