Pain catastrophizing behaviors and their relation to poor patient-reported outcomes after scapular muscle reattachment

Abstract

We hypothesized that the patient-reported status following treatment of traumatic scapular muscle detachment would improve from the preoperative status and that higher pain catastrophizing scores would be more common in patients with poor postsurgical outcomes. We studied 50 patients who met the diagnostic criteria for scapular muscle detachment and in whom rehabilitation failed. American Shoulder and Elbow Surgeons (ASES) scores were collected preoperatively and postoperatively. Patients completed a 7-point global rating of change scale, the Pain Catastrophizing Scale (PCS), and a 10-point satisfaction scale (0-3, not satisfied [NS]; 4-6, moderately satisfied [MS]; or 7-10, highly satisfied [HS]) focused on current shoulder use. Statistical analyses compared preoperative and postoperative ASES scores, compared the 3 levels of satisfaction and ASES scores, and compared ASES scores in patients with low PCS scores (LPCS) (<20) versus high PCS scores (HPCS) (≥20). Significance was set at P < .05. ASES scores significantly improved following surgery (42 ± 20 preoperatively and 73 ± 21 postoperatively) (P < .001), and the global rating of change score was 2 ± 2. There were 39 LPCS patients (mean PCS, 7 ± 6) and 11 HPCS patients (mean PCS, 34 ± 8). HPCS patients had significantly lower postoperative ASES scores (53 ± 18) than LPCS patients (79 ± 18) (P < .001). The MS patients (n = 11) had significantly higher ASES scores than the NS patients (n = 10) (P = .003), while the HS patients (n = 29) had significantly greater ASES scores than the other groups (P ≤ .001). Of the HPCS patients, 90% were in the NS and MS groups compared with 10% in the HS group. Surgical restoration for scapular muscle detachment can result in meaningful improvement in outcomes. Pain catastrophizing negatively affected the self-reported outcome scores.