Which questionnaire is more effective for follow-up diagnosed subacromial impingement syndrome? A comparison of the responsiveness of SDQ, SPADI and WORC index

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

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

Background: Subacromial corticosteroid injections are frequently used for short-term pain relief in patients with subacromial impingement syndrome (SIS). However, the efficacy of corticosteroid injections is contested. The purpose of this study is to assess patient reported outcome measures (PROMs) and evaluate the duration of pain relief following a single subacromial corticosteroid injection to treat SIS. Methods: This prospective, single center cohort study enrolled 34 patients with a diagnosis of SIS. Participants received one subacromial corticosteroid injection in the affected shoulder and were evaluated at baseline, 2-week, 3- and 6-month post-injection. Results: Participants had statistically significant improvements at 3- and 6-month post injection in Visual Analogue Scale (VAS) pain, Western Ontario Rotator Cuff index (WORC), Shoulder Pain Disability Index (SPADI), and the 36-Item Short Form Survey (SF-36) subsections of pain, physical functioning, physical functioning role limiting, emotional role limiting and energy. Conclusions: Our study addresses some of the inconsistencies in the literature and supports the practice of administering subacromial corticosteroid injections for patients with SIS as patients demonstrated clinically significant improvements in VAS pain and other PROMs at both 3- and 6-month post-injection.

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

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)

Scapula alata: description of a physical therapy program and its effectiveness measured by a shoulder-specific quality-of-life measurement

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

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.

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

Validity of a shoulder-specific quality of life questionnaire, the Western Ontario Rotator Cuff Index, for patients with scapula alata

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.

Objectives:The objectives of this project are: (1) to compare the efficacy of surgical versus non-surgical management of full-thickness rotator cuff tears, and (2) to detect variables that predict success within each treatment group.Methods:Patients who presented to our care for management of symptomatic full-thickness rotator cuff tears were enrolled in our Shoulder Registry and clinical data were collected prospectively. In addition to baseline demographic information, the following outcome measures were collected at baseline, 6 months, 1 year and annually up to 3 years: Western Ontario Rotator Cuff (WORC) Index, American Shoulder and Elbow Surgeons (ASES) score, Modified Marx Shoulder Activity Level Scale, VR-12, 100-point Single Assessment Numeric Evaluation (SANE) rating, 100-point visual analog scale (VAS) for pain, and a patient satisfaction scale. All patients were allocated treatment as recommended by the attending surgeon. We described all patient demographic characteristics, and performed linear and logistic regression for variables associated with treatment allocation and with treatment effects. We also used Student’ t-tests and Wilcoxon rank-sum tests where appropriate, to explore differences in treatment effects between the groups for all outcome measures at all time points.Results:A total of 292 patients were included with 155 allocated to surgery and 137 to non-surgical treatment. Those allocated to surgery were younger (58.6 years vs 65.2 years; P<.0001), less likely to have diabetes (12% vs 21%; P=0.05), more likely to have a known traumatic injury (71% vs 55%; P=0.002), and tended to be worse off on all outcome measures at baseline then the non-surgical group. Both the surgical group and non-surgical group improved on all outcome measures across the follow up period with several variables predicting changes at each time point. Table 1 contains the list of specific variables that predicted improved outcomes separately for both treatment groups. Also, at one year the surgical group improvement was significantly greater than the non-surgical group on all outcome measures. At both two and three years the surgical group showed a significantly greater degree of improvement than the non-surgical group on both the WORC index and the ASES score.Conclusion:We found that patients with rotator cuff tears who undergo surgical or nonsurgical treatment tend to improve, with patients allocated to surgery improving to a greater degree across three years of follow-up. In addition, there appear to be important predictors of improved outcomes that may help us to tailor our treatments to individuals with specific characteristics.

Arthroscopic rotator cuff repair (ARCR) generally improves clinical outcomes, but the impact of pre-existing glenohumeral osteoarthritis (GHOA) severity on these outcomes remains unclear. This study aims to evaluate the correlation between preoperative GHOA severity, assessed via the Shoulder Osteoarthritis Severity (SOAS) score, and postoperative patient-reported outcomes (PROs) following ARCR with a minimum of two years follow-up. In this retrospective cohort study, 150 patients who underwent ARCR between 2018 and 2023 were included. Preoperative GHOA severity was assessed independently by two reviewers using magnetic resonance imaging (MRI) and graded using the SOAS score. PROs included the American Shoulder and Elbow Surgeons (ASES) score, University of California-Los Angeles (UCLA) score, and Western Ontario Rotator Cuff (WORC) index. Correlation and multivariate regression analyses were used to identify predictors of PROs. Receiver operating characteristic (ROC) curve was performed to assess the SOAS score's predictive value. Of 150 eligible patients, the cohort had a mean age of 66.6 ± 8.8 years and a mean follow-up of 42.3 ± 14.5 months. Inter-reader reliability of total SOAS was excellent (ICC = 0.942). Higher total SOAS scores were significantly associated with lower ASES (r=-0.21, p = 0.012) and UCLA (r=-0.22, p = 0.006) scores. Subdomain analysis revealed that labral-bicipital complex pathology negatively correlated with all three PROs (ASES: r=-0.21, p = 0.010; UCLA: r=-0.20, p = 0.013; WORC: r=-0.18, p = 0.026), while cartilage degeneration correlated with lower UCLA score (r=-0.18, p = 0.033). On multivariate analysis, long head of biceps pathology was an independent predictor of a lower ASES score (β=-2.14, p = 0.029) and WORC index (β=-0.1, p = 0.032). An optimal SOAS cut-point of 17 for predicting failure showed poor discriminative ability (AUC = 0.596). The SOAS score demonstrated a significant correlation with Kellgren-Lawrence grading system (r = 0.71, p < 0.001). Although continuous GHOA severity correlates with lower postoperative scores, the overall SOAS score alone is a poor prognostic discriminator for clinical failure. Therefore, GHOA should not be considered an absolute contraindication for ARCR. A holistic preoperative assessment integrating these critical factors is essential for optimizing clinical decision making.