Shoulder Activity Level Research Articles

Shoulder activity level in patients with idiopathic adhesive capsulitis

Idiopathic adhesive capsulitis is a common condition resulting in painful multidirectional restriction of motion. Adhesive capsulitis may inhibit shoulder activity level, but this relationship has not been previously studied. This study tested the hypothesis that patients with idiopathic adhesive capsulitis have lower shoulder activity than sex- and age-matched controls. Seventy-two eligible patients (37 men and 35 women) with idiopathic adhesive capsulitis completed a validated shoulder activity scale that was compared with sex- and age-matched norms from a healthy population with no history of shoulder disorders. The association of shoulder activity level with patient age, sex, and American Shoulder and Elbow Surgeons and Simple Shoulder Test (SST) scores was evaluated. Overall, 58% of patients actually had higher shoulder activity scores than sex- and age-matched controls. Among patients aged 51 to 70 years, 68% of patients (73% of men and 63% of women) demonstrated higher Shoulder Activity Scale scores compared with controls. The activity level was higher among all patients aged 51 to 70 years compared with controls (10.3 ± 1.48 vs. 8 ± 0.52, P = .0067). The difference was significant for men in this age group (12.2 ± 1.7 vs. 9 ± 0.75, P = .0042). There was a statistically significant positive correlation of the Shoulder Activity Scale score with the SST score (r = 0.31, P = .009). Patients with idiopathic adhesive capsulitis do not have a lower shoulder activity level than sex- and age-matched controls, and older men may actually have a higher level of shoulder activity than controls. Shoulder activity level is correlated with the SST score in patients with idiopathic adhesive capsulitis.

Relationship of shoulder activity and skin intrinsic fluorescence with low level shoulder pain and disability in people with type 2 diabetes

AimPeople with type 2 diabetes (T2DM) have a high incidence of musculoskeletal disorders thought to be influenced by high non-enzymatic advanced glycated end-products (AGEs). The goals of this study were to determine differences in shoulder activity level and AGEs in people with T2DM compared to matched controls, and to determine factors associated with shoulder pain and disability. MethodsEighty-one participants, T2DM (n=52) and controls (n=29), were examined for magnitude and duration of shoulder activity (measured using accelerometers), skin intrinsic florescence (SIF) as a surrogate measure of AGE level, and the Shoulder Pain and Disability Index (SPADI) as a self-report of shoulder pain and disability. ResultsCompared with controls, T2DM participants had 23% less shoulder activity (p=0.01), greater SIF level (3.6±1.7 vs 2.7±0.6AU, p=0.01), less shoulder strength (p<0.05), and the duration of their shoulder activity was moderately associated (r=0.40; p<0.01) with reported shoulder pain and disability. Shoulder pain and disability were not related to SIF level. ConclusionsPersons with T2DM have higher SIF levels and shoulder symptoms and disability indices than controls. Research is needed to determine if a shoulder mobility intervention to increase strength and mobility can help decrease shoulder pain and disability.

Outcomes in patients with glenoid labral lesions: a cohort study

Background/aimFor patients presenting with glenoid labral pathologies, there is little information on how operative interventions affect long-term outcomes and health-related quality of life (HRQoL). This study evaluated outcomes in operative...

Patients Undergoing Shoulder Stabilization Surgery Have Elevated Shoulder Activity Compared With Sex- and Age-Matched Healthy Controls.

Background:Shoulder activity level may be a risk factor for shoulder instability, an indication for surgical intervention, and a risk factor for failure of operative stabilization.Hypothesis:Patients undergoing shoulder stabilization surgery have a higher activity level compared with sex- and age-matched healthy controls.Study Design:Cross-sectional study.Level of Evidence:Level 2.Methods:Patients undergoing shoulder stabilization surgery aged 18 to 50 years were prospectively enrolled. As part of data collection, patients completed a previously validated shoulder activity scale, which generates a score reporting frequency of activity ranging from 0 (least active) to 20 (most active). The activity level of these patients was compared with sex- and age-matched norms for a healthy population with no history of shoulder disorders.Results:A total of 409 subjects (343 male, 66 female) undergoing shoulder instability surgery completed the activity scale. Seventy-seven percent of patients had higher shoulder activity level than sex- and age-matched controls. Seventy-nine percent aged 18 to 30 years had a higher shoulder activity level than controls, with an identical distribution for men (79%) and women (79%). Among patients aged 31 to 50 years, 70% had higher activity than controls. However, men were more likely to have a higher activity level than controls (72%) versus women (59%). In patients aged 18 to 30 years, median activity level for instability patients was 14 in men compared with 10 in controls, and 13 in women compared with 8 in controls. In patients aged 31 to 50 years, median activity level was 13 in men compared with 10 in controls and 10 in women compared with 8 in controls.Conclusion:Patients undergoing shoulder stabilization surgery have a higher activity level than sex- and age-matched healthy controls.Clinical Relevance:Shoulder activity is especially elevated in younger, male instability patients.

CORR Insights(®): Shoulder Activity Level is Associated with Type of Employment and Income in the Normative Population Without Shoulder Disorders.

CORR Insights(®): Shoulder Activity Level is Associated with Type of Employment and Income in the Normative Population Without Shoulder Disorders.

Are Pulley Exercises Initiated 6 Weeks After Rotator Cuff Repair a Safe and Effective Rehabilitative Treatment?

Background: There are few level 1 or 2 evidence studies that examine rehabilitation after rotator cuff repair. Pulleys have been used in postoperative shoulder rehabilitation with the intention of improving range of motion and developing strength. There is a concern that the use of pulleys in rehabilitation of rotator cuff repairs may contribute to excessive scapular motion (scapular substitution) and potentially inferior outcomes. Hypothesis: Rotator cuff repair patients treated with pulley exercises would have increased scapular substitution and inferior patient-determined outcome scores, range of motion, and strength compared with patients treated with an alternative rehabilitation program without pulleys. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 27 patients who underwent rotator cuff repair were randomized to a rehabilitation group that used pulleys initiated 6 weeks postoperatively, and 26 patients followed a rehabilitation protocol without pulleys. Inclusion criteria were patients undergoing arthroscopic rotator cuff repair. Exclusion criteria were large to massive rotator cuff tears, revision rotator cuff repair, glenohumeral osteoarthritis, adhesive capsulitis, and a symptomatic contralateral shoulder. Outcomes of intervention were patient-determined outcome scores (Western Ontario Rotator Cuff Index [WORC], American Shoulder and Elbow Surgeons [ASES] Shoulder Score, Single Assessment Numeric Evaluation [SANE], Shoulder Activity Level, and Simple Shoulder Test [SST]), range of motion, scapular substitution, and strength. Outcomes were determined at 6, 12, 18, 26, and 52 weeks. A power analysis determined that 22 patients were needed per group to have a power of 0.80, α = 0.05, and effect size of f = 0.5. Results: Both groups had statistically significant improvements in WORC, ASES Shoulder Score, SST, and SANE scores over time after rotator cuff repair (P < .0001). There were no differences between the interventions for WORC (P = .18), ASES Shoulder Score (P = .73), SANE (P = .5), Shoulder Activity Level (P = .39), or SST (P = .36). Both interventions demonstrated improvements in shoulder flexion (P = .002), abduction (P = .0001), external rotation (P = .02), strength (P ≤ .0002), and scapular substitution (P ≤ .07) over time after rotator cuff repair. However, there was no difference in range of motion (P ≥ .26), strength (P ≥ .20), or scapular substitution (P ≥ .17) between interventions. Conclusion: A rotator cuff repair rehabilitation program that uses pulleys does not result in inferior outcomes, as determined by patient-determined outcome scores, measurements of scapular substitution, range of motion, and scaption strength. Registration: ClinicalTrials.gov NCT01819909

Relationship between extrinsic factors and the acromio-humeral distance

BackgroundMaintenance of the subacromial space is important in impingement syndromes. Research exploring the correlation between biomechanical factors and the subacromial space would be beneficial. ObjectivesTo establish if relationship exists between the independent variables of scapular rotation, shoulder internal rotation, shoulder external rotation, total arc of shoulder rotation, pectoralis minor length, thoracic curve, and shoulder activity level with the dependant variables: AHD in neutral, AHD in 60° arm abduction, and percentage reduction in AHD. DesignControlled laboratory study. MethodData from 72 male control shoulders (24.28years STD 6.81 years) and 186 elite sportsmen's shoulders (25.19 STD 5.17 years) were included in the analysis. The independent variables were quantified and real time ultrasound was used to measure the dependant variable acromio-humeral distance. ResultsShoulder internal rotation and pectoralis minor length, explained 8% and 6% respectively of variance in acromio-humeral distance in neutral. Pectoralis minor length accounted for 4% of variance in 60° arm abduction. Total arc of rotation, shoulder external rotation range, and shoulder activity levels explained 9%, 15%, and 16%–29% of variance respectively in percentage reduction in acromio-humeral distance during arm abduction to 60°. ConclusionPectorals minor length, shoulder rotation ranges, total arc of shoulder rotation, and shoulder activity levels were found to have weak to moderate relationships with acromio-humeral distance. Existence and strength of relationship was population specific and dependent on arm position. Relationships only accounted for small variances in AHD indicating that in addition to these factors there are other factors involved in determining AHD.

Factors Related to Improved Quality of Life in Operative and Non-operative RCT Patients

Objectives:To examine factors that influence quality of life (QOL) outcomes for those with full thickness rotator cuff tears based on surgical versus non-surgical intervention.Methods:A convenience sample of participants (N=212) presenting to an orthopaedic clinic and identified as having full thickness rotator cuff tears were invited to participate in a prospective cohort study. Participants provided baseline demographic information and completed patient satisfaction, pain VAS, shoulder activity level, functional comorbity, WORC and ASES instruments, and the Veterans Rand 12-item health survey (VR-12). Participants were tracked for operative vs. non-operative intervention and completed the same measures as baseline at 4, 8, 16, 32, 48, and 64 weeks. Descriptive and inferential analysis was conducted using SPSS v. 21.0 (IBM Corp, Armonk, NY) Chi-square analysis and student's t-test was used to examine differences between categorical and continuous variables and baseline and 64 week scores. ANOVA was used to test differences between groups. Generalized estimating equations (GEE) were used to examine the effects of fixed factors on quality of life such as gender, BMI, age, diabetes, smoking, tear size, pain VAS, functional comorbidity, ASES, and WORC scores longitudinally from baseline to 64 weeks.Results:Participant demographics consisted of 126 males and 86 females with a mean age of 60 ±9.6. There were 93 non-operative subjects and 119 in the operative group. Baseline characteristics between groups indicated a significant difference in age (p<.001), gender (p<.05), and cause of injury (p<.001). Among baseline scores there were differences in pain VAS (p<.05), shoulder activity level (p<.01), functional comorbidity (p<.05), ASES (p<.05), and WORC (p<.05), with all baseline scores indicating “worse” scores for the operative group. There were no significant differences noted between groups for baseline PCS (p=.508) and MCS (p=.862) scores. Paired samples t-tests within the non-operative group indicate no difference between baseline and 64 week PCS (p=.434) and MCS (p=.203) scores. The operative group PCS and MCS scores were both significantly different from baseline to 64 week scores (p<.001, p<.001) respectively. Between groups results show there was no significant difference in 64 week MCS scores (p=.539), however there was a significant difference in 64 week PCS scores noted (p<.001). Factors predictive of higher MCS scores were non-diabetic (β=4.82, p<.05), non-smoker (β=4.52, p<.05), lower functional comorbidity (β= -1.22, p<.05), higher baseline pain VAS (β=.087, p<.05), and a lower WORC score (β= -.011, p<.001). Factors predictive of higher PCS scores were surgical intervention (β=2.96, p<.01), non-diabetic (β=2.87, p<.05), lower functional comorbidity (β= -1.18, p<.001), higher baseline ASES (β=.128, p<.01), and lower baseline WORC (β= -.005, p<.01).Conclusion:Surgical intervention had no effect on MCS score but there was evidence to support the efficacy of operative treatment for improving PCS score. Of these patients that elected operative intervention their long-term QOL outcomes were improved.

Outcome of Large to Massive Rotator Cuff Tears Repaired With and Without Extracellular Matrix Augmentation: A Prospective Comparative Study

To compare the results of arthroscopic repair of large to massive rotator cuff tears (RCTs) with or without augmentation using an extracellular matrix (ECM) graft and to present ECM graft augmentation as a valuable surgical alternative used for biomechanical reinforcement in any RCT repair. We performed a prospective, blinded, single-center, comparative study of patients who underwent arthroscopic repair of a large to massive RCT with or without augmentation with ECM graft. The primary outcome was assessed by the presence or absence of a retear of the previously repaired rotator cuff, as noted on ultrasound examination. The secondary outcomes were patient satisfaction evaluated preoperatively and postoperatively using the 12-item Short Form Health Survey, the American Shoulder and Elbow Surgeons shoulder outcome score, a visual analog scale score, the Western Ontario Rotator Cuff index, and a shoulder activity level survey. We enrolled 35 patients in the study: 20 in the ECM-augmented rotator cuff repair group and 15 in the control group. The follow-up period ranged from 22 to 26 months, with a mean of 24.9 months. There was a significant difference between the groups in terms of the incidence of retears: 26% (4retears) in the control group and 10% (2 retears) in the ECM graft group (P= .0483). The mean pain level decreased from 6.9 to 4.1 in the control group and from 6.8 to 0.9 in the ECM graft group (P= .024). The American Shoulder and Elbow Surgeons score improved from 62.1 to 72.6 points in the control group and from 63.8 to 88.9 points (P= .02) in the treatment group. The mean Short Form 12 scores improved in the 2 groups, with a statistically significant difference favoring graft augmentation (P= .031), and correspondingly, the Western Ontario Rotator Cuff index scores improved in both arms, favoring the treatment group (P= .0412). The use of ECM for augmentation of arthroscopic repairs of large to massive RCTs reduces the incidence of retears, improves patient outcome scores, and is a viable option during complicated cases in which a significant failure rate is anticipated. Level III, prospective, blinded, nonrandomized, comparative study.

A Systematic Review of the Psychometric Properties of Patient-Reported Outcome Instruments for Use in Patients With Rotator Cuff Disease

Background: Many patient-reported outcome instruments (or questionnaires) have been developed for use in patients with rotator cuff disease. Before an instrument is implemented, its psychometric properties should be carefully assessed, and the methodological quality of papers that investigate a psychometric component of an instrument must be carefully evaluated. Together, the psychometric evidence and the methodological quality can then be used to arrive at an estimate of an instrument’s quality. Purpose: To identify patient-reported outcome instruments used in patients with rotator cuff disease and to critically appraise and summarize their psychometric properties to guide researchers and clinicians in using high-quality patient-reported outcome instruments in this population. Study Design: Systematic review. Methods: Systematic literature searches were performed to find English-language articles concerning the development or evaluation of a psychometric property of a patient-reported outcome instrument for use in patients with rotator cuff disease. Methodological quality and psychometric evidence were critically appraised and summarized through 2 standardized sets of criteria. Results: A total of 1881 articles evaluating 39 instruments were found per the search strategy, of which 73 articles evaluating 16 instruments were included in this study. The Constant-Murley score, the DASH (Disability of the Arm, Shoulder, and Hand), and the Shoulder Pain and Disability Index were the 3 most frequently evaluated instruments. In contrast, the psychometric properties of the Korean Shoulder Scoring System, Shoulder Activity Level, Subjective Shoulder Value, and Western Ontario Osteoarthritis Shoulder index were evaluated by only 1 study each. The Western Ontario Rotator Cuff Index was found to have the best overall quality of psychometric properties per the established criteria, with positive evidence found in internal consistency, reliability, content validity, hypothesis testing, and responsiveness. The DASH, Shoulder Pain and Disability Index, and Simple Shoulder Test had good evidence in support of internal consistency, reliability, structural validity, hypothesis testing, and responsiveness. Inadequate methodological quality was found across many studies, particularly in internal consistency, reliability, measurement error, hypothesis testing, and responsiveness. Conclusion: More high-quality methodological studies should be performed to assess the properties in all identified instruments.

Reliability, validity, and responsiveness of the Persian version of Shoulder Activity Scale in a group of patients with shoulder disorders

Purpose: The aim of this methodological study was to cross-culturally translate the Shoulder Activity Scale (SAS) into the Persian and determine its clinimetric properties including reliability, validity, and responsiveness in patients with shoulder disorders. Method: Persian version of the SAS was obtained after standard forward-backward translation. Three questionnaires were completed by the respondents: SAS, shoulder pain and disability index (SPADI), and Short-Form 36 Health Survey (SF-36). The patients completed the SAS, 1 week after the first visit to evaluate the test–retest reliability. Construct validity was evaluated by examining the associations between the scores on the SAS and the scores obtained from the SPADI, SF-36, and age of the patients. To assess responsiveness, data were collected in the first visit and then again after 4 weeks physiotherapy intervention. Test–retest reliability and internal consistency were assessed using Intra-class Correlation Coefficient (ICC) and Cronbach’s alpha, respectively. To evaluate construct validity, Spearman’s rank correlation was used. The ability of the SAS to detect changes was evaluated by the receiver-operating characteristics method. Results: No problem or language difficulties were reported during translation process. Test–retest reliability of the SAS was excellent with an ICC of 0.98. Also, the marginal Cronbach’s alpha level of 0.64 was obtained. The correlation between the SAS and the SPADI was low, proving divergent validity, whereas the correlations between the SAS and the SF-36/age were moderate proving convergent validity. A marginally acceptable responsiveness was achieved for the Persian SAS. Conclusions: The study provides some evidences to support the test–retest reliability, internal consistency, construct validity, and responsiveness of the Persian version of the SAS in patients with shoulder disorders. Therefore, it seems that this instrument is a useful measure of shoulder activity level in research setting and clinical practice.Implications for RehabilitationThe shoulder activity scale (SAS) is a reliable, valid, and responsive measure of shoulder activity level in Persian-speaking patients with different shoulder disorders.The results on clinimetric properties of the Persian SAS are comparable with its original, English version.Persian version of the SAS can be used in “clinical” and “research” settings of patients with shoulder disorders.

Do Overhead Sports Increase Risk for Rotator Cuff Tears in Wheelchair Users?

ObjectiveTo analyze whether frequent overhead-sports activity increases the risk for rotator cuff disease in patients with spinal cord injuries (SCIs) who are wheelchair dependent. DesignCross-sectional study, risk analysis. SettingDepartment of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury. ParticipantsPatients (N=296) with SCI requiring the full-time use of a manual wheelchair were recruited for this study. The total population was divided into 2 groups (sports vs no sports), among them 103 patients playing overhead sports on a regular basis (at least 1–2 times/wk) and 193 patients involved in overhead sports less than once a week or in no sports activity at all. The mean age of the sports group was 49.1 years. The mean duration of wheelchair dependence was 26.5 years. The mean age of the no-sports group was 48 years. The mean duration of wheelchair dependence was 25.2 years. Each individual completed a questionnaire designed to identify overhead-sports activity on a regular basis and was asked about shoulder problems. Magnetic resonance imaging scans of both shoulders were performed in each patient and analyzed in a standardized fashion. InterventionsNone. Main Outcome MeasuresPossible differences in continuous data between patients with and without rotator cuff tear were evaluated. The relative risk of suffering from a rotator cuff tear between patients playing overhead sports and those not playing overhead sports was calculated. ResultsOne hundred three patients played overhead sports regularly and 193 did not. There was no difference between groups regarding age, sex, level of SCI, and duration of wheelchair dependence. The body mass index was significantly lower in the sports group than in the no-sports group (P<.0001). A rotator cuff tear was present in 75.7% of the patients in the sports group and in 36.3% of the patients in the no-sports group (P<.0001). Rotator cuff tears were symptomatic in 92.6% of the patients. The estimated risk increase for the sports group to develop rotator cuff tears was twice as high as for the no-sports group (95% confidence interval, 1.7–2.6; P<.001). Similar results were found for the neurological level of lesion (T2–7/<T7), where the estimated risk was about 2.3 times higher in patients with a high neurological level of lesion (T2–7) than in those with a low neurological level of lesion (<T7) (95% confidence interval, 1.82–3.04; P<.001). ConclusionsOverhead-sports activities have been identified as an additional risk factor, along with age and duration of wheelchair dependence, for developing rotator cuff disease in patients with paraplegia. A high frequency of sports activity shows physiological benefits as well as improves the psychological status and quality of life in patients with SCI. The dilemma is how to increase physical activity to gain physiological and psychological health benefits without further increasing overuse of the upper extremities, particularly the shoulder, in patients with paraplegia. The data from this study may be helpful in elucidating the etiology of rotator cuff tear in athletes with paraplegia and in counseling patients with SCI regarding shoulder and upper extremity activity level and provide support for developing preventive strategies.

A Prospective Cohort Study of Patients Treated Surgically or Non-Surgically for Full-thickness Rotator Cuff Tears

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:Adult patients presenting at MedSport, University of Michigan, with full thickness rotator cuff tears diagnosed by MRI or ultrasound and no history of shoulder surgery were recruited for inclusion in the study. Consenting subjects were given baseline written questionnaires which included a Functional Comorbidity Index, a Charlson Comorbidity Index, demographics form, WORC score, ASES score, VR-12, modified shoulder activity level, and patient satisfaction forms, as well as an 100 point visual analogue pain scale. Patients then proceeded with planned treatment, either surgical or non-surgical, as recommended by their treating surgeon and decided upon themselves. Written questionnaires were mailed to participants at the following intervals after baseline: 4 weeks, 8 weeks, 16 weeks, 32, weeks, 48 weeks, and 64 weeks. Electronic medical records of subjects were monitored for treatment received. We described all patient demographic characteristics, and performed logistic regression for variables associated with treatment allocation and longitudinal modeling with generalized estimating equations for treatment effects across the follow-up period. 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 184 patients were included with 101 allocated to surgery and 73 to non-surgical treatment. Those allocated to surgery were younger (OR=0.87, P<0.0001), had a lower BMI (OR=0.83, P=0.007), less likely to be smokers (OR=0.04, P=0.002), more likely to have a known traumatic injury (OR=2.40, P=0.002), and had a lower comorbidity score (OR=0.74, P=0.096). Table 1 contains the results of all clinical outcomes measures used. At baseline the surgery group tended to be in more pain and have a higher, worse, WORC score. Both the surgical group and non-surgical group tended to improve on all outcome measures across the follow up period with the surgery group improving at a faster rate and to a greater degree after 8 or 16 weeks post baseline (see figure 1). Several variables predicted improvements across time in the surgical group including: older age, non-diabetic, shorter duration of symptoms, being male, without a known traumatic injury and a lower BMI. For the non-surgical group the following variables predicted improved outcomes across time: shorter duration of symptoms, higher baseline activity score, non-smoker, non-worker’s compensation case, nonsmoker, younger in age and lower BMI. These predictors varied by outcome measure.Conclusion:Patients with rotator cuff tears who undergo surgical or nonsurgical treatment tend to improve, with surgical patients improving to a greater degree. There appear to be several predictors of improved of treatment allocation and outcomes that may help us to tailor our treatments to individuals

Shoulder Activity Level Is Not Associated With the Severity of Symptomatic, Atraumatic Rotator Cuff Tears in Patients Electing Nonoperative Treatment

Background: Patient activity level may be an important prognostic variable relating to outcomes in patients with shoulder disorders. Little is known about the predictors of activity level in patients with shoulder disorders. Hypothesis: Tear size and patient variables would be predictive of shoulder activity level in a cohort of patients who have selected initial nonoperative treatment for a symptomatic, atraumatic rotator cuff tear on magnetic resonance imaging (MRI). Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients with an atraumatic rotator cuff tear on MRI were prospectively enrolled in the Multicenter Orthopaedic Outcomes Network (MOON) shoulder study of nonoperative treatment. As part of routine data collection, these patients were asked to complete a previously validated shoulder activity scale. A regression analysis was performed to assess the association of shoulder activity level to rotator cuff tear characteristics, including tendon involvement and retraction, and patient factors such as age, sex, smoking, and occupation. Results: A total of 434 patients (220 male, 214 female) with a mean age of 62.7 years (range, 31-90 years) completed the activity scale. Shoulder activity was not associated with severity of the rotator cuff tear, but it was negatively associated with age (P = .0001) and female sex (P = .001). The only other factor associated with shoulder activity level in this cohort was occupation (P = .0006). Conclusion: Shoulder activity level in patients with an atraumatic rotator cuff tear confirmed on MRI is not associated with severity of the tear but is affected by age, sex, and occupation.

Normative Data of Shoulder Activity Level by Age and Sex

Background: The shoulder activity score is a valid and reliable shoulder-specific questionnaire that measures a patient’s shoulder activity level over the previous year. No age- and sex-based normative data exist for the shoulder activity score. Hypothesis: The hypothesis was that age is inversely related to the shoulder activity score in patients with no history of shoulder symptoms or treatment for a shoulder condition. The authors also tested the hypothesis that in the same population of patients, men are more active with their shoulders than women. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Participants in 8 age/sex groups, composed of adults aged 18 years and older in the United States, were surveyed via the Internet by a marketing research firm. Participants completed the shoulder activity score and reported their age, sex, and any history of shoulder symptoms or treatment. The survey was sent to 2773 people, with 2403 people completing the entire survey. Participants with a history of shoulder symptoms or treatment were excluded from this analysis, leaving 1625 patients as healthy controls. Results: The mean shoulder activity score of healthy controls was 8 ± 5 (range, 0-20). Men scored higher on the shoulder activity score than women of the same age group (9 vs 7, respectively; P < .0001). Shoulder activity scores decreased with age in both men and women (P < .0001). Men were more likely to participate in contact (15% vs 7.4%, respectively; P < .001) and overhead-throwing sports (19% vs 10%, respectively; P < .001) than women. Participation in contact and overhead-throwing sports also decreased with age. Conclusion: In healthy controls, the shoulder activity score decreased with age and was lower in women than in men. Participation in contact and overhead-throwing sports decreased in women and older patients. These normative data are an important baseline for comparing untreated and treated shoulder cohorts to better understand the variance in shoulder activity level and how it may relate to clinical outcomes.

A Prospective Follow-up of Patients Treated Surgically or Non-Surgically for Full-thickness Rotator Cuff Tears

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.

Shoulder activity level in the preoperative assessment of patients with rotator cuff tears

The purpose of this study was to investigate shoulder activity level in preoperative assessment of shoulder function and health-related quality of life (QoL) for patients with rotator cuff tears. One hundred and six patients with rotator cuff tears were prospectively evaluated using the following outcome instruments: the Shoulder Activity scale, the Constant scale, the Simple Shoulder Test, and the Short Form-36v2 (SF-36v2). Clinical and structural data, including patients' demographics, comorbidities, duration of symptoms, shoulder contracture, and tear size, were collected and analyzed. We determined that the shoulder activity level was associated with gender, medical comorbidities, and age. Females had lower activity level, worse scores for health-related QoL, and longer duration of symptoms than males. Patients who had severe comorbidities had lower shoulder activity scores and worse SF-36v2 scores compared to patients who did not have such comorbidities. The patient age correlated with the shoulder activity level, but did not have significant correlation with the duration of symptoms and shoulder function. The shoulder activity level was related to patient gender, general health status and age; therefore, further investigation is warranted to determine if the activity level can be used as a prognostic variable relating to outcome in the treatment of rotator cuff tears.

Shoulder activity level varies by diagnosis

Patient activity level may be an important prognostic variable relating to outcome in patients with shoulder disorders. The purpose of this cross-sectional study was to test the hypothesis that a shoulder activity scale will detect differences in shoulder activity based on the patient diagnosis and age. A total of 157 patients of four academic orthopedic surgeons with a diagnosis of rotator cuff disease (86), glenohumeral instability (31) or osteoarthritis (40) were asked to fill out a previously validated shoulder activity scale and the ASES shoulder questionnaire. The patient's diagnosis, gender and age were recorded. The activity level was significantly higher in patients with instability than in patients with rotator cuff disease or osteoarthritis. Patients with rotator cuff disease were significantly more active than patients with osteoarthritis. Linear regression of activity level on patient age and diagnosis demonstrated a statistically significant relationship between activity level and both independent variables. Diagnosis influenced activity level independent of age. This is the first study to document diagnosis-based differences in the shoulder activity level of patients with different shoulder disorders. Shoulder activity level should be evaluated as a prognostic variable in studies of patients with shoulder disorders that may predict outcome and guide treatment in these patients.