Symptoms of Pain Do Not Correlate with Rotator Cuff Tear Severity
Symptoms of Pain Do Not Correlate with Rotator Cuff Tear Severity
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DOI：
10.2106/jbjs.l.01304
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发表时间：
2014-05-21
影响因子：
5.3
通讯作者：
Wright, Rick W.
中科院分区：
文献类型：
--
作者：
Dunn, Warren R.;Kuhn, John E.;Wright, Rick W.
背景：对于许多骨科疾病，症状与疾病严重程度相关。本研究的目的是确定疼痛程度是否与肩袖疾病的严重程度相关。方法：对 393 名患有非创伤性症状性肩袖全层撕裂并接受物理治疗的受试者进行了研究。基线预处理数据用于检查肩袖疾病的严重程度与疼痛之间的关系。通过评估撕裂大小、回缩、肱骨头上移和肩袖肌肉萎缩来确定疾病的严重程度。疼痛通过患者报告的美国肩肘外科医生 (ASES) 评分中的 10 分视觉模拟量表 (VAS) 进行测量。使用连续 VAS 评分作为因变量，并使用肩袖撕裂严重程度和其他非解剖患者因素作为自变量，构建线性多元回归模型。百分之四十八的患者是女性，中位年龄为六十一岁。 69% 的患者累及优势肩。 8%的患者症状持续时间少于一个月，22%的患者症状持续时间为1至3个月，20%的患者症状持续时间为4至6个月，15%的患者症状持续时间为7至12个月，36%的患者症状持续时间超过一年。 72% 的患者撕裂仅涉及冈上肌；冈上肌和冈下肌，有或没有小圆肌，占 21%；而只有肩胛下肌占7%。 16% 的人注意到肱骨头移位。 48% 的患者肌腱回缩最轻微，34% 的患者肌腱回缩最轻微，13% 的患者肌腱回缩最轻微，5% 的患者肌腱回缩至关节盂。基线 VAS 疼痛评分中位数为 4.4。 结果：控制其他基线因素的多变量模型发现，合并症增加 (p = 0.002)、教育水平较低 (p = 0.004) 和种族 (p = 0.041) 是与疼痛相关的唯一重要因素。没有测量与疼痛相关的肩袖撕裂严重程度（p > 0.25）。结论：定义非创伤性肩袖撕裂严重程度的解剖特征与疼痛程度无关。与疼痛相关的因素包括合并症、较低的教育水平和种族。证据级别：预后 III 级。有关证据级别的完整描述，请参阅作者须知。
Background: For many orthopaedic disorders, symptoms correlate with disease severity. The objective of this study was to determine if pain level is related to the severity of rotator cuff disorders.Methods: A cohort of 393 subjects with an atraumatic symptomatic full-thickness rotator-cuff tear treated with physical therapy was studied. Baseline pretreatment data were used to examine the relationship between the severity of rotator cuff disease and pain. Disease severity was determined by evaluating tear size, retraction, superior humeral head migration, and rotator cuff muscle atrophy. Pain was measured on the 10-point visual analog scale (VAS) in the patient-reported American Shoulder and Elbow Surgeons (ASES) score. A linear multiple regression model was constructed with use of the continuous VAS score as the dependent variable and measures of rotator cuff tear severity and other non-anatomic patient factors as the independent variables. Forty-eight percent of the patients were female, and the median age was sixty-one years. The dominant shoulder was involved in 69% of the patients. The duration of symptoms was less than one month for 8% of the patients, one to three months for 22%, four to six months for 20%, seven to twelve months for 15%, and more than a year for 36%. The tear involved only the supraspinatus in 72% of the patients; the supraspinatus and infraspinatus, with or without the teres minor, in 21%; and only the subscapularis in 7%. Humeral head migration was noted in 16%. Tendon retraction was minimal in 48%, midhumeral in 34%, glenohumeral in 13%, and to the glenoid in 5%. The median baseline VAS pain score was 4.4.Results: Multivariable modeling, controlling for other baseline factors, identified increased comorbidities (p = 0.002), lower education level (p = 0.004), and race (p = 0.041) as the only significant factors associated with pain on presentation. No measure of rotator cuff tear severity correlated with pain (p > 0.25).Conclusions: Anatomic features defining the severity of atraumatic rotator cuff tears are not associated with the pain level. Factors associated with pain are comorbidities, lower education level, and race.Level of Evidence: Prognostic Level Ill. See Instructions for Authors for a complete description of levels of evidence.