title: What Do the Patients Want and Worry in Korean Patients Who Undergo Arthroscopic Rotator Cuff Surgery? Depressive Symptoms, Anatomical Region, and Clinical Outcomes for Patients Seeking Outpatient Physical Therapy for Musculoskeletal Pain Comparison of risk factors for shoulder pain and rotator cuff syndrome in the working population. Does Rotator Cuff Repair Improve Psychologic Status and Quality of Life in Patients With Rotator Cuff Tear? One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress Natural course of nontraumatic rotator cuff tendinitis and shoulder symptoms in a working population. Patients with workers' compensation claims have worse outcomes after rotator cuff repair. Psychologic influence on experimental pain sensitivity and clinical pain intensity for patients with shoulder pain. The importance of patient expectations in predicting functional outcomes after total joint arthroplasty. Patient outcome following rehabilitation for rotator cuff repair surgery: the impact of selected medical comorbidities. Fatty Infiltration and Atrophy of the Rotator Cuff do not Improve after Rotator Cuff Repair and Correlate with Poor Functional Outcome Prospective Longitudinal Analysis of Postoperative Shoulder Function: A Ten-Year Follow-up Study of Full-Thickness Rotator Cuff Tears Patient expectations before arthroscopic shoulder surgery: correlation with patients' reasons for seeking treatment. Prospective Evaluation of the Effect of Rotator Cuff Integrity on the Outcome of Open Rotator Cuff Repairs The relationship of pain intensity, physical impairment, and pain-related fear to function in patients with shoulder pathology. The role of fear-avoidance beliefs in acute low back pain: relationships with current and future disability and work status Effect of depressive symptoms on perceived disability in patients with chronic shoulder pain Psychological Distress Negatively Affects Self-assessment of Shoulder Function in Patients With Rotator Cuff Tears Improvement in Pain After Lumbar Spine Surgery: The Role of Preoperative Expectations of Pain Relief What factors are predictors of emotional health in patients with full-thickness rotator cuff tears? Randomized Trials to Modify Patients’ Preoperative Expectations of Hip and Knee Arthroplasties Pain Sensitivity and Pain Catastrophizing Are Associated With Persistent Pain and Disability After Lumbar Spine Surgery. Comparing surgical repair with conservative treatment for degenerative rotator cuff tears: a randomized controlled trial. Mental Health Has a Stronger Association with Patient-Reported Shoulder Pain and Function Than Tear Size in Patients with Full-Thickness Rotator Cuff Tears. The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study
abstract: Background To specify what patients want and worry preoperatively is important in orthopedic practice . The aim of the current study was to analyze the patient characteristics of rotator cuff disease in Korean population who were willing to undergo arthroscopic surgery  , and to evaluate the differences in expectations and concerns by age and gender . Methods We prospect ively enrolled 303 patients who underwent rotator cuff surgery between April 2004 and August 2008 . Three question naires were completed before surgery : the first one addressing preoperative patient 's expectation , the second one focusing on concerns by covering 64 items using a visual analogue scale , and the third one evaluating patient 's demographic characteristics . The characteristics of preoperative  expectation , concern , and demographic data  were evaluated according to gender and age group . Results Female patients had lower level of sports activity ( p = 0.007 ) and lower levels of information ( p = 0.028 ) . Gender specific worries are about a caregiver during hospital stay , operating on the working side , fear about ugly scars , postoperative pain , applying makeup or combing hair . The older group responded that they ca n't be willing to change activities of daily living ( p = 0.001 ) , are not living with a spouse ( p = 0.002 ) , had previous shoulder operation history ( p = 0.008 ) , and had a lower level of information ( p = 0.007 ) . They especially worried about medical bills , worried about the physician being too young and inexperienced , postoperative pain , loss of arm function , and hospital food . Conclusions Our data showed what Korean patients wanted and were concerned about prior to rotator cuff surgery . This can empower patients to formulate realistic expectations and make informed decisions . We feel that we can achieve higher levels of postoperative satisfaction by analyzing expectations and concerns in depth and addressing these proactively Background Clinical guidelines advocate the routine identification of depressive symptoms for patients with pain in the lumbar or cervical spine , but not for other anatomical regions . Objective The purpose of this study was to investigate the prevalence and impact of depressive symptoms for patients with musculoskeletal pain across different anatomical regions . Design This was a prospect i ve , associational study . Methods Demographic , clinical ,  depressive symptom ( Symptom Checklist 90–Revised )  , and outcome data were collected by self-report from a convenience sample of 8,304 patients . Frequency of severe depressive symptoms was assessed by chi-square analysis for demographic and clinical variables . An analysis of variance examined the influence of depressive symptoms and anatomical region on intake pain intensity and functional status . Separate hierarchical multiple regression models by anatomical region examined the influence of depressive symptoms on clinical outcomes . Results Prevalence of severe depression  was higher in women , in industrial and pain clinics , and in patients who reported chronic pain or prior surgery . Lower prevalence rates were found in patients older than 65 years and those who had upper- or lower-extremity pain .  Depressive symptoms had a moderate to large effect on pain ratings ( Cohen d=0.55–0.87 ) and a small to large effect on functional status ( Cohen d=0.28–0.95 ) . In multivariate analysis , depressive symptoms contributed additional variance to pain intensity and functional status for all anatomical locations , except for discharge values for the cervical region . Conclusions Rates of depressive symptoms varied slightly based on anatomical region of musculoskeletal pain . Depressive symptoms had a consistent detrimental influence on outcomes , except on discharge scores for the cervical anatomical region . Exp and ing screening recommendations for depressive symptoms to include more anatomical regions may be indicated in physical therapy setting BACKGROUND To compare risk factors for shoulder pain without and with rotator cuff syndrome ( RCS ) . METHODS A total of 3,710 workers of a French region were r and omly included in the cross-sectional study between 2002 and 2005 .  Personal and occupational risk factors were assessed during a physical examination and by a self-administered question naire . Multinomial logistic modeling was used for the following outcomes : no shoulder pain and no RCS ( reference ) , shoulder pain without RCS ( called " shoulder pain " ) and RCS , separately for men and women . RESULTS The prevalence rates of " shoulder pain " for men and women were 28.0 % and 31.1 % , respectively , and the prevalence rates of RCS were 6.6 % and 8.5 % , respectively . In men , " shoulder pain " and RCS were associated with age , high-perceived physical exertion , and arm abduction . Automatic work pace and low supervisor support were associated with " shoulder pain , " and high psychological dem and and low skill discretion with RCS . In women , " shoulder pain " and RCS were associated with age , repetitiveness of tasks , and low supervisor support . High perceived physical exertion and exposure to cold temperatures were associated with " shoulder pain . " CONCLUSIONS Age was more strongly associated with RCS than with shoulder pain without RCS for both genders . Biomechanical and psychosocial factors were associated with " shoulder pain " and RCS and differed between genders Background Recently , psychological status , patient-centered outcomes , and health-related quality of life ( HRQoL ) in patients with scheduled or who underwent orthopaedic surgeries have been emphasized . The relationship between preoperative psychological status and postoperative clinical outcome in patients with rotator cuff repair has not yet been investigated . Questions / purpose sThe primary objective of this study was to investigate changes in psychological status ( depression , anxiety , insomnia ) and HRQoL after rotator cuff repair . The secondary objective was to assess whether preoperative depression , anxiety , and insomnia predict clinical outcome after rotator cuff repair . Methods Forty-seven patients who underwent rotator cuff repair prospect ively completed the  visual analog scale ( VAS ) pain score , the UCLA Scale , the  American Shoulder and Elbow Surgeons ’ Scale ( ASES ) , the Hospital Anxiety and Depression Scale ( HADS ) , the Pittsburgh Sleep Quality Index ( PSQI ) , and the World Health Organization Quality -of-life Scale Abbreviated Version ( WHOQOL-BREF ) before surgery and at 3 , 6 , and 12 months after surgery . Repeated- measures analysis of variance was used to evaluate the serial changes in psychological parameters and outcome measurements . The chi-square test was also used to compare preoperative and postoperative prevalence of depression , anxiety , and insomnia . Finally , multiple regression analysis was applied to determine the relationship between preoperative psychological status and postoperative clinical outcome . Results With surgery , depression , anxiety , and insomnia decreased , whereas quality of life increased . The mean HADS-D and HADS-A scores and the mean PSQI score decreased from 3.7 ± 3.3 , 4.3 ± 4.3 , and 6.6 ± 3.6 , respectively , before surgery to 2.1 ± 2.3 , 1.4 ± 2.4 , and 4.2 ± 3.3 , respectively , at 12 months after surgery ( HADS-D mean difference 1.6 [ 95 % confidence interval { CI } , 0.6–2.6 ] , p = 0.003 ; HADS-A mean difference 2.9 [ 1.5–4.4 ] , p < 0.001 ; PSQI mean difference 2.4 [ 1.3–3.4 ] , p < 0.001 ) . The mean WHOQOL-BREF score increased from 60.4 ± 11.0 before surgery to 67.4 ± 11.8 at 12 months after surgery ( mean difference −7.0 [ 95 % CI , −10.7 to −3.4 ] , p < 0.001 ) . At 12 months after surgery , there were decreases in the prevalence of depression ( six of 47 [ 22.8 % ] versus three of 47 [ 6.4 % ] , p = 0.002 ) , anxiety ( 11 of 47 [ 23.4 % ] versus two of 47 [ 4.3 % ] , p = 0.016 ) , and insomnia ( 33 of 47 [ 70.2 % ] versus 20 of 47 [ 42.6 % ] , p = 0.022 ) . Preoperative HADS-depression , HADS-anxiety , and PSQI scores did not correlate with the VAS pain score , UCLA , or ASES scores at 12 months after surgery . Conclusions Psychological status and HRQoL improved with decreasing pain and increasing functional ability from 3 months after surgery . Preoperative depression , anxiety , and insomnia did not predict poor outcome after rotator cuff repair . Our findings suggest that successful rotator cuff repair may improve psychological status and HRQoL.Level of Evidence Level II , prospect i ve study Background Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative self- assessment s of pain and function . In several other areas of orthopaedics , higher levels of distress correlate with a higher likelihood of persistent pain and disability after recovery from surgery . To our knowledge , the relationship between psychological distress and outcomes after arthroscopic rotator cuff repair has not been similarly investigated . Questions / purpose s(1 ) Are higher levels of preoperative psychological distress associated with differences in outcome scores ( visual analog scale [ VAS ] for pain , Simple Shoulder Test , and American Shoulder and Elbow Surgeons score ) 1 year after arthroscopic rotator cuff repair ? ( 2 ) Are higher levels of preoperative psychological distress associated with less improvement in outcome scores ( VAS for pain , Simple Shoulder Test , and American Shoulder and Elbow Surgeons score ) 1 year after arthroscopic rotator cuff repair ? ( 3 ) Does the prevalence of psychological distress in a population with full-thickness rotator cuff tears change when assessed preoperatively and 1 year after arthroscopic rotator cuff repair ? Methods Eighty-five patients with full-thickness rotator cuff tears were prospect ively enrolled ; 70 patients ( 82 % ) were assessed at 1-year followup . During the study period , the three participating surgeons performed 269  rotator cuff repairs ; in large part , the low overall rate of enrollment was related to two surgeons enrolling only two patients total in the initial 14 months of the study . Psychological distress was quantified using the Distress Risk Assessment Method question naire , and patients completed self- assessment s including the VAS for pain , the Simple Shoulder Test , and the American Shoulder and Elbow Surgeons score preoperatively and 1 year after arthroscopic rotator cuff repair . Fifty of 85 patients ( 59 % ) had normal levels of distress , 26 of 85 ( 31 % ) had moderate levels of distress , and nine of 85 ( 11 % ) had severe levels of distress . Statistical models were used to assess the effect of psychological distress on patient self- assessment of shoulder pain and function at 1 year after surgery . Results With the numbers available , distressed patients were not different from nondistressed patients in terms of postoperative VAS for pain ( 1.9 [ 95 % confidence interval { CI } , 1.0–2.8 ] versus 1.0 [ 95 % CI , 0.5–1.4 ] , p = 0.10 ) , Simple Shoulder Test ( 9 [ 95 % CI , 8.1–10.4 ] versus 11 [ 95 % CI , 10.0–11.0 ] , p = 0.06 ) , or American Shoulder and Elbow Surgeons scores ( 80 [ 95 % CI , 72–88 ] versus 88 [ 95 % CI , 84–92 ] , p = 0.08 ) 1 year after arthroscopic rotator cuff repair . With the numbers available , distressed patients also were not different from nondistressed patients in terms of the amount of improvement in scores between preoperative assessment and 1-year followup on the VAS for pain ( 3 [ 95 % CI , 2.2–4.1 ] versus 2 [ 95 % CI , 1.4–2.9 ] , p = 0.10 ) , Simple Shoulder Test ( 5.2 [ 95 % CI , 3.7–6.6 ] versus 5.0 [ 95 % CI , 4.2–5.8 ] , p = 0.86 ) , or American Shoulder and Elbow Surgeons scale ( 38 [ 95 % CI , 29–47 ] versus 30 [ 95 % CI , 25–36 ] , p = 0.16 ) . The prevalence of psychological distress in our patient population was lower at 1 year after surgery 14 of 70 ( 20 % ) versus 35 of 85 ( 41 % ) preoperatively ( odds ratio , 0.36 ; 95 % CI , 0.17–0.74 ; p = 0.005 ) . Conclusions Mild to moderate levels of distress did not diminish patient-reported outcomes to a clinical ly important degree in this small series of patients with rotator cuff tears . This contrasts with reports from other areas of orthopaedic surgery and may be related to a more self-limited course of symptoms in patients with rotator cuff disease or possibly to a beneficial effect of rotator cuff repair on sleep quality or other unrecognized determinants of psychosocial status . Level of Evidence Level I , prognostic study OBJECTIVES This study assessed the prevalence , incidence , and persistence of nontraumatic rotator cuff tendinitis  and shoulder symptoms over a 1-year period in a working population and the predictive value of symptoms and physical findings . METHODS A 1-year prospect i ve study of 436 active workers was conducted at 12 different worksites .  Detailed health interviews , psychosocial question naires , and physical examinations were conducted at baseline and again after 1 year , with shorter evaluations at 4 and 8 months . Individual observed exposure assessment of shoulder posture , arm-h and activity , and h and forces  was conducted . RESULTS The prevalence of rotator cuff tendinitis at baseline was 7.6 % [ 95 % confidence interval ( 95 % CI 5.1 - 10.1 % ) ] for the right and 4.8 % ( 95 % CI 3.0 - 7.0 % ) for the left , compared with shoulder symptoms of 18.6 % ( 95 % CI 14.9 - 22.3 % ) ( right ) and 11.2 % ( 95 % CI 8.2 - 14.2 % ) ( left ) . The incidence of rotator cuff tendinitis was 5.5 % ( 95 % CI 2.8 - 6.8 % ) and 2.9 % ( 95 % CI 1.0 - 3.8 % ) , respectively . Higher proportions of participants with current symptoms or physical findings at baseline became clinical cases after 1 year than those without symptoms or findings . The 1-year persistence of clinical case status was 31.3 % ( 95 % CI 26.9 - 35.7 % ) ( right ) and 31.6 % ( 95 % CI 27.2 - 36.0 % ) ( left ) . There were significant differences at baseline between the asymptomatic participants and the clinical cases with respect to physical health on the 12-item Short-form Health Survey ( P=0.0002 ) , the perception of general health ( P=0.0027 ) , and the frequency of high h and force exposure ( P=0.0177 ) . CONCLUSIONS Considerable movement occurs between different stages of shoulder problems . Symptoms and physical findings alone appear to predict clinical case status within 1 year . Frequent follow-up is necessary to capture changes in health and exposure status in prospect i ve studies BACKGROUND Previous studies have demonstrated varying correlations between Workers ' Compensation status and the outcome of rotator cuff repair . However , none of those studies have formally accounted for potential confounding factors with multivariable analysis . We hypothesized that patients with Workers ' Compensation cl aims who undergo rotator cuff repair have worse outcomes , even after controlling for confounding factors . METHODS One hundred and twenty-five patients ( including thirty-nine with Workers ' Compensation cl aims ) who underwent unilateral primary repair of a chronic rotator cuff tear by a single surgeon were studied prospect ively and were evaluated one year postoperatively , prior to the settlement of any cl aims . Outcomes were assessed with the  Simple Shoulder Test ( SST ) ; the Disabilities of the Arm , Shoulder and H and ( DASH ) index ; three visual analog scales ( shoulder pain , shoulder function , and quality of life ) ; and the Short Form-36 ( SF-36 ) . RESULTS Patients in the Workers ' Compensation group were significantly younger , had greater work dem and s , and had lower marital rates , education levels , and preoperative expectations for the outcome of treatment as compared with those in the non-Workers ' Compensation group ( p = 0.001 to 0.016 ) . Preoperatively , patients in the Workers ' Compensation group had significantly lower scores on the SST , the SF-36 Physical Function scale , and the SF-36 Social Function scale ( p = 0.01 to 0.038 ) . One year postoperatively , those patients reported worse performance on the SST , the DASH , all three visual analog scales , and the SF-36 ( p = 0.0007 to 0.05 ) and had worse improvement on the DASH , the visual analog scales for shoulder pain and function , and the SF-36 Bodily Pain and Role Emotional scales ( p = 0.0028 to 0.038 ) . Multivariable analysis controlling for age , sex , comorbidities , smoking , marital status , education , duration of symptoms , work dem and s , expectations , and tear size confirmed that Workers ' Compensation status was an independent predictor of worse DASH scores . CONCLUSIONS Patients with Workers ' Compensation cl aims report worse outcomes , even after controlling for confounding factors . The present study provides further evidence that the existence of a Workers ' Compensation cl aim portends a less robust outcome following rotator cuff repair . LEVEL OF EVIDENCE Prognostic Level I. See Instructions to Authors for a complete description of levels of evidence UNLABELLED Pain-related fear and pain catastrophizing are 2 central psychologic factors in fear-avoidance models . Our previous studies in healthy subjects indicated that pain-related fear , but not pain catastrophizing , was associated with cold pressor pain outcomes . The current study extends previous work by investigating pain-related fear and pain catastrophizing in a group of subjects with shoulder pain , and included concurrent measures of experimental and clinical pain . Fifty nine consecutive subjects seeking operative treatment of shoulder pain were enrolled in this study ( 24 women , mean age = 50.4 , SD = 14.9 ) . Subjects completed vali date d measures of  pain-related fear , pain catastrophizing , and clinical pain intensity  and then underwent a cold pressor task to determine experimental pain sensitivity . Multivariate regression models used sex , age , pain-related fear , and pain catastrophizing to predict experimental pain sensitivity and clinical pain intensity . Results indicated that only pain-related fear uniquely contributed to variance in experimental pain sensitivity ( beta = -.42 , P < .01 ) . In contrast , sex ( beta = -.29 , P = .02 ) and pain catastrophizing ( beta = .43 , P < .01 ) uniquely contributed to variance in clinical pain intensity . These data provide additional support for application of fear-avoidance models to subjects with shoulder pain . Our results also suggest that pain-related fear and pain catastrophizing may influence different components of the pain experience , providing preliminary support for recent theoretical conceptualizations of the role of pain catastrophizing . PERSPECTIVE This study provided additional information on how specific psychological variables potentially influence experimental and clinical pain . In this sample of subjects with shoulder pain , we replicated findings from our previous studies involving healthy subjects , as fear of pain was uniquely associated with experimental pain sensitivity . In contrast , pain catastrophizing emerged as the sole psychological variable related to clinical pain intensity OBJECTIVE To evaluate the relationship between patient expectations of  total joint arthroplasty ( TJA ) and health related quality of life plus satisfaction 6 months after surgery . Methods . This prospect i ve cohort study included patients undergoing primary total hip ( THA ) and knee arthroplasty ( TKA ) .  Patients were evaluated with  self-report question naires prior to surgery and 6 months post-surgery . Medical Outcomes Study Short Form 36 ( SF-36 ) , the Western Ontario McMaster Universities Osteoarthritis Index ( WOMAC ) , and a satisfaction scale were used to evaluate outcomes at final followup . Multivariate regression models were used to evaluate the impact of expectations on outcomes . RESULTS There were 102 patients with THA and 89 with TKA . Mean age was 66 years . All patients achieved significant improvements in their WOMAC and SF-36 scores following surgery . Patient expectations regarding surgery were not associated with their age , gender , index joint of surgery , marital status , or race . Expectations were not correlated with pre-operative functional health status . Expectation of complete pain relief after surgery was an independent predictor of better physical function and improvement in level of pain at 6 months post-surgery . Expectation of low risk of complications from TJA was an independent predictor of greater satisfaction . CONCLUSIONS Patient expectations were important independent predictors of improved functional outcomes and satisfaction following TJA . Greater underst and ing of the relationship between expectations and outcomes may improve the process of care and outcomes of TJA STUDY DESIGN Prospect i ve , multicenter research design . OBJECTIVES To assess functional and health status outcomes in patients following a physical therapy program after rotator cuff repair surgery , and to determine the impact of selected patient medical comorbidities on rehabilitation outcomes . BACKGROUND While authors have studied the influence of multiple factors on patient outcomes after rotator cuff repair surgery , little research has been done on the impact of comorbidities , particularly as it relates to establishing an accurate patient prognosis . eighteen patients who had recently undergone a rotator cuff repair surgical procedure were recruited at 1 of 30 Physiotherapy Associates , Inc outpatient clinics located in 13 states . A rehabilitation protocol was implemented and included the following interventions , as indicated : therapeutic exercise , manual therapy , electrotherapeutic modalities , and physical agents . Patient health history factors were documented during the initial examination , including age , race , body mass index , smoking , rotator cuff tear size , type of surgical procedure , and selected medications and comorbidities . The Disabilities of the Arm , Shoulder , and H and ( DASH ) and the Short-Form-36 ( SF-36 ) were completed prior to rehabilitation , at discharge , and at 6 months postdischarg RESULTS DASH and most SF-36 domain mean scores obtained postrehabilitation were significantly improved from pretherapy scores . Most health status outcomes were maintained at 6-month follow-up , with slight further improvement noted in SF-36 physical dimensions and DASH scores . Having a greater number of comorbidities was associated with worse postrehabilitation SF-36 scores , but not with the DASH shoulder function scores . The mean change scores ( difference between prerehabilitation and postrehabilitation status ) for the DASH and SF-36 were not significantly different for patients with 0 to 1 , 2 , or at least 3 or more comorbidities ( except for emotional role ) . In regression analyses a model with baseline physical function score ( P = .0001 ) , age ( P = .03 ) , and number of comorbidities ( P = .003 ) fitted the data well and explained 38 % of the variance in the physical function score at discharge . CONCLUSIONS A higher number of comorbidities had a negative effect on general health status outcomes but not on shoulder function outcomes at the time of patient discharge following rehabilitation . Despite a negative effect of more comorbidities on health status outcomes , the specific number of medical comorbidities did not affect the overall level of improvement prerehabilitation to postrehabilitation in function and health status . The findings describing the influence of comorbidities on rehabilitation outcomes may assist therapists in establishing accurate patient prognosis Background The role of degenerative changes in rotator cuff musculature with respect to the functional outcomes of rotator cuff repair have only recently been recognized and are still not well understood . In addition , the reversibility of these changes with repair of the tendons is question able . Hypothesis Poorer preoperative muscle quality negatively affects outcome , and a successful outcome ( in terms of a healed repair ) might demonstrate improvements in fatty infiltration and muscle atrophy . Study Design Cohort study ; Level of evidence , 2 . Methods Thirty-eight patients ( mean age , 62 years ) were prospect ively evaluated with preoperative and 1-year postoperative clinical examination and appropriate magnetic resonance image sequencing to determine grade s of muscle atrophy and fatty infiltration of the supraspinatus and infraspinatus muscles . American Shoulder and Elbow Society ( ASES ) , Constant , and pain scores were determined as well as strength measurements . The retear rate and progression of muscle degeneration were also evaluated . Independent predictors of outcome measurements and cuff integrity were determined . Results The overall clinical outcome , including ASES , Constant , and pain scores , improved significantly ( P < .0001 ) . Strength in forward elevation improved significantly ( P < .006 ) , while external rotation strength did not . There was a strongly negative correlation between muscle quality and outcome results in most cases . When the results were adjusted for multivariate effect , muscle atrophy and fatty infiltration of the infraspinatus muscle were the only independent predictors of ASES and Constant scores ( P < .03 ) . Tear size and rotator cuff healing did not play an independent role . Tear size , however , was the only independent predictor of ultimate cuff integrity ( P = .002 ) . Both atrophy and fatty infiltration progressed significantly over the course of the study . In cases in which the tendon had re-torn , the progression was found to be more significant than when the repair proved successful ( P < .003 ) . Conclusion Muscle atrophy and fatty infiltration of the rotator cuff muscles , particularly of the infraspinatus , play a significant role in determining functional outcome after cuff repair . Tear size appears to have the most influential effect on repair integrity . A successful repair did not lead to improvement or reversal of muscle degeneration and a failed repair result ed in significantly more progression . In general , healed repairs demonstrated minimal progression . These findings suggest that repairs should be performed , if possible , before more significant deterioration in the cuff musculature in order to optimize outcomes , and that underst and ing the degree of muscle atrophy and fatty infiltration before surgery can help guide patient expectations Background : Rotator cuff repair  is associated with good short or mid-term results , but to date there have been no long-term functional outcome studies demonstrating durability of results over time . In most long-term studies , the results have been compared with those of historical controls or with those of other , short-term follow-up studies . The purpose of the present prospect i ve study was to evaluate short and long-term shoulder function after surgical repair in a single population of patients in order to follow changes over time . Methods : Thirty-three patients underwent surgery , performed by one surgeon , for the treatment of a chronic , symptomatic , full-thickness rotator cuff defect . Data were obtained from question naires and physical examinations preoperatively , at two years , and at ten years . Identical st and ardized pain and function question naires were used and clinical evaluation was performed in a consistent fashion at all time-periods . The activity level , Constant score , level of disability , shoulder function score , and patient ’s subjective rating of the outcome were determined at the time of the final follow-up and compared with the same parameters at the two-year follow-up examination in order to determine if early results change with time . Results : At the ten-year follow-up examination , there was no change in the raw Constant score determined at the two-year examination . When the Constant score was normalized for expected age-related changes , the percentage of patients who had a satisfactory result at ten years was even greater than the percentage at two years . Activity level decreased significantly over the time-period ( p = 0.005 ) . At the final follow-up examination , twelve patients worked at the same occupation as they had when the two-year examination was performed , two worked at a less strenuous occupation , and the remaining patients were retired . Only two patients retired because of problems related to the shoulder . The level of disability decreased over the study period , and there was a small improvement in the patients ’ self- assessment shoulder function score . The patients ’ subjective assessment of the outcome remained unchanged . Conclusions : The results of open rotator cuff repair for chronic tears do not deteriorate with time ( ten years ) . The level of disability decreases , presumably because of a concurrent decrease in the activity level and in the dem and on the shoulder as the patient ages . It is important to consider age-related changes when assessing the final outcome BACKGROUND Elevated expectations before orthopaedic procedures appear to correlate with inferior preoperative subjective measures . The purpose of this study was to evaluate preoperative patient expectations before  arthroscopic shoulder surgery  and to correlate them with preoperative subjective measures and patients ' reasons for seeking treatment . METHODS We prospect ively collected and retrospectively analyzed data from patients before elective arthroscopic shoulder surgery for a wide range of pathologic processes . Preoperative subjective data included QuickDASH scores , pain and functional components of the American Shoulder and Elbow Surgeons ( ASES ) score , and mental and physical components of the SF-12 score . Expectations data were collected and grouped on the basis of the reasons for seeking of medical treatment and ranked according to their relative importance . RESULTS The study included 313 shoulders . There were 205 men and 108 women with a mean age at surgery of 48.7 years ( range , 18 - 78 years ) . Overall , the most important expectations were for the " shoulder to be back to the way it was before the problem started " and to continue participation in sporting activities . Patients who presented with the " shoulder coming out " had fewer important expectations than did those who presented for other reasons . Those patients who indicated a desire to continue participation in sports had significantly less pain ( improved ASES pain scores ) compared with the rest of the population . CONCLUSIONS Although return to sport was the most important expectation overall , the importance of other expectations varied by patients ' reasons for seeking treatment . The current question naire may have limited use in patients with shoulder instability . LEVEL OF EVIDENCE Level III , cross-sectional design , epidemiology Background Open rotator cuff repairs have led to excellent clinical results ; however , several studies have linked postoperative structural integrity to patient outcomes . The purpose of this study is to prospect ively assess postoperative cuff integrity after  open rotator cuff repair  and assess its relationship to clinical outcome . Hypothesis Preoperative rotator cuff tear size and postoperative rotator cuff integrity are important factors in overall clinical outcomes . Study Design Prospect i ve nonr and omized clinical outcomes study . Methods Forty-seven consecutive patients undergoing repair of full-thickness rotator cuff tears by a single surgeon were enrolled in this prospect i ve study . A st and ardized evaluation was performed preoperatively and postoperatively at annual intervals . All patients underwent  postoperative magnetic resonance imaging at least 1 year after surgery . Statistical evaluation was performed using paired and unpaired 2-tailed t tests for comparison . Results Thirty-two patients were available for evaluation . Overall , the patients experienced a significant ( P < .05 ) improvement in their American Shoulder and Elbow Surgeons survey ( 40 - 85 ) and Constant ( 53 - 80 ) scores . The overall retear rate was 31 % . Although patients with large tears preoperatively and retears postoperatively had lower overall outcomes scores , this was not significant . Conclusion These data support open rotator cuff repair as an effective technique that restores excellent shoulder function . The authors did not find postoperative cuff integrity to have a significant effect on outcomes when compared with those with an intact cuff . In fact , those with a retear still had a significant improvement in all clinical areas assessed , including strength STUDY DESIGN Cross-sectional . OBJECTIVES This study examined the baseline relationship of pain intensity , physical impairment , and pain-related fear to shoulder function . BACKGROUND There is no consensus regarding the influence psychological variable have on function and recovery in individuals with shoulder pathologies . While pain-related fear has been shown to predict disability for patients with low-back and cervical pain , this relationship has not been consistently reported for patients with shoulder pain . METHODS AND MEASURES One hundred forty-two subjects ( 78 male , 64 female ; mean age , 41.4 years ) with nonoperative unilateral shoulder disorders were identified from a clinical data base of impairment and outcome measures .Demographic information , duration of symptoms , mechanism of injury , pain intensity , pain-related fear , and range-of-motion ( ROM ) measures were collected . Self-report of function was measured with the Shoulder Pain and Disability Index ( SPADI ) . Hierarchical regression analysis determined the proportions of explained variance in function . RESULTS Demographic variables ( duration of symptoms , sex , age , and mechanism of injury ) collectively contributed approximately 9 % ( P=.003 ) of the variance in function scores . Average pain intensity and flexion ROM contributed an additional 22 % ( P<.001 ) of the variance , and Tampa Scale of Kinesiophobia ( TSK-11 ) scores contributed an additional 3 % ( P<.001 ) . In the final parsimonious model , presence of symptoms longer than 3 months ( beta=.23 , P=.003 ) , pain intensity ( beta=.25 , P=.002 ) , shoulder flexion ROM index ( beta=-.35 , P=.001 ) , and kinesiophobia ( beta=.17 , P=.026 ) explained 33 % of the variance in SPADI function score ( P<.001 ) . CONCLUSIONS Presence of symptoms longer than 3 months , average pain intensity , flexion ROM index ( strongest contributor in multivariate model ) , and fear-of-pain scores all contributed to baseline shoulder function . The immediate clinical relevance of these findings is unclear but they do provide direction for prospect i ve studies & NA ; Fear‐avoidance beliefs have been identified as an important psychosocial variable in patients with chronic disability doe to low back pain . The importance of fear‐avoidance beliefs for individuals with acute low back pain has not been explored . Seventy‐eight subjects with work‐related low back pain of less than 3 weeks ' duration were studied .  Measurements of pain intensity , physical impairment , disability , nonorganic signs and symptoms , and depression were taken at the initial evaluation . Fear‐avoidance beliefs were measured with the  work and physical activity subscales of the Fear‐avoidance Beliefs Question naire .  Disability and work status were re‐assessed after 4 weeks of physical therapy . Patterns of correlation between fear‐avoidance beliefs and other concurrently‐measured variables were similar to those reported in patients with chronic low back pain . Fear‐avoidance beliefs did not explain a significant amount of the variability in initial disability levels after controlling for pain intensity and physical impairment . Fear‐avoidance beliefs about work were significant predictors of 4‐week disability and work status even after controlling for initial levels of pain intensity , physical impairment , and disability , and the type of therapy received . Fear‐avoidance beliefs are present in patients with acute low back pain , and may be an important factor in explaining the transition from acute to chronic conditions . Screening for fear‐avoidance beliefs may be useful for identifying patients at risk of prolonged disability and work absence Background Psychological distress may be an important determinant of perceived disability in patients with chronic musculoskeletal disorders . We evaluated the relationship between depressive symptoms and perceived disability in patients with chronic shoulder pain and quantified the contribution made by depression to perceived disability . Methods In this prospect i ve study , 109 patients with chronic shoulder pain caused by degenerative or inflammatory disorders were evaluated using the  Disability of Arm , Shoulder and H and ( DASH ) question naire and the Center for Epidemiologic Studies -Depression ( CES-D ) Scale to determine relationships between depressive symptoms and perceived disability in patients with chronic shoulder pain . In addition , pain scores were evaluated using a  visual analog scale  ( VAS ) during activity , and range of motion ( ROM ) and abduction strength ( strength ) measurements were measured . Multivariate analyses of variance and regression modeling were used to assess the relative contributions made by depressive symptoms ( CES-D ) and other clinical parameters to patient-perceived disability ( DASH ) . Results DASH scores were found to be moderately correlated ( 0.3 < r < 0.6 ) with ROM , strength , pain VAS and CES-D ; DASH scores were more strongly correlated with CES-D scores than with pain VAS scores or range of motion ( r = 0.58 ; p < 0.001 , 0.37 ; p < 0.001 , 0.32 ; p = 0.04 respectively ) . Multiple stepwise regression analyses revealed that gender , ROM , pain VAS and CES-D scores independently predicted DASH score and accounted for 43 % of the variance . CES-D score was found to be the strongest predictor of DASH score and accounted for 23 % of the variance . Conclusions Degrees of depressive symptoms were found to be significantly associated with higher symptom scores and greater disability in patients with chronic shoulder pain . Although a large proportion of perceived disability remains unexplained , perceived disability in patients with chronic shoulder pain was found to be strongly influenced by depressive symptoms . Type of study /level of evidence Level 2 , prospect i ve cohort study , prognostic study Background In many areas of orthopaedics , patients with greater levels of psychological distress report inferior self- assessment s of pain and function . This effect can lead to lower-than-expected baseline scores on common patient-reported outcome scales , even those not traditionally considered to have a psychological component . Questions / purpose sThis study attempts to answer the following questions : ( 1 ) Are higher levels of psychological distress associated with clinical ly important differences in baseline scores on the VAS for pain , the Simple Shoulder Test , and the American Shoulder and Elbow Surgeons score in patients undergoing arthroscopic rotator cuff repair ? ( 2 ) Does psychological distress remain a negative predictor of baseline shoulder scores when other clinical variables are controlled ? Methods Eighty-five patients with full-thickness rotator cuff tears were prospect ively enrolled . Psychological distress was quantified using the Distress Risk Assessment Method question naire . Patients completed baseline self- assessment s including the  VAS for pain ,  the  Simple Shoulder Test  , and the  American Shoulder and Elbow Surgeons score . Age , sex , BMI , smoking status , American Society of Anesthesiologists classification , tear size , and tear retraction were recorded for each patient . Bivariate correlations and multivariate regression models were used to assess the effect of psychological distress on patient self- assessment of shoulder pain and function . Results Distressed patients reported higher baseline VAS scores ( 6.7 [ 95 % CI , 4.4–9.0 ] versus 2.9 [ 95 % CI , 2.3–3.6 ] , p = 0.001 ) and lower baseline Simple Shoulder Test ( 3.7 [ 95 % CI , 2.9–4.5 ] versus 5.7 [ 95 % CI 5.0–6.4 ] , p = 0.001 ) and American Shoulder and Elbow Surgeons scores ( 39 [ 95 % CI , 34–45 ] versus 58 [ 95 % CI , 53–63 ] , p < 0.001 ) . Distress remained associated with higher VAS scores ( p = 0.001 ) and lower Simple Shoulder Test ( p < 0.001 ) and American Shoulder and Elbow Surgeons scores ( p < 0.001 ) when age , sex , BMI , American Society of Anesthesiologists classification , smoking status , tear size , and tear retraction were controlled . Conclusions Higher levels of psychological distress are associated with inferior baseline patient self- assessment of shoulder pain and function using the VAS , the Simple Shoulder Test , and the American Shoulder and Elbow Surgeons score . Longitudinal followup is warranted to clarify the relationship between distress and self-perceived disability and the effect of distress on postoperative outcomes  after arthroscopic rotator cuff repair .  Level of Evidence Level I , prognostic study . See the Instructions for Authors for a complete description of levels of evidence Objectives : Improvement in pain is a major expectation of patients undergoing lumbar spine surgery . Material s and Methods : Among 422 patients , the goal of this prospect i ve study was to measure 2-year postoperative pain and to determine whether this outcome varied according to patient and clinical characteristics , including amount of pain relief expected preoperatively . Before surgery patients completed valid question naires that addressed clinical characteristics and expectations for pain improvement . Two years after surgery patients reported how much pain improvement they actually received . Results : The mean age was 56 years old and 55 % were men . Two years after surgery 11 % of patients reported no improvement in pain , 28 % reported a little to moderate improvement , 44 % reported a lot of improvement , and 17 % reported complete improvement . In multivariable analysis , patients reported less pain improvement if , before surgery , they expected greater pain improvement ( odds ratio [ OR ] 1.4 ) , had a positive screen for depression ( OR 1.7 ) , were having revision surgery ( OR 1.6 ) , had surgery at L4 or L5 ( OR 2.5 ) , had a degenerative diagnosis ( OR 1.6 ) , and if , after surgery , they had another surgery ( OR 2.8 ) and greater back ( OR 1.3 ) and leg ( OR 1.1 ) pain ( all variables P⩽0.05 ) . Conclusions : Pain is not uncommon after lumbar surgery and is associated with a network of clinical , surgical , and psychological variables . This study provides evidence that patients ’ expectations about pain are an independent variable in this network . Because expectations are potentially modifiable this study supports addressing pain-related expectations with patients before surgery through discussion s with surgeons and through formal preoperative patient education BACKGROUND The importance of emotional and psychological factors in treatment of patients with rotator cuff disease has been recently emphasized . Our goal was to establish factors most predictive of poor emotional health in patients with full-thickness rotator cuff tears ( FT RCTs ) . METHODS In 2007 , we began to prospect ively collect data on patients with symptomatic , atraumatic FT RCTs . All patients completed a question naire collecting data on demographics , symptom characteristics , comorbidities , willingness to undergo surgery , and patient-related outcomes ( 12-Item Short Form Health Survey , American Shoulder and Elbow Surgeons score , Western Ontario Rotator Cuff Index [ WORC ] , Single Assessment Numeric Evaluation score , Shoulder Activity Scale ) . Physicians recorded physical examination and imaging data . To evaluate the predictors of lower WORC emotion scores , a linear multiple regression model was fit . RESULTS Baseline data for 452 patients were used for analysis . In patients with symptomatic FT RCTs , the factors most predictive of worse WORC emotion scores were higher levels of pain ( interquartile range odds ratio , -18.9 ; 95 % confidence interval , -20.2 to -11.6 ; P < .0001 ) and lower Single Assessment Numeric Evaluation scores ( rating of percentage normal that patients perceive their shoulder to be ; interquartile range odds ratio , 6.2 ; 95 % confidence interval , 2.5 - 9.95 ; P = .0012 ) . Higher education ( P = .006 ) and unemployment status ( P = .0025 ) were associated with higher WORC emotion scores . CONCLUSIONS Education level , employment status , pain levels , and patient perception of percentage of shoulder normalcy were most predictive of emotional health in patients with FT RCTs . Structural data , such astendon tear size , were not . Those with poor emotional health may perceive their shoulder to be worse than others and experience more pain . This may allow us to better optimize patient outcomes with nonoperative and operative treatment of rotator cuff tears Abstract Patients have multiple expectations of THA and TKA . We asked whether preoperative educational classes addressing recovery during the first year could modify patients ’ expectations of their 12-month postoperative recovery . Participants were enrolled consecutively in two r and omized , controlled trials , one for THA ( 177 patients ) and one for TKA ( 143 patients ) . Control patients preoperatively received a st and ard THA or TKA class addressing recovery immediately after surgery . Intervention patients preoperatively received the st and ard class plus a joint-specific module addressing recovery during the first 12 months . Before and after the class , patients completed either a hip-specific or knee-specific vali date d expectations survey . The main outcome was the within-patient change in expectation scores ( maximum increase , + 100 ; maximum decrease , −100 ) before and after the class but preoperatively . Mean changes in hip scores were + 3.3 ± 8 for intervention patients ( range , −22–+32 ) and + 4.9 ± 8 for control patients ( range , −13–+29 ) . Mean changes in knee scores were −3.4 ± 10 for intervention patients ( range , −26–+33 ) and + 2.4 ± 10 for control patients ( range , −30–+30 ) . Patients ’ preoperative expectations of their recovery from THA or TKA can be modified by preoperative educational classes . Level of Evidence : Level I , therapeutic study . See the Guidelines for Authors for a complete description of levels of evidence OBJECTIVE To examine whether pain sensitivity and pain catastrophizing are associated with  persistent pain and disability after lumbar spine surgery . DESIGN Prospect i ve observational cohort study . SETTING Academic medical center . PARTICIPANTS Patients ( N=68 ; mean age , 57.9±13.1y ; 40 women [ 58.8 % ] ) undergoing spine surgery for a degenerative condition from March 1 , 2012 to April 30 , 2013 were assessed 6 weeks , 3 months , and 6 months after surgery . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The main outcome measures were persistent back pain intensity , pain interference , and disability .  Patients with persistent back pain intensity , pain interference , or disability  were identified as those patients reporting Brief Pain Inventory scores ≥4 and Oswestry Disability Index scores ≥21 at all postoperative time points . RESULTS From 6 weeks to 6 months after surgery , approximately 12.9 % , 24.2 % , and 46.8 % of patients reported persistent back pain intensity , pain interference , or disability , respectively . Increased pain sensitivity at 6 weeks was associated with having persistent back pain intensity ( odds ratio [ OR ] , 2.0 ; 95 % confidence interval [ CI ] , 1.0 - 4.1 ) after surgery . Increased pain catastrophizing at 6 weeks was associated with having persistent back pain intensity ( OR , 1.1 ; 95 % CI , 1.0 - 1.2 ) , pain interference ( OR , 1.1 ; 95 % CI , 1.0 - 1.2 ) , and disability ( OR , 1.3 ; 95 % CI , 1.1 - 1.4 ) . An interaction effect was not found between pain sensitivity and pain catastrophizing on persistent outcomes ( P>.05 ) . CONCLUSIONS The findings suggest the importance of early postoperative screening for pain sensitivity and pain catastrophizing to identify patients at risk for poor postoperative pain intensity , pain interference , and /or disability outcomes . Future research should consider the benefit of targeted therapeutic strategies for patients with these postoperative prognostic factors BACKGROUND Good clinical results have been reported for both surgical and conservative treatment of rotator cuff tears . The primary aim of this r and omized controlled trial was to compare functional and radiologic improvement after surgical and conservative treatment of degenerative rotator cuff tears . METHODS We conducted a r and omized controlled trial that included 56 patients with a degenerative full-thickness rotator cuff tear between January 2009 and December 2012 ; 31 patients were treated conservatively , and rotator cuff repair was performed in 25 patients . Outcome measures , including the Constant-Murley score ( CMS ) , visual analog scale ( VAS ) pain and VAS disability scores , were assessed preoperatively and after 6 weeks and 3 , 6 , and 12 months . Magnetic resonance imaging was performed preoperatively and at 12 months postoperatively . RESULTS At 12 months postoperatively , the mean CMS was 81.9 ( st and ard deviation [ SD ] , 15.6 ) in the surgery group vs 73.7 ( SD , 18.4 ) in the conservative group ( P = .08 ) . VAS pain ( P = .04 ) and VAS disability ( P = .02 ) were significantly lower in the surgery group at the 12-month follow-up . A subgroup analysis showed postoperative CMS results were significantly better in surgically treated patients without a retear compared with conservatively treated patients ( 88.5 [ SD , 6.2 ] vs 73.7 [ SD , 18.4 ] ) . CONCLUSION In our population of patients with degenerative rotator cuff tears who were r and omly treated by surgery or conservative protocol , we did not observe differences in functional outcome as measured with the CMS 1 year after treatment . However , significant differences in pain and disabilities were observed in favor of surgical treatment . The best outcomes in function and pain were seen in patients with an intact rotator cuff postoperatively BACKGROUND Patient-reported outcome measures have increasingly accompanied objective examination findings in the evaluation of orthopaedic interventions . Our objective was to determine whether a vali date d measure of mental health ( Short Form-36 Mental Component Summary [ SF-36 MCS ] ) or measures of tear severity on magnetic resonance imaging were more strongly associated with self-assessed shoulder pain and function in patients with symptomatic full-thickness rotator cuff tears . METHODS One hundred and sixty-nine patients with full-thickness rotator cuff tears were prospect ively enrolled . Patients completed the Short Form-36 , visual analog scales for shoulder pain  and function , the Simple Shoulder Test ( SST ) , and the American Shoulder and Elbow Surgeons ( ASES ) instrument at the time of diagnosis . Shoulder magnetic resonance imaging examinations were review ed to document the number of tendons involved , tear size , tendon retraction , and tear surface area . Age , sex , body mass index , number of medical comorbidities , smoking status , and Workers ' Compensation status were recorded . Bivariate correlations and multivariate regression models were calculated to identify associations with baseline shoulder scores . RESULTS The SF-36 MCS had the strongest correlation with the visual analog scale for shoulder pain ( Pearson correlation coefficient , -0.48 ; p < 0.001 ) , the visual analog scale for shoulder function ( Pearson correlation coefficient , -0.33 ; p < 0.001 ) , the SST ( Pearson correlation coefficient , 0.37 ; p < 0.001 ) , and the ASES score ( Pearson correlation coefficient , 0.51 ; p < 0.001 ) . Tear severity only correlated with the visual analog scale for shoulder function ; the Pearson correlation coefficient was 0.19 for tear size ( p = 0.018 ) , 0.18 for tendon retraction ( p = 0.025 ) , 0.18 for tear area ( p = 0.022 ) , and 0.20 for the number of tendons involved ( p = 0.011 ) . Tear severity did not correlate with other scores in bivariate correlations ( all p > 0.05 ) . In all multivariate models , the SF-36 MCS had the strongest association with the visual analog scale for shoulder pain , the visual analog scale for shoulder function , the SST , and the ASES score ( all p < 0.001 ) . CONCLUSIONS Patient mental health may play an influential role in patient-reported pain and function in patients with full-thickness rotator cuff tears . Further studies are needed to determine its effect on the outcome of the treatment of rotator cuff disease Background Psychological symptoms are highly prevalent in patients with shoulder complaints . Psychological symptoms in patients with shoulder complaints might play a role in the aetiology , perceived disability and pain and clinical outcome of treatment . The aim of this study was to assess whether preoperative symptoms of distress , depression , anxiety and somatisation were associated with a change in function after shoulder surgery and postoperative patient perceived improvement of pain and function . In addition , the change of psychological symptoms after shoulder surgery was analyzed and the influence of postoperative symptoms of psychological disorders after surgery on the change in function after shoulder surgery and perceived postoperative improvement of pain and function . Methods and Findings A prospect i ve longitudinal cohort study was performed in a general teaching hospital . 315 consecutive patients planned for elective shoulder surgery were included . Outcome measures included change of Disabilities of the Arm , Shoulder and H and ( DASH ) score and anchor questions about improvement in pain and function after surgery . Psychological symptoms were identified before and 12 months after surgery with the vali date d Four-Dimensional Symptom Question naire ( 4DSQ ) . Psychological symptoms were encountered in all the various shoulder diagnoses . Preoperative symptoms of psychological disorders persisted after surgery in 56 % of patients , 10 % of patients with no symptoms of psychological disorders before surgery developed new psychological symptoms . Preoperative symptoms of psychological disorders were not associated with the change of DASH score and perceived improvement of pain and function after shoulder surgery . Patients with symptoms of psychological disorders after surgery were less likely to improve on the DASH score . Postoperative symptoms of distress and depression were associated with worse perceived improvement of pain . Postoperative symptoms of distress , depression and somatisation were associated with worse perceived improvement of function . Conclusions Preoperative symptoms of distress , depression , anxiety and somatisation were not associated with worse clinical outcome 12 months after shoulder surgery . Symptoms of psychological disorders before shoulder surgery persisted in 56 % of patients after surgery . Postoperative symptoms of psychological disorders 12 months after shoulder surgery were strongly associated with worse clinical outcome
target: Results Weak to moderate cross-sectional associations were found for emotional or mental health with function or disability and pain in multiple studies .
  Lower emotional or mental health function was associated with greater pain or disability or lower physical function at initial evaluation .
  Conclusions At the initial evaluation of patients with rotator cuff tear , there was an association between self-reported function and pain and emotional or mental health .
  However , these factors were not associated with patient-reported outcomes after intervention .
  Preoperative patient expectation is an important predictor of patient-reported outcomes in patients after rotator cuff surgery and may be a modifiable target for enhancing recovery .
background: Background Psychosocial factors are key determinants of health and can influence patient-reported outcomes after rotator cuff tears .
  However , to our knowledge , a systematic review of published studies has not been conducted to determine the degree of consistency and strength of the relationship between psychosocial factors and patient-reported outcomes in this patient population .
  Questions / purpose s ( 1 ) Are psychosocial factors associated with patient-reported measures at initial clinical presentation in patients with rotator cuff tears ? (
  2 ) Are psychosocial factors associated with patient-reported outcomes after treatment in patients with rotator cuff tears ?