Postoperative assessment of shoulder function: a prospective study of full-thickness rotator cuff tears.

Abstract

Forty patients underwent surgery by a single surgeon for chronic, symptomatic, full-thickness rotator cuff defects. The study evaluated preoperative and intraoperative factors that influence postoperative outcome. The study also correlated objective measures of shoulder function with postoperative symptoms, patient satisfaction, and disability. Follow-up history and physical examination and strength measurements were performed at 2 years after surgery by three independent observers. There were 88% good or excellent results. Postscores correlated most closely with preoperative tear size. Postoperative Constant scores also correlated significantly with the patient's subjective rating of the end result. Preoperative cuff tear size also correlated with the presence of postoperative fatigue symptoms and objective measures of shoulder strength. Preoperative cuff tear size strongly correlated with other prognostic factors including the quality of the tendon tissue, the difficulty for tendon mobilization, and the presence of a rupture of the long head of the biceps. Together these factors adversely affect postoperative function, patient satisfaction, and overall shoulder score. Neither premorbid activity level nor the presence of a worker's compensation claim adversely affected the postoperative Constant score. The premorbid activity level significantly influenced the postoperative disability rating and the ability to return to work. All patients who were gainfully employed before surgery returned to employment after surgery, although in some patients at a lesser activity level.