Factors Contributing to Failure of Rotator Cuff Surgery in Persons with Work-Related Injuries

Abstract

Purpose: Shoulder pain is a major musculoskeletal and economic concern in industrialized countries, with the rate of surgical failure reportedly higher in patients injured at work. The purposes of this study were (1) to examine the prevalence of identifiable causes of rotator cuff surgery failure and (2) to examine the relationship among the existence of these causes and outcome scores, patient expectations, and overall satisfaction. Methods: This was a cross-sectional study of patients who experienced continued impairments following surgical treatment for work-related injuries. The primary outcome was a disease-specific measure, the Western Ontario Rotator Cuff (WORC) index. Patients were categorized into two groups based on the existence of an identifiable reason for surgical failure vs. no reason for failure, as demonstrated by clinical and radiologic investigations and decided upon by a shoulder surgeon and a physical therapist. Analyses included a t-test for independent sample means, linear regression, non-parametric Wilcoxon test, and Fisher's exact test. Results: Thirty-eight consecutive patients were included in the study, and 24 causes of surgical failure were identified in 19 patients (50%). Overall, patients with findings of failure were more disabled according to the total WORC index and had higher levels of symptoms, emotional difficulties, and limitations in sports and recreational activities. Expectations and satisfaction levels were not significantly different between groups. Conclusion: Our results indicate that 50% of patients who reported failed surgery had at least one reason to explain their ongoing symptoms, emotional difficulties, and functional limitations.