Pain Intensity and Distribution



Fig. 1
Upper limb dermatomes



Exclusion criteria were: neck pain symptoms, clinical features indicating subscapularis tears; neck pathology; ipsilateral upper limb problems (elbow; wrist and hand pathologies, neuropathies due to intrinsic or extrinsic factors); traumatic tears, biceps and/or labral pathologies; diabetes, os acromiale; degenerative arthritis of the gleno-humeral joint; autoimmune or rheumatologic disease; previous surgery in the same shoulder; and Workers’ Compensation claims. Furthermore, we excluded patients who were submitted to physical and/or non-steroidal anti-inflammatory drug therapy and those whose symptoms arose by more than 12 months.

All operations were performed by the senior of us (SG), with patients in the beach chair position under general anesthesia and interscalene block. A standard arthroscopic pump was used in all cases, and standard posterior, lateral, antero-lateral, and mid-glenoid portals were used to perform a thorough diagnostic examination. After the intra-articular evaluation, the scope was placed in the subacromial space. Subacromial bursa was removed to gain a clear view of the RCT. The Southern California Orthopedic Institute (SCOI) classification of complete rotator cuff tears [10] (see the Chapter “Classifications of the Rotator Cuff Tears”) was used to classify tendon tears intraoperatively.

To limit the number of groups and make the sample more representative, we considered the lesions belonging to type I as small, those of the type II and III as large, and those of the type IV as massive.

For the statistical analysis, we used parametric and non-parametric tests (Kolmogorov-Smirnov’s test and Levene’s test). The chi-square test was used to evaluate the differences in prevalence of tears between male and female, or right and left side. Moreover, according to rotator cuff tear size, we used chi-square test to analyze the relationship between dermatomes involved.

According to tear’s size group, we used the unpaired t test to analyze the pain level differences between males and females, right and left side and history of the symptoms.

Mann-Whitney test was performed to analyze the VAS score differences between patients that had pain until and over the elbow.

The one-way ANOVA test was used to evaluate the pain level differences between patients in regard to age and rotator cuff tear size.

The calculation of sample size was performed using G*Power 3 software.



Results


One hundred forty-seven patients were men [mean age: 64.31 (37–82)] and 138 were women [mean age: 66.39 (40–80)] (p = 0.503). The right shoulder was involved in 211 cases (74.03 %) and the left one in 74 (25.96 %) (p < 0.001) (Table 1).


Table 1
Baseline characteristics of patients















Mean age

 65.32 (37–82)

Sex

 Male: 147 (51.6 %)

 Female: 138 (48.4 %)

Shoulder

 Right: 211 (74 %)

 Left: 74 (26 %)

Tear size

 Small: 87 (30.5 %)

 Large: 100 (35.1 %)

 Massive: 98 (34.4 %)

Pain history

 <6 months: 123 (43.1 %)

 >6 months: 162 (56.9 %)

The main important results derived from the study:



  • The average of pain intensity in male and female was 5.1 (0.67–10) and 5.63 (0–9.33), respectively. Overall, a significant difference between the two groups was found (p = 0.024); however, this result is exclusively influenced by patients with a large tear (Table 2).


    Table 2
    Comparison between pain intensity and different sized RCTs, according to gender













































     
    Gender

    Mean VAS (range)

    Mean difference

    95 % confidence interval of the difference

    p value

    Lower

    Upper

    Small

    F vs M

    43 F

    44 M

    5.84 (2–9.33)

    5.13 (0.67–8.67)

    0.70

    −0.08

    1.49

    0.78

    Large

    F vs M

    51 F

    49 M

    6.05 (1.33–9.33)

    5.31 (2–9.33)

    0.73

    0.05

    1.40

    0.034

    Massive

    F vs M

    44 F

    54 M

    5.30 (0.67–10)

    4.60 (0–8.67)

    0.69

    −0.19

    0.59

    0.126


    In bold the significant p value

    F female, M male


  • We did not find a significant difference between the average of pain intensity on right and left side in patients with the same severity of tear (p = 0.630).


  • No statistically significant differences were found between pain intensity in patients older than 65 years old and those younger (p = 0.307).


  • The average of pain intensity was lower in patients with massive tears than in those with small or large tears (Table 3).


    Table 3
    Comparison between pain intensity registered in patients with different sized RCTs




































    RCTs

    Mean difference

    95 % confidence interval of the difference

    p value

    Lower

    Upper

    Small vs large

    −0.20

    −0.899

    0.486

    1.0

    Small vs massive

    0.56

    0.1285

    1.264

    0.045

    Large vs massive

    0.77

    0.1029

    1.447

    0.018


    In bold the significant p value


  • We did not find significant differences, about pain intensity, between patients whose pain arose by less than 6 months and those whose symptoms arose by more than 6 months (Table 4).
Jul 14, 2017 | Posted by in ORTHOPEDIC | Comments Off on Pain Intensity and Distribution

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