Rotator cuff tendinopathy: magnitude of incapability is associated with greater symptoms of depression rather than pathology severity

Abstract

Background: Population-based studies have established that rotator cuff tendinopathy develops in most persons during their lifetimes, it is often accommodated, and there is limited correspondence between symptom intensity and pathology severity. To test the relationship between effective accommodation and mental health on its continuum, we studied the relative association of magnitude of capability with symptoms of anxiety or depression compared with quantifications of rotator cuff pathology such as defect size, degree of retraction, and muscle atrophy among patients presenting for specialty care.

Methods: We analyzed a retrospective cohort of 71 adults seeking specialty care for symptoms of rotator cuff tendinopathy who underwent a recent magnetic resonance imaging scan of the shoulder and completed the following questionnaires: Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health questionnaire (a measure of symptom intensity and magnitude of capability, consisting of mental and physical health subscores), Generalized Anxiety Disorder questionnaire (measuring symptoms of anxiety), and Patient Health Questionnaire (measuring symptoms of depression). Two independent reviewers measured the sagittal length of the rotator cuff defect and tendon retraction in millimeters on magnetic resonance imaging scans (excellent reliability) and rated rotator cuff muscle atrophy and fatty infiltration (more limited reliability), and we used the average measurement or rating for each patient. Multivariable statistical models were used to identify factors associated with the PROMIS Global Health score and mental and physical health subscores.

Results: Accounting for potential confounding in multivariable analysis, lower PROMIS Global Health total scores and physical health subscale scores were independently associated with greater symptoms of depression but not with measures of pathology. Lower PROMIS mental health subscale scores were independently associated with greater symptoms of anxiety and greater muscle atrophy.

Conclusions: The observation that magnitude of incapability among patients seeking care for symptoms of rotator cuff pathology is associated with symptoms of depression but not with measures of the severity of the rotator cuff pathology suggests that treatment strategies for patients who seek care for symptoms of rotator cuff tendinopathy may be incomplete if they do not anticipate and address mental health.

Keywords: PROM; Rotator cuff tendinopathy; anxiety; defect size; depression; magnitude of capability; mental health; pathology.