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Journal of Shoulder and Elbow Surgery

Comparing patient-reported outcome measures and physical examination for internal rotation in patients undergoing reverse shoulder arthroplasty: does surgery alter patients' perception of function?

Published:February 15, 2021DOI:https://doi.org/10.1016/j.jse.2021.01.020

      Background

      The purpose of this study was to evaluate how patients treated with reverse shoulder arthroplasty (RSA) achieve internal rotation (IR) using video assessment and to compare this to patient-reported outcome measures (PROMs).

      Methods

      We reviewed 215 preoperative and 657 postoperative videos (3-78 months) for 215 patients who underwent primary RSA, performing IR using the modified vertebral level method. Their functional motion pattern was then grouped into 3 types: type I, could not reach behind their back; type II, able to reach to at least waist level, with assistance; and type III, able to reach to a minimum of waist level in an uninterrupted fashion. Patients completed functional questions (put on a coat, wash back, tuck in a shirt, and manage toileting) and a diagram of perceived IR. Patients’ functional motion types were compared to PROM answers. Pre- and postoperative scores were also compared to assess the effect of surgery on patients’ perception of IR function.

      Results

      Patients undergoing RSA will achieve IR in 3 distinct motion patterns. Analysis of self-reported IR indicated statistically significant difference between the 3 functional types of IR (P < .001). Patient-perceived IR was not significantly different between the 3 studied IR functional types (P = .076) in the analysis of preoperative measures but was significantly different in the postoperative setting (P < .001).

      Conclusion

      Patients attempt IR in 3 distinct functional motion patterns. The improvement of IR after RSA is measured better by patient questionnaires than by physical examination.

      Level of Evidence

      Keywords

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      References

        • Aleem A.W.
        • Chamberlain A.M.
        • Keener J.D.
        The functional internal rotation scale: a novel shoulder arthroplasty outcome measure.
        JSES Int. 2019; 4: 202-206https://doi.org/10.1016/j.jses.2019.10.002
        • Awan R.
        • Smith J.
        • Boon A.J.
        Measuring shoulder internal rotation range of motion: a comparison of 3 techniques.
        Arch Phys Med Rehabil. 2002; 83: 1229-1234https://doi.org/10.1053/apmr.2002.34815
        • Bigdon S.
        • Bollinger L.
        • Albers C.
        • Collin P.
        • Zumstein M.
        Subscapularis in reverse total shoulder arthroplasty.
        J Shoulder Elbow Arthroplasty. 2019; 3: 1-8
        • Chelli M.
        • Levy Y.
        • Lavoué V.
        • Clowez G.
        • Gonzalez J.F.
        • Boileau P.
        The "Auto-Constant": can we estimate the Constant-Murley score with a self-administered questionnaire? A pilot study.
        Orthop Traumatol Surg Res. 2019; 105: 251-256https://doi.org/10.1016/j.otsr.2018.11.023
        • Collin P.
        • Baverel L.
        • Ferrand M.
        • Gain S.
        Internal rotation after reverse shoulder arthroplasty.
        in: Favard L. Mansat P. Reverse shoulder arthroplasty. Elsevier Masson, Paris2020: 153-156
        • Friedman R.
        • Flurin P.H.
        • Wright T.W.
        • Zuckerman J.D.
        • Roche C.
        Comparison of reverse total shoulder arthroplasty outcomes with and without subscapularis repair.
        J Shoulder Elbow Surg. 2017; 26: 662-668https://doi.org/10.1016/j.jse.2016.09.027
        • Godfrey J.
        • Hamman R.
        • Lowenstein S.
        • Briggs K.
        • Kocher M.
        Reliability, validity, and responsiveness of the Simple Shoulder Test: psychometric properties by age and injury type.
        J Shoulder Elbow Surg. 2007; 16: 260-267https://doi.org/10.1016/j.jse.2006.07.003
        • Goodman J.
        • Lau B.C.
        • Krupp R.J.
        • Getz C.L.
        • Feeley B.T.
        • Ma C.B.
        • et al.
        Clinical measurements versus patient-reported outcomes: analysis of the American Shoulder and Elbow Surgeons physician assessment in patients undergoing reverse total shoulder arthroplasty.
        JSES Open Access. 2018; 2: 144-149https://doi.org/10.1016/j.jse.2018.01.003
        • Hsu J.E.
        • Russ S.M.
        • Somerson J.S.
        • Tang A.
        • Warme W.J.
        • Matsen 3rd, F.A.
        Is the Simple Shoulder Test a valid outcome instrument for shoulder arthroplasty?.
        J Shoulder Elbow Surg. 2017; 26: 1693-1700https://doi.org/10.1016/j.jse.2017.03.029
        • Kim M.S.
        • Jeong H.Y.
        • Kim J.D.
        • Ro K.H.
        • Rhee S.M.
        • Rhee Y.G.
        Difficulty in performing activities of daily living associated with internal rotation after reverse total shoulder arthroplasty.
        J Shoulder Elbow Surg. 2020; 29: 86-94https://doi.org/10.1016/j.jse.2019.05.031
        • McClure P.
        • Michener L.
        Measures of adult shoulder function: The American Shoulder and Elbow Surgeons Standardized Shoulder Form Patient Self-Report Section (ASES), Disabilities of the Arm, Shoulder, and Hand (DASH), Shoulder Disability Questionnaire, Shoulder Pain and Disability Index (SPADI), and Simple Shoulder Test.
        Arthritis Rheum. 2003; 49: S50-S58https://doi.org/10.1002/art.11404
        • McHugh M.L.
        Interrater reliability: the kappa statistic.
        Biochem Med (Zagreb). 2012; 22: 276-282
        • Rojas J.
        • Bitzer A.
        • Joseph J.
        • Srikumaran U.
        • McFarland E.G.
        Toileting ability of patients after primary reverse total shoulder arthroplasty.
        JSES Int. 2019; 4: 174-181https://doi.org/10.1016/j.jses.2019.10.104
        • Rojas J.
        • Joseph J.
        • Srikumaran U.
        • McFarland E.G.
        How internal rotation is measured in reverse total shoulder arthroplasty: a systematic review of the literature.
        JSES Int. 2019; 4: 182-188https://doi.org/10.1016/j.jses.2019.10.109
        • Roy J.S.
        • Macdermid J.C.
        • Faber K.J.
        • Drosdowech D.S.
        • Athwal G.S.
        The Simple Shoulder Test is responsive in assessing change following shoulder arthroplasty.
        J Orthop Sports Phys Ther. 2010; 40: 413-421https://doi.org/10.2519/jospt.2010.3209
        • Sraj S.A.
        Internal rotation behind-the-back angle: a reliable angular measurement for shoulder internal rotation behind the back.
        Sports Health. 2015; 7: 299-302https://doi.org/10.1177/1941738113502159
        • Torrens C.
        • Guirro P.
        • Santana F.
        The minimal clinically important difference for function and strength in patients undergoing reverse shoulder arthroplasty.
        J Shoulder Elbow Surg. 2016; 25: 262-268https://doi.org/10.1016/j.jse.2015.07.020
        • Wirth B.
        • Kolling C.
        • Schwyzer H.-K.
        • Flury M.
        • Audige L.
        Risk of insufficient internal rotation after bilateral reverse shoulder arthroplasty: clinical and patient-reported outcome in 57 patients.
        J Shoulder Elbow Surg. 2016; 25: 1146e54https://doi.org/10.1016/J.JSE.2015.11.01