Factors determining the chronicity of shoulder pain in case of traumatic injury to the rotator tendons

Chronic shoulder pain (CSP) is a common pathology of the musculoskeletal system that causes suffering, a significant decrease in working ability and quality of life. One of the leading causes of CSP is traumatic injury to the tendons of the rotator muscles of the shoulder. The identification of factors contributing to the chronic pain in this pathology is of great importance for medical practice.

The purpose of the study: to determine the factors associated with the development of chronic shoulder pain after injury to the shoulder joint.

Material and methods. The study involved 202 patients with shoulder pain (51.5% of women; average age – 50.5±14.7 years) lasting up to 3 months, who were observed in the clinic of V.A. Nasonova Research Institute with a diagnosis of shoulder rotator compression syndrome. All patients had a history (within the last 6 months) of injury to the shoulder joint. Initially, the pain intensity averaged 5.82±1.51 on a numerical rating scale (NRS 0–10). Functional disorders were assessed according to the ASES (American Shoulder and Elbow Surgeons) and CSS (Constant – Murley Score) indices, the average values of which were 52.2±14.8 and 53.5±16.6, respectively. Subclinical depression and anxiety (≥8 according to the Hospital Anxiety and Depression Scale (HADS)) were 7.9% and 8.4%, signs of central sensitization (CS; score ≥40 according to the CSI-A (Central Sensitization Inventory Part A) questionnaire) – 11.9% of patients. The presence of CSP was determined in the case of persistent pain during movement in the shoulder joint ≥4 NRS on examination after 3-6 months. after the course of treatment.

Results. 81.1% of patients received nonsteroidal anti–inflammatory drugs (NSAIDs), 18.5% received local injection therapy with glucocorticoids (GK), 9.9% with hyaluronic acid (HA), 5.4% with platelet-rich blood plasma (PRP); physiotherapy and physical therapy were also performed. At the second visit, CSP was detected in 27.2% of patients. The development of CSP was not affected by the gender, age, body mass index of patients and anxiety according to HADS. Factors associated with CSP included initial severe pain (>7 NRS; odds ratio (OR) – 2.869; 95% confidence interval (95% CI): 1.496–5.503; p=0.002), ASES≤50 (OR=5.525; 95% CI: 2,801–10,899; p<0.001), CSS≤70 (OR=6.235; 95% CI: 1,434–27,135; p=0.006), depression (HADS≥8; OR=2.957; 95% CI: 1,051–8,520; p=0.042), CS (CSI≥40; OR=2.577; 95% CI: 1,077–6.164; p=0.048). The incidence of CSR was significantly reduced by local injection therapy with HA (OR=0.270; 95% CI: 0.061–0.925; p=0.048). Taking NSAIDs, local injection therapy with GK and PRP did not reduce the risk of developing CSP.

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