Clinical evaluation

Preoperatively, shoulder active range of motion (ROM) was documented, including forward flexion (FF), external rotation at the side (ERs), and internal rotation to the posterior (IRp). Shoulder internal rotation was measured by vertebral segments and converted to the following discrete assignments for statistical evaluation: 0° = 0, hip = 1, buttock = 2, sacrum = 3, L5-L4 = 4, L3-L1 = 5, T12-T8 = 6, T7 or higher = 7.²¹ Subjective pain with activity was recorded using a Visual Analogue Scale (VAS), with 0 being no pain in the affected shoulder and 10 being the worst possible pain.

Postoperatively, patients completed questionnaires either in person or over telephone. Functional outcomes included the Patient Reported Outcome Measurement Information System Upper Extremity Computer Adaptive Test (PROMIS UE CAT), American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV), and pain VAS. PROMIS Pain Interference and Pain Intensity scores, in addition to PROMIS Global 10 Physical Health and Mental Health, were also completed. PROMIS instruments are scored are on the T-score metric, with the mean of 50 and standard deviation of 10 set to equal the mean of the US general population, and scores ranging from approximately 15-60.⁶ A higher score indicates more of that domain being measured; a higher UE CAT indicates higher upper extremity physical function and, for instance, a higher score in Global 10 Physical Health indicates higher levels of physical health.⁶

Follow-up ROM data were collected using subjective patient assessment. If unable to be examined in person, subjects were sent pictorial diagrams and asked to choose the highest level they could reach without assistance in FF, ERs, and IRp. Previous literature has demonstrated suitable reliability of subjective patient ROM assessment using these diagrams.^2,17,25

In addition, subjects were asked about level of satisfaction, return to work, and return to sports. Satisfaction was evaluated both by using a scale from 0-4 (0 = extremely dissatisfied, 1 = dissatisfied, 2 = neither dissatisfied nor satisfied, 3 = satisfied, and 4 = extremely satisfied) and a yes/no response to undergoing the surgery again. Clinical failures were defined as any revision surgery in the ipsilateral shoulder after undergoing arthroscopic tuberoplasty.