Natural History and Prognostic Factors in Soft Tissue Injuries of the Shoulder: A Prospective Cohort Pilot Study
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Introduction: Soft Tissue Injuries (STIs) of the shoulder are common presentations to the Emergency Department but very little is known about the natural history, long-term disability or prognostic factors associated with these injuries. The goals of this pilot study are to describe the three-month outcome of these injuries, to begin to identify prognostic factors associated with poor outcome and to determine the feasibility of a future study aimed at predicting poor outcome. Methods: A cohort of 117 working-age adults presenting to the Emergency Department with acute STIs of the shoulder were prospectively recruited. Patients were interviewed by phone at one week, one month and three months. During the calls, patients completed the Disabilities of the Arm and Shoulder (DASH) questionnaire and provided information about treatments and follow-up that had occurred. Results: Of the 117 subjects, 72.3% had pain and disability above the population norm at one month and that number only decreased to 38.7% at three months. A substantial effect was also seen on Work and Leisure activities. The following prognostic factors were identified as having some association with poor three-month outcome: age, mechanism of injury, ability to rotate arm and abduct arm in ED, pain at one week, whether the injury was work-related, visit with family physician in first week and DASH score (disability) at one week. Conclusions: At the present time, the emergency physician must treat patients with STIs of the shoulder without any substantial knowledge of the morbidity that these injuries cause, which patients are at high risk of poor outcome or what would constitute optimum management. This study has determined that poor outcome is common and it has begun to identify factors that can help predict which patients will have a more complicated course. As it is now felt that the transition from acute to chronic pain begins well before three months, it will be important for future studies to develop a method of early identification of patients at high risk of poor outcome and to determine effective management in an attempt to prevent that transition.