The effect of psychological status on pain and surgical outcome in patients requiring arthroscopic subacromial decompression

We prospectively investigated the association between pre-operative psychological status and early post-operative shoulder pain and function in patients requiring arthroscopic subacromial decompression for impingement syndrome.

A consecutive series of patients in 2009/10 completed questionnaires 2 weeks pre-operatively and three and 6 weeks post-operatively that assessed psychological state, shoulder function and pain. The hospital anxiety and depression scale, the oxford shoulder score and a pain visual analogue scale assessed psychological status, shoulder function and shoulder pain, respectively.

Thirty-one patients participated (21 women; 10 men; mean age 54.6 years; age range 21-89 years). Pre-operative anxiety was significantly associated with pre-operative shoulder pain (P <0.05). Pre-operative psychological status did not correlate with post-operative shoulder pain or function. Greater pre-operative anxiety and depression were significantly associated with post-operative psychological distress (P <0.05). Overall shoulder pain, function and psychological state improved significantly during the study (P <0.05) regardless of pre-operative psychological status.

Despite pre-operative associations between anxiety and shoulder pain, there were no associations between pre-operative psychological status and post-operative outcomes. There may be no justification for assessing psychological state in cases of 'uncomplicated' impingement syndromes requiring arthroscopic subacromial decompression. Abnormal pre-operative psychological status is not a justifiable reason for delaying or denying this effective operation.