Divergence Between Pain and Functional Recovery After Rotator Cuff Repair: A Prospective Comparative Analysis of Visual Analogue Scale, Constant-Murley Score, Disabilities of the Arm, Shoulder and Hand, and Shoulder Pain and Disability Index Scores.

INTRODUCTION: Rotator cuff tears are a common injury, with patients presenting with shoulder pain and functional limitation. Clinically significant tears are usually managed by surgery, with the hope of faster and superior recovery, both in terms of pain relief and shoulder function. In day-to-day practice, we often use good pain relief as a sign that the patient is doing well overall. However, whether pain relief and functional recovery actually move together, or whether one lags behind the other, is not something that is usually checked directly in the same group of patients.

OBJECTIVE: The aim of this study was to evaluate the trajectories of pain, measured by the visual analogue scale (VAS), and function, measured by the Constant-Murley Score (CMS), Disabilities of the Arm, Shoulder and Hand (DASH), and Shoulder Pain and Disability Index (SPADI), over the first year after rotator cuff repair, and to determine whether the extent of pain relief in a given patient corresponds to a matching improvement in function.

METHODS: We carried out a prospective study on 40 patients who underwent surgery for a post-traumatic full-thickness supraspinatus tear at our institute, between February 2025 and July 2026. Pain and function were assessed using VAS, CMS, DASH and SPADI, recorded before surgery (pre-operatively), and again at 1, 3, 6 and 12 months after surgery. For every patient, the change in each of these four scores was calculated from the pre-operative reading to the 12-month reading. Pearson's correlation, calculated using Microsoft Excel (2024; Microsoft Corp., Redmond, WA, USA), was then used to see whether the change seen in VAS matched the change seen in CMS, DASH and SPADI in the same patient.

RESULTS: The mean age of the patients was 40.6 ± 6.9 years, and the group included 26 men and 14 women. The mean VAS score improved from 7.85 ± 1.00 at baseline to 1.98 ± 1.14 at 12 months (a mean improvement of 5.88 points). The mean CMS improved from 62.83 ± 10.28 to 69.62 ± 3.81 (an improvement of 6.80 points). The mean DASH score improved from 71.47 ± 6.24 to 26.30 ± 5.71 (an improvement of 45.17 points), and the mean SPADI score improved from 65.20 ± 7.43 to 23.65 ± 10.58 (an improvement of 41.55 points). CMS showed an early fall at one month before improving by 12 months, whereas VAS, DASH and SPADI improved steadily from the start. The correlations between change in VAS and change in CMS, DASH, and SPADI were assessed using Pearson's correlation and were found to be r = -0.34 (p = 0.03), r = 0.38 (p = 0.01), and r = 0.18 (p = 0.27), respectively. The correlation between change in DASH and SPADI was r = 0.38 (p = 0.02). Overall, 33 of our 40 patients (82.5%) did not have any complications during the follow-up period.

CONCLUSION: Our study suggests that the amount of pain relief and the amount of functional gain do not necessarily match each other in the same patient after rotator cuff repair. A patient who reports good pain relief may not always show the best improvement in shoulder function, and the reverse may also be true. Pain score alone may therefore not give a complete picture of recovery. Recording a pain score together with a separate functional or disability score may provide a better assessment of postoperative recovery.