Examining Differences Between Groups by Race, Sex, and Insurance Status in Treatment of Rotator Cuff Pathology

Authors

  • Anthony V. Paterno, MS UNC School of Medicine
  • Bryan A. Chadwick University of North Carolina School of Medicine
  • Jackson S. Perry University of North Carolina School of Medicine
  • Daniel E. Marks, MS University of North Carolina School of Medicine
  • Jessica A. Knapp, DO Mountain Area Health Education Center Sports Medicine Clinic

DOI:

https://doi.org/10.47265/cjim.v1i1.554

Keywords:

rotator cuff, disparities, inequity

Abstract

Statement of Significance

The purpose of this study was to investigate disparities in the treatment of rotator cuff pathology by sex, race, and insurance status. The findings suggested that disadvantaged groups did not receive less interventions within the clinic of interest. The study was limited by a small sample size in a single clinic in rural North Carolina. Future studies are needed to make the findings generalizable across different clinic settings.

Background: Rotator cuff pathology (RCP) affects a significant portion of the global population and can cause notable pain and reduction in function. Many treatment options exist for RCP, including physical therapy, injections, and surgery. Literature indicates management disparities exist between demographic groups, such as racial self-identity, gender, and socioeconomic status. Studies suggest women, non-white patients, and those of low socioeconomic status are less likely to receive definitive surgical treatment and experience increased time from presentation to surgery.

Methods: We conducted a retrospective chart review to determine if race, gender, or socioeconomic status affected treatment decisions for RCP at a sports medicine clinic in western North Carolina. Data from patients with clinically suspected RCP from January 2018–April 2020 were assessed for associations between demographic factors and differences in the management. Management options included MRI, physical therapy, injection, or referral to orthopedic surgery.

Results: 178 patients were included in the study. There was not a statistically significant difference in treatments between genders, although females showed a trend towards more referrals to orthopaedic surgery (p=0.06). Non-white patients were found to receive MRI at a higher rate (p<0.05), but race and insurance status otherwise exhibited no significant differences in management.

Conclusions: Our data did not observe management disparities based on sex, race, or insurance status, which was used as a surrogate for socioeconomic status, in the sample population.

References

Kweon C, Gagnier JJ, Robbins CB, Bedi A, Carpenter JE, Miller BS. Surgical Versus Nonsurgical Management of Rotator Cuff Tears: Predictors of Treatment Allocation. Am J Sports Med. 2015;43(10):2368-2372. doi:10.1177/0363546515593954

Li L, Bokshan SL, Mehta SR, Owens BD. Disparities in Cost and Access by Caseload for Arthroscopic Rotator Cuff Repair: An Analysis of 18,616 Cases. Orthop J Sport Med. 2019;7(6):2325967119850503. doi:10.1177/2325967119850503

Heron SR, Woby SR, Thompson DP. Comparison of three types of exercise in the treatment of rotator cuff tendinopathy/shoulder impingement syndrome: A randomized controlled trial. Physiotherapy. 2017;103(2):167-173. doi:10.1016/j.physio.2016.09.001

Bertrand H, Reeves KD, Bennett CJ, Bicknell S, Cheng A-L. Dextrose Prolotherapy Versus Control Injections in Painful Rotator Cuff Tendinopathy. Arch Phys Med Rehabil. 2016;97(1):17-25. doi:10.1016/j.apmr.2015.08.412

Weekes DG, Campbell RE, Allegretto JR, et al. A Prospective Study of Patient Factors and Decision-making for Surgical Repair of Symptomatic Full-Thickness Rotator Cuff Tears. Orthopedics. 2020;43(2):85-90. doi:10.3928/01477447-20191223-02

Moosmayer S, Lund G, Seljom US, et al. Tendon repair compared with physiotherapy in the treatment of rotator cuff tears: a randomized controlled study in 103 cases with a five-year follow-up. J Bone Joint Surg Am. 2014;96(18):1504-1514. doi:10.2106/JBJS.M.01393

Chapman CG, Floyd SB, Thigpen CA, Tokish JM, Chen B, Brooks JM. Treatment for Rotator Cuff Tear Is Influenced by Demographics and Characteristics of the Area Where Patients Live. JB JS open access. 2018;3(3):e0005-e0005. doi:10.2106/JBJS.OA.18.00005

Kukkonen J, Joukainen A, Lehtinen J, et al. Treatment of non-traumatic rotator cuff tears: A randomised controlled trial with one-year clinical results. Bone Joint J. 2014;96-B(1):75-81. doi:10.1302/0301-620X.96B1.32168

Ryösä A, Laimi K, Äärimaa V, Lehtimäki K, Kukkonen J, Saltychev M. Surgery or conservative treatment for rotator cuff tear: a meta-analysis. Disabil Rehabil. 2017;39(14):1357-1363. doi:10.1080/09638288.2016.1198431

Nazarian LN, Jacobson JA, Benson CB, et al. Imaging algorithms for evaluating suspected rotator cuff disease: Society of Radiologists in Ultrasound consensus conference statement. Radiology. 2013;267(2):589-595. doi:10.1148/radiol.13121947

Jennings JM, Angerame MR, Eschen CL, Phocas AJ, Dennis DA. Cannabis Use Does Not Affect Outcomes After Total Knee Arthroplasty. J Arthroplasty. 2019;34(8):1667-1669. doi:10.1016/j.arth.2019.04.015

Chou W-Y, Ko J-Y, Wang F-S, et al. Effect of sodium hyaluronate treatment on rotator cuff lesions without complete tears: a randomized, double-blind, placebo-controlled study. J shoulder Elb Surg. 2010;19(4):557-563. doi:10.1016/j.jse.2009.08.006

Steuri R, Sattelmayer M, Elsig S, et al. Effectiveness of conservative interventions including exercise, manual therapy and medical management in adults with shoulder impingement: a systematic review and meta-analysis of RCTs. Br J Sports Med. 2017;51(18):1340-1347. doi:10.1136/bjsports-2016-096515

Min KS, St Pierre P, Ryan PM, Marchant BG, Wilson CJ, Arrington ED. A double-blind randomized controlled trial comparing the effects of subacromial injection with corticosteroid versus NSAID in patients with shoulder impingement syndrome. J shoulder Elb Surg. 2013;22(5):595-601. doi:10.1016/j.jse.2012.08.026

Razmjou H, Lincoln S, Macritchie I, Richards RR, Medeiros D, Elmaraghy A. Sex and gender disparity in pathology, disability, referral pattern, and wait time for surgery in workers with shoulder injury. BMC Musculoskelet Disord. 2016;17(1):401. doi:10.1186/s12891-016-1257-7

Zelle BA, Morton-Gonzaba NA, Adcock CF, Lacci J V, Dang KH, Seifi A. Healthcare disparities among orthopedic trauma patients in the USA: socio-demographic factors influence the management of calcaneus fractures. J Orthop Surg Res. 2019;14(1):359. doi:10.1186/s13018-019-1402-8

Garner EF, Maizlin II, Dellinger MB, et al. Effects of socioeconomic status on children with well-differentiated thyroid cancer. Surgery. 2017;162(3):662-669. doi:10.1016/j.surg.2017.04.008

Minagawa H, Yamamoto N, Abe H, et al. Prevalence of symptomatic and asymptomatic rotator cuff tears in the general population: From mass-screening in one village. J Orthop. 2013;10(1):8-12. doi:10.1016/j.jor.2013.01.008

Additional Files

Published

2021-09-28

How to Cite

Paterno, A., Chadwick, B., Perry, J., Marks, D. ., & Knapp, J. (2021). Examining Differences Between Groups by Race, Sex, and Insurance Status in Treatment of Rotator Cuff Pathology . Carolina Journal of Interdisciplinary Medicine, 1(1), 36 -. https://doi.org/10.47265/cjim.v1i1.554