探究关节镜下肩袖撕裂修复后肩痛管理策略对上肢功能、日常生活能力等早期功能结局的影响。

选取2022年8月至2024年11月于本院接受关节镜下肩袖撕裂修复术的80例患者。采用随机数字表法进行分组（由统计软件生成1~80随机数字，按入院顺序分配，奇数纳入常规组，偶数纳入管理组），常规组接受常规镇痛干预，管理组执行个性化多模式镇痛+心理干预+阶梯式康复训练。对比两组干预前与干预3个月后的富格迈耶上肢运动功能评分表（Fugl-Mmeyer assessment of upper extremity, FMA）、美国肩肘外科协会评分系统（American shoulder and elbow surgeons, ASES）、视觉模拟评分法（visual analogue scale, VAS）、肩关节活动度及改良Barthel指数（modified Barthel index，MBI）、肩袖愈合情况。

干预后两组FMA、ASES评分均较前升高（P<0.05），且管理组FMA、ASES评分显著高于常规组（P<0.05）；轻度疼痛亚组：两组VAS评分均降至1分以下，组间差异无统计学意义（P>0.05）；中度疼痛亚组：管理组VAS评分显著低于常规组（P<0.05）；重度疼痛亚组：管理组VAS评分显著低于常规组（P<0.05）。干预后两组肩关节的前屈、外展、内旋及外旋活动度均较前提升，且管理组肩关节活动改善程度显著优于常规组（P<0.05）；干预后两组MBI评分均较前上升，且管理组显著高于常规组（P<0.05）；管理组再撕裂率为4.76%，显著低于常规组的21.05%（P<0.05），且管理组在撕裂位置分类上例数均低于常规组。

针对关节镜下肩袖撕裂修复术患者采用肩痛管理策略，可显著提高上肢与肩关节功能，促进肩关节活动度恢复，降低撕裂再发生率，有效缓解疼痛并提升日常生活能力，有利于患者早期康复。

The rotator cuff is a complex of four tendons that wrap around the head of the humerus, consisting of the anterior subscapularis muscle, the superior supraspinatus muscle, the posterior supraspinatus muscle, and the teres minor muscle. It is named for its shape, resembling a sleeve, and is crucial for maintaining the function and stability of the shoulder joint. Rotator cuff tear is an important cause of shoulder pain and limited joint movement. It is often triggered by factors such as overuse of the shoulder and external trauma, which can lead to weakened elasticity of the muscle tissue and result in partial or full-thickness tears of the shoulder muscle structure. Among them, athletes who repeatedly perform shoulder activities over a long period, such as swimmers, tennis players, and shot put players, are prone to injuries due to excessive use of the shoulder joint and significant mechanical pressure on the rotator cuff. The elderly are also a high-risk group for this disease. As people age, the rotator cuff tendons undergo degenerative changes, and minor injuries or impacts may cause acute rotator cuff tears. In addition to causing pain around the shoulder, rotator cuff tears can also affect the quality of life of patients due to shoulder dysfunction and increase their self-perceived burden. Epidemiological studies have shown that the incidence of rotator cuff tears accounts for 14%-32% of shoulder diseases and increases with age. At present, arthroscopic rotator cuff repair is the mainstream surgical method for treating rotator cuff tears in clinical practice. It has the advantages of minor trauma, quick recovery, and few complications. It can minimize the damage to shoulder joint tissues and facilitate the repair of rotator cuff tissues. Most patients can achieve shoulder joint function that is close to normal after this surgery. However, postoperative pain in patients remains an urgent clinical problem to be solved. Patients often resist rehabilitation exercises due to shoulder pain, which not only affects the recovery of upper limb function but may also lead to complications such as muscle atrophy and shoulder adhesions. Although the commonly used drug analgesic method in clinical practice can relieve pain, due to the limited analgesic effect and the different tolerance of patients, it is difficult to achieve the ideal analgesic state, which affects rehabilitation compliance.

To explore the impact of shoulder pain management strategies after arthroscopic rotator cuff tear repair on early functional outcomes such as upper limb function and activities of daily living.

A total of 80 patients who underwent arthroscopic rotator cuff tear repair in our hospital from August 2022 to November 2024 were selected. The groups were grouped by the random number table method (random numbers ranging from 1 to 80 were generated by statistical software and assigned according to the order of admission. Odd numbers were included in the conventional group and even numbers in the management group. The conventional group received conventional analgesic intervention, while the management group implemented personalized multimodal analgesia + psychological intervention + stepwise rehabilitation training. The Fugmeyer upper limb motor function scale (FMA), the evaluation criteria of the American society for shoulder and elbow surgery (ASES) scoring system, the visual analogue scale (VAS) for pain, the range of motion of the shoulder joint, the modified Barthel index (MBI), and the rotator cuff healing conditions were compared between the two groups before the intervention and 3 months after the intervention.

After the intervention, the FMA and ASES scores of both groups increased compared with those before (P<0.05), and the FMA and ASES scores of the management group were significantly higher than those of the conventional group (P<0.05). Mild pain subgroup: The VAS scores of both groups dropped below 1 point, and there was no statistically significant difference between the groups (P>0.05). Moderate pain subgroup: The VAS score of the management group was significantly lower than that of the conventional group (P<0.05). In the severe pain subgroup, the VAS score of the management group was significantly lower than that of the conventional group (P<0.05). After the intervention, the ranges of motion of forward flexion, abduction, internal rotation, and external rotation of the shoulder joint in both groups were improved compared with before, and the improvement degree of shoulder joint motion in the management group was significantly better than that in the conventional group (P<0.05). After the intervention, the MBI scores of both groups increased compared with those before, and the management group was significantly higher than the conventional group (P<0.05). The re-tearing rate in the management group was 4.76%, significantly lower than 21.05% in the conventional group (P<0.05), and the number of cases classified by tear location in the management group was lower than that in the conventional group.

The application of shoulder pain management strategies for patients undergoing arthroscopic rotator cuff tear repair can significantly improve the function of the upper limb and shoulder joint, promote the recovery of shoulder joint range of motion, reduce the recurrence rate of tear, effectively relievePainn and enhance the ability of daily living, which is conducive to the early rehabilitation of patients.