Archives of Orthopaedic and Trauma Surgery

, Volume 132, Issue 9, pp 1251–1257 | Cite as

Effect of depressive symptoms on perceived disability in patients with chronic shoulder pain

  • Young Hak Roh
  • Beom Koo Lee
  • Jung Ho NohEmail author
  • Joo Han Oh
  • Hyun Sik Gong
  • Goo Hyun Baek
Orthopaedic Surgery



Psychological distress may be an important determinant of perceived disability in patients with chronic musculoskeletal disorders. We evaluated the relationship between depressive symptoms and perceived disability in patients with chronic shoulder pain and quantified the contribution made by depression to perceived disability.


In this prospective study, 109 patients with chronic shoulder pain caused by degenerative or inflammatory disorders were evaluated using the Disability of Arm, Shoulder and Hand (DASH) questionnaire and the Center for Epidemiologic Studies-Depression (CES-D) Scale to determine relationships between depressive symptoms and perceived disability in patients with chronic shoulder pain. In addition, pain scores were evaluated using a visual analog scale (VAS) during activity, and range of motion (ROM) and abduction strength (strength) measurements were measured. Multivariate analyses of variance and regression modeling were used to assess the relative contributions made by depressive symptoms (CES-D) and other clinical parameters to patient-perceived disability (DASH).


DASH scores were found to be moderately correlated (0.3 < r < 0.6) with ROM, strength, pain VAS and CES-D; DASH scores were more strongly correlated with CES-D scores than with pain VAS scores or range of motion (r = 0.58; p < 0.001, 0.37; p < 0.001, 0.32; p = 0.04 respectively). Multiple stepwise regression analyses revealed that gender, ROM, pain VAS and CES-D scores independently predicted DASH score and accounted for 43 % of the variance. CES-D score was found to be the strongest predictor of DASH score and accounted for 23 % of the variance.


Degrees of depressive symptoms were found to be significantly associated with higher symptom scores and greater disability in patients with chronic shoulder pain. Although a large proportion of perceived disability remains unexplained, perceived disability in patients with chronic shoulder pain was found to be strongly influenced by depressive symptoms.

Type of study/level of evidence

Level 2, prospective cohort study, prognostic study.


Chronic shoulder pain Perceived disability Depressive symptom 


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Young Hak Roh
    • 1
  • Beom Koo Lee
    • 1
  • Jung Ho Noh
    • 2
    Email author
  • Joo Han Oh
    • 3
  • Hyun Sik Gong
    • 3
  • Goo Hyun Baek
    • 3
  1. 1.Department of Orthopedic Surgery, Gil Medical CenterGachon University School of MedicineIncheonKorea
  2. 2.Department of Orthopedic SurgeryKangwon National University HospitalChuncheon-siKorea
  3. 3.Department of Orthopedic SurgerySeoul National University College of MedicineSeoulKorea

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