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Stern BZ, Zubizarreta N, Anthony SG, Poeran J, Gladstone JN. Association between timing of initiating supervised physical rehabilitation after rotator cuff repair and incidence of repeat repair and capsulitis: a population-based analysis. J Shoulder Elbow Surg 2024; 33:1747-1754. [PMID: 38378128 DOI: 10.1016/j.jse.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 12/21/2023] [Accepted: 01/01/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND There is limited consensus on the optimal time to initiate supervised physical rehabilitation after a rotator cuff repair (RCR). We examined whether timing of initiating supervised physical rehabilitation was associated with repeat RCR or development of adhesive capsulitis within 12 months postoperatively in an observational cohort of commercially insured adults. METHODS This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters Database. We included adults aged 18-64 who underwent a unilateral outpatient RCR between 2017 and 2020 and initiated supervised physical rehabilitation 1-90 days postoperatively. Multivariable logistic regression models examined the adjusted association between time of initiating supervised physical rehabilitation (1-13, 14-27, 28-41, and 42-90 days postoperatively) and each of the primary outcomes: repeat RCR and capsulitis. In a sensitivity analysis, time to rehabilitation was alternatively categorized using a data-driven approach of quartiles (1-7, 8-16, 17-30, and 31-90 days postoperatively). We report adjusted odds ratios (OR). RESULTS Among 33,841 patients (86.7% arthroscopic index RCR), the median time between index RCR and rehabilitation initiation was 16 days (interquartile range 7-30), with 39.9% initiating rehabilitation at 1-13 days. Additionally, 2.2% underwent repeat RCR within 12 months, and 12-month capsulitis was identified in 1.9% of patients. There were no significant associations between timing of initiating rehabilitation and 12-month repeat RCR (OR 0.85-0.93, P = .18-.49) or 12-month capsulitis (OR 0.83-0.94, P = .22-.63). Lack of associations between timing and outcomes was supported in sensitivity analyses. CONCLUSIONS Timing of initiating rehabilitation was not significantly associated with adverse outcomes after RCR. The finding of no increased odds of repeat RCR or capsulitis with the earliest timing may support earlier initiation of rehabilitation to accelerate return to daily activities. Findings should be replicated in another dataset of similarly-aged patients.
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Affiliation(s)
- Brocha Z Stern
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Nicole Zubizarreta
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shawn G Anthony
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jashvant Poeran
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Population Health Science and Policy, Institute for Healthcare Delivery Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - James N Gladstone
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Zhang M, Lai J, Chen D, Jian C. Use of a Spinal Needle Through the Deep Rotator Cuff Tissue to Treat Rotator Cuff Tears Under Direct Articular Vision. Arthrosc Tech 2024; 13:102960. [PMID: 38835475 PMCID: PMC11144957 DOI: 10.1016/j.eats.2024.102960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/20/2024] [Indexed: 06/06/2024] Open
Abstract
Achieving sufficient attachment of deep rotator cuff tissue to the footprint area on the greater tubercle of the humerus is essential for functional recovery, yet the optimal approach remains uncertain. We introduce a surgical technique for rotator cuff tear repair using a spinal needle to penetrate deep rotator cuff tissue under direct arthroscopic visualization. After trimming the torn edge, an arthroscope is inserted into the joint cavity through a posterior portal, and a hole is drilled into the humeral head cartilage margin using an upper approach, facilitating the implantation of an internal shoulder row nail. A spinal needle is used to introduce a No. 2 polydioxanone (PDS; Johnson & Johnson) line through sufficient deep rotator cuff tissue. Graspers are then used to extract the stitch and PDS together through the anterolateral opening. Once the PDS is knotted, the stitch is introduced into the rotator cuff. This process is replicated to insert additional stitches into the rotator cuff. Our proposed technique, involving a spinal needle under direct visualization, ensures sufficient coverage of the deep rotator cuff tissue over the footprint area and promotes the healing of the repaired rotator cuff. This method is safe, effective, convenient, and reproducible.
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Affiliation(s)
- Minghua Zhang
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Jiajing Lai
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Daohua Chen
- Department of Bone and Joint Sports Medicine, Longyan First Affiliated Hospital of Fujian Medical University, Fujian, China
| | - Chunfang Jian
- Department of Anesthesiology, Longyan First Affiliated Hospital of Fujian Medical University, Fujian, China
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Retraction to: Clinical outcome of arthroscopic acromioplasty vs. arthroscopic rotator cuff repair for irreparable rotator cuff tears: A 3-year follow-up. Technol Health Care 2024; 32:2851. [PMID: 38393862 DOI: 10.3233/thc-231589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2024]
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Ching-Wei H, Tsai SLH, Chen CH, Tang HC, Su CY, Tischler EH, Yang YC, Chan YS, Chiu CH, Chen ACY. Early versus delayed mobilization for arthroscopic rotator cuff repair (small to large sized tear): a meta-analysis of randomized controlled trials. BMC Musculoskelet Disord 2023; 24:938. [PMID: 38049792 PMCID: PMC10694899 DOI: 10.1186/s12891-023-07075-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/28/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND The timing to start passive or active range of motion (ROM) after arthroscopic rotator cuff repair remains unclear. This systematic review and meta-analysis evaluated early versus delayed passive and active ROM protocols following arthroscopic rotator cuff repair. The aim of this study is to systematically review the literature on the outcomes of early active/passive versus delayed active/passive postoperative arthroscopic rotator cuff repair rehabilitation protocols. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) published up to April 2022 comparing early motion (EM) versus delayed motion (DM) rehabilitation protocols after arthroscopic rotator cuff repair for partial and full-thickness tear was conducted. The primary outcome was range of motion (anterior flexion, external rotation, internal rotation, abduction) and the secondary outcomes were Constant-Murley score (CMS), Simple Shoulder Test Score (SST score) and Visual Analogue Scale (VAS). RESULTS Thirteen RCTs with 1,082 patients were included in this study (7 RCTs for early passive motion (EPM) vs. delayed passive motion (DPM) and 7 RCTs for early active motion (EAM) vs. delayed active motion (DAM). Anterior flexion (1.40, 95% confidence interval (CI), 0.55-2.25) and abduction (2.73, 95%CI, 0.74-4.71) were higher in the EPM group compared to DPM. Similarly, EAM showed superiority in anterior flexion (1.57, 95%CI, 0.62-2.52) and external rotation (1.59, 95%CI, 0.36-2.82), compared to DAM. There was no difference between EPM and DPM for external rotation, retear rate, CMS and SST scores. There was no difference between EAM and DAM for retear rate, abduction, CMS and VAS. CONCLUSION EAM and EPM were both associated with superior ROM compared to the DAM and DPM protocols. EAM and EPM were both safe and beneficial to improve ROM after arthroscopic surgery for the patients with small to large sized tears.
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Affiliation(s)
- Hu Ching-Wei
- Department of Orthopaedic Surgery, Keelung branch, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Sung Laurent Huang Tsai
- Department of Orthopaedic Surgery, Keelung branch, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Chien-Hao Chen
- Department of Orthopaedic Surgery, Keelung branch, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Hao-Che Tang
- Department of Orthopaedic Surgery, Keelung branch, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Chun-Yi Su
- Department of Orthopaedic Surgery, Keelung branch, Bone and Joint Research Center, Chang Gung Memorial Hospital, Chang Gung University, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Eric H Tischler
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York, 450 Clarkson Ave, Brooklyn, NY, 11203, USA
| | - Yi-Chiang Yang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Sheng Chan
- Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital-Linkou & University College of Medicine, Taoyuan City, Taiwan
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital Taiwan, Taoyuan City, Taiwan
| | - Chih-Hao Chiu
- Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital-Linkou & University College of Medicine, Taoyuan City, Taiwan.
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital Taiwan, Taoyuan City, Taiwan.
- Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
| | - Alvin Chao Yu Chen
- Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital-Linkou & University College of Medicine, Taoyuan City, Taiwan.
- Comprehensive Sports Medicine Center, Chang Gung Memorial Hospital Taiwan, Taoyuan City, Taiwan.
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Paolucci T, Agostini F, Conti M, Cazzolla S, Mussomeli E, Santilli G, Poso F, Bernetti A, Paoloni M, Mangone M. Comparison of Early versus Traditional Rehabilitation Protocol after Rotator Cuff Repair: An Umbrella-Review. J Clin Med 2023; 12:6743. [PMID: 37959210 PMCID: PMC10650668 DOI: 10.3390/jcm12216743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/15/2023] Open
Abstract
Rehabilitation after rotator cuff repair is crucial for functional recovery and for minimizing the risk of retear. There are two rehabilitation protocols (early and traditional) and the debate about which is the best is open. This umbrella review aimed to compare the effect of these rehabilitation protocols in terms of reduction in pain, functional recovery, and retear risk. We selected systematic reviews and meta-analyses published between 2012 and 2022 dealing with the aim. Nineteen systematic reviews were included. No significant differences were found between early and traditional protocols in terms of pain reduction. Early rehabilitation provided better short-term results regarding Range of Motion improvement, but long-term functional outcomes were similar. Retear risk remains a significant concern for the early protocol. We found major differences between the analyzed protocols. This review suggests that both protocols are useful to recover global shoulder function, but the standard protocol has a greater safety profile for larger tears. On the other hand, the early protocol may be preferable for smaller lesions, allowing a faster recovery and having less impact on medical costs. Further research is needed to identify optimal rehabilitation strategies tailored to the individual patient's needs and characteristics.
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Affiliation(s)
- Teresa Paolucci
- Department of Oral Medical Science and Biotechnology, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (T.P.); (F.P.)
| | - Francesco Agostini
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (M.C.); (S.C.); (E.M.); (M.P.)
- IRCSS San Raffaele Roma, 00163 Rome, Italy
| | - Marco Conti
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (M.C.); (S.C.); (E.M.); (M.P.)
| | - Sara Cazzolla
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (M.C.); (S.C.); (E.M.); (M.P.)
| | - Elena Mussomeli
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (M.C.); (S.C.); (E.M.); (M.P.)
| | - Gabriele Santilli
- Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00185 Rome, Italy;
| | - Federica Poso
- Department of Oral Medical Science and Biotechnology, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (T.P.); (F.P.)
| | - Andrea Bernetti
- Department of Biological and Environmental Sciences and Technologies (DiSTeBA), University of Salento, 73100 Lecce, Italy;
| | - Marco Paoloni
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (M.C.); (S.C.); (E.M.); (M.P.)
| | - Massimiliano Mangone
- Department of Anatomical and Histological Sciences, Legal Medicine and Orthopedics, Sapienza University, 00185 Rome, Italy; (F.A.); (M.C.); (S.C.); (E.M.); (M.P.)
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Sequeira SB, Wright MA, Murthi AM. Statistical Fragility of Randomized Controlled Trials Evaluating Rehabilitation After Arthroscopic Rotator Cuff Repair. Orthop J Sports Med 2023; 11:23259671231184946. [PMID: 37533502 PMCID: PMC10392395 DOI: 10.1177/23259671231184946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/02/2023] [Indexed: 08/04/2023] Open
Abstract
Background Clinical decision-making often relies on evidence-based medicine, derived from objective data with conventional and rigorous statistical tests to evaluate significance. The literature surrounding rehabilitation after rotator cuff repair (RCR) is conflicting, with no defined standard of practice. Purpose To determine the fragility index (FI) and the fragility quotient (FQ) of randomized controlled trials (RCTs) evaluating rehabilitation protocols after RCR. Study Design Systematic review. Methods A systematic review was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching the PubMed, Cochrane Library, and Embase databases for RCTs evaluating rehabilitation protocols after arthroscopic RCRs from 2000 to June 1, 2022. The FI was determined by manipulating the dichotomous outcome events from each article until a reversal of significance with 2 × 2 contingency tables was achieved. The FQ was determined by dividing the FI by the sample size. Results Fourteen RCTs with 48 dichotomous outcomes were ultimately included for analysis. The mean FI for the included dichotomous outcomes was 4 (interquartile range, 3-6), suggesting that the reversal of 4 events is required to change study significance. The mean FQ was 0.048. Of the RCTs that reported data regarding loss to follow-up, most studies (58.5%) indicated that >4 patients had been lost to follow-up. Conclusion The results of RCT studies of RCR rehabilitation protocols are moderately fragile, something clinicians should be aware of when implementing study results into practice. We recommend the inclusion of FI and FQ in addition to standard P values when reporting statistical results in future RCTs with dichotomous outcome variables on this topic.
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Affiliation(s)
- Sean B. Sequeira
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Melissa A. Wright
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
| | - Anand M. Murthi
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland, USA
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Shoulder Surgery Postoperative Immobilization: An International Survey of Shoulder Surgeons. BIOLOGY 2023; 12:biology12020291. [PMID: 36829567 PMCID: PMC9953745 DOI: 10.3390/biology12020291] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/03/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND There is currently no consensus on immobilization protocols following shoulder surgery. The aim of this study was to establish patterns and types of sling use for various surgical procedures in the United States (US) and Europe, and to identify factors associated with the variations. METHODS An online survey was sent to all members of the American Shoulder and Elbow Society (ASES) and European Society for Surgery of the Shoulder and Elbow (ESSSE). The survey gathered member data, including practice location and years in practice. It also obtained preferences for the type and duration of sling use after the following surgical procedures: arthroscopic Bankart repair, Latarjet, arthroscopic superior/posterosuperior rotator cuff repair (ARCR) of tears <3 cm and >3 cm, anatomic total shoulder arthroplasty (aTSA) and reverse TSA (rTSA), and isolated biceps tenodesis (BT). Relationships between physician location and sling type for each procedure were analyzed using Fisher's exact tests and post-hoc tests using Bonferroni-adjusted p-values. Relationships looking at years in practice and sling duration preferred were analyzed using Spearman's correlation tests. RESULTS In total, 499 surgeons with a median of 15 years of experience (IQR = 9-25) responded, with 54.7% from the US and 45.3% from Europe. US respondents reported higher abduction pillow sling use than European respondents for the following: Bankart repair (62% vs. 15%, p < 0.0001), Latarjet (53% vs. 12%, p < 0.001), ARCR < 3 cm (80% vs. 42%, p < 0.001) and >3 cm (84% vs. 61%, p < 0.001), aTSA (50% vs. 21%, p < 0.001) and rTSA with subscapularis repair (61% vs. 22%, p < 0.001) and without subscapularis repair (57% vs. 17%, p < 0.001), and isolated BT (18% vs. 7%, p = 0.006). European respondents reported higher simple sling use than US respondents for the following: Bankart repair (74% vs. 31%, p < 0.001), Latarjet (78% vs. 44%, p < 0.001), ARCR < 3 cm (50% vs. 17%, p < 0.001) and >3 cm (34% vs. 13%, p < 0.001), and aTSA (69% vs. 41%, p < 0.001) and rTSA with subscapularis repair (70% vs. 35%, p < 0.001) and without subscapularis repair (73% vs. 39%, p < 0.001). Increasing years of experience demonstrated a negative correlation with the duration of sling use after Bankart repair (r = -0.20, p < 0.001), Latarjet (r = -0.25, p < 0.001), ARCR < 3 cm (r = -0.14, p = 0.014) and >3 cm (r = -0.20, p < 0.002), and aTSA (r = -0.37, p < 0.001), and rTSA with subscapularis repair (r = -0.10, p = 0.049) and without subscapularis repair (r = -0.19, p = 0.022. Thus, the more experienced surgeons tended to recommend shorter durations of post-operative sling use. US surgeons reported longer post-operative sling durations for Bankart repair (4.8 vs. 4.1 weeks, p < 0.001), Latarjet (4.6 vs. 3.6 weeks, p < 0.001), ARCR < 3 cm (5.2 vs. 4.5 weeks p < 0.001) and >3 cm (5.9 vs. 5.1 weeks, p < 0.001), aTSA (4.9 vs. 4.3 weeks, p < 0.001), rTSR without subscapularis repair (4.0 vs. 3.6 weeks, p = 0.031), and isolated BT (3.7 vs. 3.3 weeks, p = 0.012) than Europe respondents. No significant differences between regions within the US and Europe were demonstrated. CONCLUSIONS There is considerable variation in the immobilization advocated by surgeons, with geographic location and years of clinical experience influencing patterns of sling use. Future work is required to establish the most clinically beneficial protocols for immobilization following shoulder surgery. LEVEL OF EVIDENCE Level IV.
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The Applicability of Provocative Functional Tests in the Diagnosis of Rotator Cuff Muscle Injuries of the Best University Athletes. BIOMED RESEARCH INTERNATIONAL 2022; 2022:7728277. [PMID: 36277881 PMCID: PMC9584688 DOI: 10.1155/2022/7728277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/28/2022] [Indexed: 11/18/2022]
Abstract
Rotator cuff disease, external and internal impingement syndromes, low shoulder stability, various types of trauma, and overuse injuries are all related to sports activities. In order to check symptoms in patients with disability and shoulder pain, clinicians use different methods and diagnostic imaging assessment. The research is aimed at evaluating whether there is a difference between provocation function tests (PFT) and ultrasonographic (US) testing of muscles within the rotator cuff in elite collegiate athletes. Patients (
) were recruited from university team sports selections and tested with a standardized US examination of the shoulder and five PFTs (Speed’s test, Neer’s test, Hawkins test, lift-off test, Yergason’s test). Based on the VAS pain assessment scale, 60 subjects had some pain, which was taken for further processing in the work (124 subjects did not have the presence of pain and were excluded from further processing). The US examination was conducted using Voluson 730 apparatus, by a linear probe, with the frequency in the range of 6-12 MHz. The chi-square test showed significant differences between PFT and the occurrence of shoulder muscle tendinitis for the following variables: Speed’s test and subscapularis tendinitis (
) and Speed’s test and infraspinatus tendinitis (
); Neer test and biceps brachii caput longum tendinitis (
), Neer test and supraspinatus tendinitis (
) and Neer test and infraspinatus tendinitis (
); lift-off test and subscapularis tendinitis (
); and Yergason’s test and biceps brachii caput longum tendinitis (
) and Yergason’s test and subscapitis tendinitis (
). The greatest effect of differences was observed in Neer’s test and biceps brachii caput longum tendinitis (
), while the other effects can be described as medium and small in most cases. It can be concluded that functional tests are good predictors of soft tissue changes in the muscles of the rotator cuff of the shoulder. Further monitoring and analysis are needed on a larger number of athletes.
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