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Garcia M, Landi G, Covan B, Caro D, Khak M, Razavi AH, DeAngelis JP, Ramappa AJ, Nazarian A. Effect of Tear Size and Location on Supraspinatus Tendon Strain During Activities of Daily Living and Physiotherapy. Ann Biomed Eng 2024:10.1007/s10439-024-03538-5. [PMID: 39033199 DOI: 10.1007/s10439-024-03538-5] [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: 10/07/2023] [Accepted: 05/06/2024] [Indexed: 07/23/2024]
Abstract
The supraspinatus tendon plays a crucial role in shoulder abduction, making it one of the common structures affected by injury. Clinically, crescent-shaped tears are the most commonly seen tear shape. By developing six specimen-specific, three-dimensional, supraspinatus-infraspinatus finite element model with heterogeneous material properties, this study aimed to examine the changes in tissue deformation (maximum principal strain) of the supraspinatus tendon due to specimen-specific material properties and rotator cuff tear size. FE models with small- and medium-sized full-thickness crescent-shaped tears were subjected to loads seen during activities of daily living and physiotherapy. Six fresh-frozen cadaveric shoulders were dissected to mechanically test the supraspinatus tendon and develop and validate FE models that can be used to assess changes in strain due to small (< 1 cm, equivalent to 20-30% of the tendon width) and medium-sized (1-3 cm, equivalent to 40-50% of the tendon width) tears that are located in the middle and posterior regions of the supraspinatus tendon. FE predictions of maximum principal strain at the tear tips were examined to determine whether failure strain was reached during activities of daily living (drinking and brushing teeth) and physiotherapy exercises (prone abduction and external rotation at 90° abduction). No significant differences were observed between the middle and posterior tear failure loads for small- and medium-sized tears. For prone abduction, there was a potential risk for tear progression (exceeded failure strain) for medium-sized tears in the supraspinatus tendon's middle and posterior regions. For external rotation at 90° abduction, one model with a middle tear and two with posterior tears experienced failure. For all daily activity loads, the strain never exceeded the failure strain. Our three-dimensional supraspinatus-infraspinatus FE model shows that small tears appear unlikely to progress based on the regional strain response; however, medium-sized tears are at higher risk during more strenuous physiotherapy exercises. Furthermore, differences in patient-specific tendon material properties are important in determining whether the tear will progress. Therefore, patient-specific management plans based on tear size may be beneficial to improve clinical outcomes.
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Affiliation(s)
- Mason Garcia
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Mechanical Engineering Department, Boston University, Boston, MA, USA
| | - Gabriel Landi
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Bailee Covan
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Daniela Caro
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
| | - Mohammad Khak
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ahmad Hedayatzadeh Razavi
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Mechanical Engineering Department, Boston University, Boston, MA, USA
| | - Joseph P DeAngelis
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Arun J Ramappa
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, RN123, Boston, MA, 02115, USA.
- Mechanical Engineering Department, Boston University, Boston, MA, USA.
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
- Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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Ankar P, Harjpal P. Comparative Analysis of Various Rotator Cuff Stretching Techniques: Efficacy and Recommendations for Gym Enthusiasts. Cureus 2024; 16:e51785. [PMID: 38322067 PMCID: PMC10844772 DOI: 10.7759/cureus.51785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/06/2024] [Indexed: 02/08/2024] Open
Abstract
Shoulder pain is a common complaint among gym-going individuals, particularly those engaged in upper limb workouts. The rotator cuff, comprising four muscles, plays a crucial role in stabilizing the shoulder joint during movements and supporting its mobility. Imbalances or weaknesses in these muscles can lead to shoulder injuries, affecting performance and overall well-being. The main aim of this review is to explore the benefit of one of the approaches in preventing shoulder pain and improving performance among gym-going individuals. Specific rotator cuff stretching exercises target the entire shoulder complex to enhance the mobility, control, and stabilization of the joint. The dynamic warm-up routine will actively engage the relevant muscles in various planes of motion, promoting the increased range of motion and reduced inflammation. Ultimately, the results from this review can serve as important knowledge for gym-going individuals, trainers, and fitness enthusiasts, guiding them in incorporating evidence-based warm-up strategies to optimize their workouts. Empowering individuals to take proactive measures in caring for their shoulder health can lead to improved overall performance and a better training experience in the gym.
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Affiliation(s)
- Prajyot Ankar
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Rabin A, Maman E, Dolkart O, Kazum E, Kozol Z, Uhl TL, Chechik O. Regaining motion among patients with shoulder pathology - are all exercises equal? Shoulder Elbow 2023; 15:105-112. [PMID: 36895611 PMCID: PMC9990106 DOI: 10.1177/17585732211067161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 09/06/2021] [Accepted: 11/25/2021] [Indexed: 11/17/2022]
Abstract
Background Little information exists to guide the choice of exercise for regaining shoulder range of motion (ROM). The purpose of this study was to compare the maximal ROM reached, pain and difficulty associated with 4 commonly prescribed exercises. Methods Forty (9 females) patients with various shoulder disorders and a limited flexion ROM performed 4 exercises for regaining shoulder flexion ROM in a randomized order. Exercises included the self-assisted flexion, forward bow, table slide and rope-and-pulley. Participants were videotaped while performing all exercises and the maximal flexion angle reached during each exercise was recorded using Kinovea motion analysis freeware (Kinovea 0.8.15). Pain intensity and the perceived level of difficulty associated with each exercise were also recorded. Results The forward bow and table slide generated significantly greater ROM compared with the self-assisted flexion and rope-and-pulley (P ≤ 0.005). The self-assisted flexion was associated with a greater pain intensity compared with the table slide and rope-and-pulley (P = 0.002) and a greater perceived level of difficulty compared with the table slide (P = 0.006). Conclusions Due to the greater ROM allowed, and similar or even lower level of pain or difficulty, clinicians may wish to initially recommend the forward bow and table slide for regaining shoulder flexion ROM.
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Affiliation(s)
- Alon Rabin
- Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Eran Maman
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Oleg Dolkart
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Efi Kazum
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Tel-Aviv, Israel
| | - Zvi Kozol
- Department of Physiotherapy, Ariel University, Ariel, Israel
| | - Timothy L Uhl
- Department of Physical therapy, College of Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Ofir Chechik
- Department of Orthopaedic Surgery, Tel-Aviv Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Ishikawa H, Muraki T, Yamamoto N, Itoi E, Izumi SI. Effect of shoulder immobilization position and activities of daily living on the stiffness of the repaired supraspinatus tendon. Clin Biomech (Bristol, Avon) 2023; 101:105856. [PMID: 36512943 DOI: 10.1016/j.clinbiomech.2022.105856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although tension on the supraspinatus tendon may be increased by wearing an abduction brace in an improper position or activities of daily living with the operated arm in the brace, the amount of tension has not been objectively evaluated. METHODS Eighteen patients who underwent arthroscopic rotator cuff repair were enrolled. The stiffness of the repaired supraspinatus tendon was measured with ultrasound elastography to estimate the tension on the repaired tendon. Measurements were performed in 5 immobilization positions (0°, 30°, and 45° of arm elevation in the scapular plane; 30° of arm elevation in the scapular plane+60° (horizontal adduction) and -60° (horizontal abduction)) and 3 static positions simulating drinking, brushing teeth, and dressing. FINDINGS Stiffness at 30° of scapular plane elevation was lower than 0° of scapular plane elevation (P = 0.034), 30° of elevation in the scapular plane+60° (P < 0.001), and -60° (P < 0.001). There was no significant difference in the stiffness between 30° and 45° of scapular plane elevation (P = 1.000). The stiffness was the greatest at 30° of elevation in the scapular plane-60° among the 5 immobilization positions. The stiffnesses at drinking and brushing teeth were greater than 30° of scapular plane elevation (P < 0.001). INTERPRETATION Immobilization with the arm ≥30° of elevation in the scapular plane may be an optimal position for minimizing stiffness or tension on the repaired tendon. Drinking and brushing teeth may need to be performed using the non-operated arm to protect the repaired tendon.
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Affiliation(s)
- Hiroaki Ishikawa
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Takayuki Muraki
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuyuki Yamamoto
- Department of Orthopaedic Surgery, Tohoku University School of Medicine, Sendai, Japan
| | - Eiji Itoi
- Department of Orthopaedic Surgery, Tohoku Rosai Hospital, Sendai, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai, Japan
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Grim C, Baumgart C, Schlarmann M, Hotfiel T, Javanmardi S, Hoffmann N, Kurz E, Freiwald J, Engelhardt M, Hoppe MW. Effects of Different Orthoses on Neuromuscular Activity of Superficial and Deep Shoulder Muscles during Activities of Daily Living and Physiotherapeutic Exercises in Healthy Participants. J Pers Med 2022; 12:jpm12122068. [PMID: 36556288 PMCID: PMC9786644 DOI: 10.3390/jpm12122068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/11/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND This study aimed to investigate the effects of different shoulder orthoses on the neuromuscular activity of superficial and deep shoulder muscles during activities of daily living (ADL) and physiotherapeutic exercises. METHODS Ten participants with healthy shoulders (31 ± 3 years, 23.1 ± 3.8 kg/m2) were randomized to receive a "shoulder sling", an "abduction pillow" and a "variably adjustable orthosis" on the dominant side. With each orthosis, they completed seven ADL with and four physiotherapeutic exercises without wearing the orthoses. An electromyographic system was used to record the neuromuscular activity of three superficial (trapezius, deltoid, pectoralis major) and two deep shoulder muscles (infraspinatus, supraspinatus) using surface and intramuscular fine-wire electrodes. RESULTS The neuromuscular activity differs between the orthoses during ADL (p ≤ 0.045), whereby the "variably adjustable orthosis" mostly showed the highest activation levels associated with the worst subjective wearing comfort rated on a visual analog scale. In addition, differences exist between the physiotherapeutic exercises (p ≤ 0.006) demonstrating the highest activations of the infra- and supraspinatus muscles for assistive elevation and wipe across a table, middle for pendulum and lowest for continuous passive motion exercises. CONCLUSIONS The neuromuscular activity of superficial and deep shoulder muscles differs between the orthoses during ADL and also between the physiotherapeutic exercises.
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Affiliation(s)
- Casper Grim
- Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Am Finkenhügel 1, 49076 Osnabrueck, Germany
- Institute for Health Research and Education (IGB), Faculty of Human Sciences, University of Osnabrueck, Nelson-Mandela-Straße 11, 49076 Osnabrueck, Germany
| | - Christian Baumgart
- Department of Movement and Training Science, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - Manuel Schlarmann
- Institute of Human Movement and Sport Scienes, University of Osnabrueck, Jahnstraße 75, 49080 Osnabrueck, Germany
| | - Thilo Hotfiel
- Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Am Finkenhügel 1, 49076 Osnabrueck, Germany
- Department of Trauma and Orthopaedic Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054 Erlangen, Germany
| | - Sasha Javanmardi
- Department of Movement and Training Science, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - Natalie Hoffmann
- Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Am Finkenhügel 1, 49076 Osnabrueck, Germany
| | - Eduard Kurz
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Straße 40, 06112 Halle (Saale), Germany
| | - Jürgen Freiwald
- Department of Movement and Training Science, University of Wuppertal, Gaußstraße 20, 42119 Wuppertal, Germany
| | - Martin Engelhardt
- Center for Musculoskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück, Am Finkenhügel 1, 49076 Osnabrueck, Germany
| | - Matthias W. Hoppe
- Movement and Training Science, Leipzig University, Jahnallee 59, 04109 Leipzig, Germany
- Correspondence: ; Tel.: +49-341-97-31823
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Edwards PK, Kwong PWH, Ackland T, Wang A, Donnelly CJ, Ebert JR. Electromyographic Evaluation of Early-Stage Shoulder Rehabilitation Exercises Following Rotator Cuff Repair. Int J Sports Phys Ther 2021; 16:1459-1469. [PMID: 34909253 PMCID: PMC8637301 DOI: 10.26603/001c.29513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 06/15/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Electromyography (EMG) is frequently used as a guide for exercise rehabilitation progression following rotator cuff repair. Knowledge of EMG activity during passive and active-assisted exercises may help guide clinicians when considering exercise prescription in the early post-operative period. PURPOSE The purpose of this study was to investigate EMG activity of the rotator cuff and deltoid musculature during passive and active-assisted shoulder range of motion (ROM) exercises commonly performed in post-operative rehabilitation. STUDY DESIGN Descriptive cohort laboratory study using healthy subjects. METHODS In sixteen active healthy volunteers, surface and fine-wire EMG activity was measured in the supraspinatus, infraspinatus, subscapularis, and anterior, middle and posterior deltoid muscles during eight common ROM exercises. Mean %MVIC values and 95% confidence intervals were used to rank exercises from the least to the most amount of muscular activity generated during the exercises. RESULTS Standard pendulum exercises generated low levels of EMG activity in the supraspinatus and infraspinatus (≤15% MVIC), while active-assisted table slides, and the upright wall slide generated low levels of EMG activity in only the supraspinatus. No exercises were found to generate low levels of muscular activation (≤15% MVIC) in the subscapularis. CONCLUSION This study found no clear distinctions between the EMG activity of the supraspinatus or the infraspinatus occurring during common passive and active-assisted ROM exercises. Subdividing ROM exercises based on muscle activity, may not be necessary to guide progression of exercises prior to commencing active motion after rotator cuff repair. LEVEL OF EVIDENCE Level 3b.
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Affiliation(s)
- Peter K Edwards
- School of Human Sciences, University of Western Australia; School of Physiotherapy and Exercise Science, Curtin University
| | | | | | - Allan Wang
- Department of Orthopaedic Surgery, The University of Western Australia; Murdoch Centre of Orthopaedic Research
| | - Cyril J Donnelly
- School of Human Sciences, University of Western Australia; Rehabilitation Research Institute of Singapore, Nanyang Technological University
| | - Jay R Ebert
- School of Human Sciences, University of Western Australia
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Ezell DJ, Malcarney HL. Rotator cuff repair rehabilitation considerations and respective guidelines: a narrative review. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:179-185. [PMID: 37588949 PMCID: PMC10426574 DOI: 10.1016/j.xrrt.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Current rotator cuff repair rehabilitation protocols focus on multiple areas, including protecting the healing tissue, optimizing range of motion and strength, and returning the individual to labor demanding and sport-specific tasks. Post-operative rehabilitation timelines with consideration of the tear size remain variable among practitioners. Prognostic factors, healing rates, range of motion timeline, exercise progressions, and guidance on return to sport and work activity are the many factors that can help guide rotator cuff repair rehabilitation and ultimately may reduce failure rates and improve outcomes. The purpose of this narrative review is to outline the multi-factorial nature of rotator cuff pathology and guide treatment based on a multitude of factors.
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Cross JA, deVries J, Mocarski M, Ketchum NC, Compty E, Krimmer M, Fritz JM, Vetter CS. Electromyography of the Shoulder Musculature during Passive Rehabilitation Exercises. J Shoulder Elb Arthroplast 2020. [DOI: 10.1177/2471549220960044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Medical professionals remain conflicted about the best rehabilitation protocol a patient should perform after rotator cuff repair surgery. Exercises deemed passive may be activating the shoulder muscles to a moderate level, thus putting the surgical repair construct at risk for re-injury. The purpose of this study was to measure the activation of the rotator cuff and surrounding musculature during exercises used in physical therapy following rotator cuff repair surgery using electromyography (EMG). Methods Muscle activation was recorded in fourteen participants performing sixteen exercises. Four fine wire electrodes (supraspinatus, infraspinatus, subscapularis, teres minor) and six surface electrodes (upper and middle division of the trapezius, anterior, medial and posterior head of the deltoid, biceps brachii) were utilized. EMG activity values for each muscle were normalized to the maximum voluntary isometric contraction and activation levels were assessed. Results Twelve of the sixteen exercises tested were moderately active in the subscapularis muscle. The results show the subscapularis muscle was activated in all three planes of motion. Discussion Most exercises were found to have low activation levels for the supraspinatus, infraspinatus and teres minor muscles. While the exercises examined in this study appear to be safe for the more commonly repaired supraspinatus, caution should be used when administering exercises to individuals with repairs involving the subscapularis.
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Affiliation(s)
- Janelle A Cross
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John deVries
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | | | - Nicholas C Ketchum
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Eileen Compty
- Froedtert Sports Medicine Center, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Matthew Krimmer
- Froedtert Sports Medicine Center, Froedtert & Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Jessica M Fritz
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Carole S Vetter
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
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Cunningham G, Charbonnier C, Lädermann A, Chagué S, Sonnabend DH. Shoulder Motion Analysis During Codman Pendulum Exercises. Arthrosc Sports Med Rehabil 2020; 2:e333-e339. [PMID: 32875297 PMCID: PMC7451869 DOI: 10.1016/j.asmr.2020.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 04/23/2020] [Indexed: 11/15/2022] Open
Abstract
Purpose To quantify shoulder motion during Codman pendulum exercises. Methods Shoulder kinematics were analyzed in 17 healthy volunteers using a validated biomechanical model coupling patient-specific imaging and motion capture. Participants were instructed to perform medio-lateral, antero-posterior and circular pendulum exercises. Glenohumeral (GH), scapulothoracic (ST), thoracohumeral (TH) ROM and overall exercise amplitude were calculated for each sequence. Linear regression analyses were carried out to determine association between different components of shoulder motion. Results Mean overall exercise amplitude was 40.59±11.24° (range, 25.38 to 70.25°) for medio-lateral exercises, 46.5±22.02° (range, 20.68 to 100.24°) for antero-posterior exercises, and 20.28±7.13° (range, 10.9 to 35.49°) for circular exercises. Mean GH and ST involvement remained minimal, ranging from 6.74 to 13.81°, and 1.5° to 5.12°, respectively. There was no significant correlation between overall exercise amplitude and GH (R = 0.31, p = 0.01) or ST ROM (adjusted R2 = 0.57, p < 0.001), but a moderate correlation with TH ROM (R = 0.73, p < 0.001). Conclusion This study demonstrates that Codman pendulum exercises depend mainly on truncal movement and produce very little movement in the GH and ST joints. Although they may be a safe way to promote early general stretching of the upper limb, they may be of limited further use in restoring passive shoulder ROM. Clinical Relevance This study quantifies motion during frequently administered shoulder rehabilitation exercises and shows that they do not produce significant movement in the shoulder. Their use in restoring passive range of motion is thus questionable.
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Affiliation(s)
- Gregory Cunningham
- Division of Orthopaedic and Trauma surgery, Geneva University Hospitals, Geneva, Switzerland.,Shoulder Center, Hirslanden Clinique La Colline, Geneva, Switzerland
| | - Caecilia Charbonnier
- Artanim Foundation, Medical Research Department, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexandre Lädermann
- Division of Orthopaedic and Trauma surgery, Geneva University Hospitals, Geneva, Switzerland.,Shoulder Center, Hirslanden Clinique La Colline, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Sylvain Chagué
- Artanim Foundation, Medical Research Department, Geneva, Switzerland
| | - David H Sonnabend
- Institute of Bone and Joint Surgery, University of Sydney, Australia
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10
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Lulic-Kuryllo T, Alenabi T, McDonald AC, Kim SY, Dickerson CR. Sub-regional activation of supraspinatus and infraspinatus muscles during activities of daily living is task dependent. J Electromyogr Kinesiol 2020; 54:102450. [PMID: 32711359 DOI: 10.1016/j.jelekin.2020.102450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 11/18/2022] Open
Abstract
The supraspinatus and infraspinatus muscles each have multiple sub-regions that may activate differentially in activities of daily living. Awareness of these differential demands critically informs rehabilitation of rotator cuff muscle following injury, particularly if centered on recovering and strengthening the rotator cuff to perform daily tasks. This study quantified muscle activation of supraspinatus and infraspinatus sub-regions during the performance of six activities of daily living. Twenty-three participants (mean: 22.6 ± 2.6 years) completed the following tasks: opening a jar, reaching at shoulder height, overhead reaching, pouring water from a pitcher, eating with a spoon, and combing hair. Indwelling electromyography was collected from the anterior and posterior supraspinatus and superior, middle, and inferior infraspinatus. Tasks requiring high arm elevations (e.g. reaching at shoulder and overhead height) activated anterior supraspinatus between 21 and 28% MVC. The posterior supraspinatus consistently activated between 10 and 30% MVC across all tasks. All sub-regions of infraspinatus activated highly (between 18 and 25% MVC) in tasks requiring high arm elevations in flexion. These findings may be leveraged to define effective measures to increase rotator cuff function in daily tasks.
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Affiliation(s)
- Tea Lulic-Kuryllo
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Talia Alenabi
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Alison C McDonald
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Soo Y Kim
- University of Saskatchewan, College of Medicine, School of Rehabilitation Science, Saskatoon, Saskatchewan, Canada
| | - Clark R Dickerson
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada.
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Gutiérrez-Espinoza H, Araya-Quintanilla F, Pinto-Concha S, Zavala-González J, Gana-Hervias G, Cavero-Redondo I, Álvarez-Bueno C. Effectiveness of supervised early exercise program in patients with arthroscopic rotator cuff repair: Study protocol clinical trial. Medicine (Baltimore) 2020; 99:e18846. [PMID: 31977882 PMCID: PMC7004761 DOI: 10.1097/md.0000000000018846] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Based on the available evidence, it is difficult to make a clinical decision about the best exercise program and to establish the most favorable time to start postoperative treatment after rotator cuff (RC) repair. The aim of this trial is to evaluate the effects of adding a supervised early exercise program to standard treatment for functional improvement and pain relief compared with standard treatment alone in patients with arthroscopic RC repair. METHOD/DESIGN A total of 118 patients between the ages of 18 and 50 years with arthroscopic RC repair will be randomized to 2 treatment arms. The control group will receive a standard exercise program based on a consensus statement on shoulder rehabilitation developed by the American Society of Shoulder and Elbow Therapists. The intervention group will receive a supervised early exercise program in combination with standard treatment. This supervised exercise program will be based on electromyographic evidence. Three evaluations will be performed: before surgery, at 6 weeks, and at 12 weeks. The primary outcome measure will be the shoulder function by the Constant-Murley questionnaire, and the secondary outcome measures will be the upper limb function by the disabilities of the arm, shoulder, and hand questionnaire; pain by the visual analog scale; and the shoulder range of motion by a goniometer. DISCUSSION We hypothesize that patients who receive a supervised early exercise program in combination with standard treatment will benefit more in respect to shoulder function, pain reduction, and range of motion than those who receive a standard exercise program. If this is confirmed, our study can be used clinically to enhance the recovery of patients with arthroscopic RC repair. TRIAL REGISTRATION Brazilian registry of clinical trials UTN number U1111-1224-4143. Registered December 18, 2018.
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Affiliation(s)
- Héctor Gutiérrez-Espinoza
- Rehabilitation and Health Research Center, CIRES, University of the Americas
- Physical Therapy Department, Clinical Hospital San Borja Arriaran
| | - Felipe Araya-Quintanilla
- Rehabilitation and Health Research Center, CIRES, University of the Americas
- Faculty of Health Sciences, University SEK
| | | | - Jonathan Zavala-González
- Rehabilitation and Health Research Center, CIRES, University of the Americas
- Physical Therapy Department, Clinical Hospital San Borja Arriaran
| | - Gonzalo Gana-Hervias
- Adult Orthopedic Department, Clinical Hospital San Borja Arriaran, Santiago, Chile
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Politécnica y Artística del Paraguay, Mayor Sebastián Bullo, Asunción, Paraguay
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
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Shin HR, Park K, An SH, Park SJ, Gu JH, Lee EJ, Lee JE, Choi JB, Yeom SR. Chuna manual therapy combined with acupuncture and cupping for frozen shoulder (adhesive capsulitis): multicenter, randomized, patient-assessor blind, clinical trial. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2019.101012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Chuna manual therapy combined with acupuncture and cupping for frozen shoulder (adhesive capsulitis): Study protocol for a multicenter, randomized, patient-assessor blind, clinical trial. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Abstract
PURPOSE OF REVIEW With improvements in surgical techniques and increased knowledge of rotator cuff healing, there was a need to identify a safe progression after rotator cuff repair. The rehabilitation specialist plays an integral role in the care of these patients, and by implementing an evidence and criteria-based model, patients may be able to return to their prior levels of function sooner with fewer complications. RECENT FINDINGS Timing of progression for rotator cuff patients should align not only with healing but also potential strain on the involved tissue. Recent electromyography studies have identified exercises which elicit highest level of muscle activation for individual dynamic stabilizers. The physical therapist should also be aware of potential complications and be prepared to manage appropriately if they should arise. During rehabilitation after rotator cuff repair, there should be constant communication with the surgical team. Awareness of complication management, healing potential of the repaired tendon, and anatomy of the shoulder complex are critical. During the early stages, reducing pain and inflammation should be prioritized followed by progressive restoration of range of motion. When advancing range of motion, progression from passive, active assisted, and active movements allow for gradual introduction of stress to the healing construct. Even though time frames are not used for progression, it is important not to place excessive stress on the shoulder for up to 12 weeks to allow for proper tendon-to-bone healing. As exercises are progressed, scapular muscle activation is initiated, followed by isometric and lastly isotonic rotator cuff exercises. When treating overhead athletes, advanced strengthening in the overhead position is performed, followed by plyometric training. Advanced strengthening is initiated when all preceding criteria have been met. It is important that patients are educated early in the rehabilitation process so that they can manage their expectations to realistic time frames.
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Affiliation(s)
- Terrance A Sgroi
- Hospital for Special Surgery, Sports Rehabilitation and Performance, 525 E 71st St., New York, NY, USA.
| | - Michelle Cilenti
- Hospital for Special Surgery, Sports Rehabilitation and Performance, 525 E 71st St., New York, NY, USA
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Rehabilitation following rotator cuff repair: A work of the Commission Rehabilitation of the German Society of Shoulder and Elbow Surgery e. V. (DVSE) in collaboration with the German Association for Physiotherapy (ZVK) e. V., the Association Physical Therapy, Association for Physical Professions (VPT) e. V. and the Section Rehabilitation-Physical Therapy of the German Society for Orthopaedics and Trauma e. V. (DGOU). ACTA ACUST UNITED AC 2018. [PMID: 29527239 PMCID: PMC5834570 DOI: 10.1007/s11678-018-0448-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Tears and lesions of the rotator cuff are a frequent cause of shoulder pain and disability. Surgical repair of the rotator cuff is a valuable procedure to improve shoulder function and decrease pain. However, there is no consensus concerning the rehabilitation protocol following surgery. Objectives To review and evaluate current rehabilitation contents and protocols after rotator cuff repair by reviewing the existing scientific literature and providing an overview of the clinical practice of selected German Society of Shoulder and Elbow Surgery e. V. (DVSE) shoulder experts. Materials and methods A literature search for the years 2004-2014 was conducted in relevant databases and bibliographies including the Guidelines International Network, National Guidelines, PubMed, Cochrane CentralRegister of Controlled Trials, Cochrane Database of Systematic Reviews, and the Physiotherapy Evidence Database. In addition, 63 DVSE experts were contacted via online questionnaire. Results A total of 17 studies, four reviews and one guideline fulfilled the inclusion criteria. Based on these results and the obtained expert opinions, a four-phase rehabilitation protocol could be developed.
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A Systematic Review of Electromyography Studies in Normal Shoulders to Inform Postoperative Rehabilitation Following Rotator Cuff Repair. J Orthop Sports Phys Ther 2017; 47:931-944. [PMID: 28704624 DOI: 10.2519/jospt.2017.7271] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review. Background Electromyography (EMG) has previously been used to guide postoperative rehabilitation progression following rotator cuff repair to prevent deleterious loading of early surgical repair. Objective To review the current literature investigating EMG during rehabilitation exercises in normal shoulders, and to identify exercises that meet a cut point of 15% maximal voluntary isometric contraction (MVIC) or less and are unlikely to result in excessive loading in the early postoperative stages. Methods An electronic search of MEDLINE via Ovid, Embase, CINAHL, SPORTDiscus, PubMed, and the Cochrane Library for all years up to June 2016 was performed. Studies were selected in relation to predefined selection criteria. Pooled mean MVICs were reported and classified as low (0%-15% MVIC), low to moderate (16%-20% MVIC), moderate (21%-40% MVIC), high (41%-60% MVIC), and very high (greater than 60% MVIC). Results A search identified 2159 studies. After applying the selection criteria, 20 studies were included for quality assessment, data extraction, and data synthesis. In total, 43 exercises spanning passive range of motion, active-assisted range of motion, and strengthening exercises were evaluated. Out of 13 active-assisted exercises, 9 were identified as suitable (15% MVIC or less) to load the supraspinatus and 10 as suitable to load the infraspinatus early after surgery. All exercises were placed in a theoretical-continuum model, by which general recommendations could be made for prescription in patients post rotator cuff repair. Conclusion This review identified passive and active-assisted exercises that may be appropriate in the early stages after rotator cuff repair. J Orthop Sports Phys Ther 2017;47(12):931-944. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7271.
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Nikolaidou O, Migkou S, Karampalis C. Rehabilitation after Rotator Cuff Repair. Open Orthop J 2017; 11:154-162. [PMID: 28400883 PMCID: PMC5366376 DOI: 10.2174/1874325001711010154] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Rotator cuff tears are a very common condition that is often incapacitating. Whether non-surgical or surgical, successful management of rotator cuff disease is dependent on appropriate rehabilitation. If conservative management is insufficient, surgical repair is often indicated. Postsurgical outcomes for patients having had rotator cuff repair can be quite good. A successful outcome is much dependent on surgical technique as it is on rehabilitation. Numerous rehabilitation protocols for the management of rotator cuff disease are based primarily on clinical experience and expert opinion. This article describes the different rehabilitation protocols that aim to protect the repair in the immediate postoperative period, minimize postoperative stiffness and muscle atrophy. METHODS A review of currently available literature on rehabilitation after arthroscopic rotator cuff tear repair was performed to illustrate the available evidence behind various postoperative treatment modalities. RESULTS There were no statistically significant differences between a conservative and an accelerated rehabilitation protocol . Early passive range of motion (ROM) following arthroscopic cuff repair is thought to decrease postoperative stiffness and improve functionality. However, early aggressive rehabilitation may compromise repair integrity. CONCLUSION The currently available literature did not identify any significant differences in functional outcomes and relative risks of re-tears between delayed and early motion in patients undergoing arthroscopic rotator cuff repairs. A gentle rehabilitation protocol with limits in range of motion and exercise times after arthroscopic rotator cuff repair would be better for tendon healing without taking any substantial risks. A close communication between the surgeon, the patient and the physical therapy team is important and should continue throughout the whole recovery process.
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Affiliation(s)
- Ourania Nikolaidou
- Physical and Rehabilitation Medicine, B' Orthopaedic Department, 424 General Army Hospital, Thessaloniki, Greece
| | - Stefania Migkou
- Physical and Rehabilitation Medicine, B' Orthopaedic Department, 424 General Army Hospital, Thessaloniki, Greece
| | - Christos Karampalis
- Physical and Rehabilitation Medicine, B' Orthopaedic Department, 424 General Army Hospital, Thessaloniki, Greece
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Electromyographic Activities of the Rotator Cuff Muscles During Walking, Eating, and Washing. Am J Phys Med Rehabil 2016; 95:e169-e176. [PMID: 27763907 DOI: 10.1097/phm.0000000000000587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the activity of rotator cuff (RC) muscles during activities of daily living. DESIGN Motion analysis was conducted with 14 volunteers. Activation of RC (subscapularis, supraspinatus, and infraspinatus) was assessed using electromyography (EMG). Walking was performed with or without a shoulder immobilizer. Eating was conducted with or without the support of the elbow with the contralateral hand. Washing the hair was simulated while standing or leaning forward; washing the body was simulated while standing or holding the elbow; and washing the face was simulated using both hands while leaning forward. RESULTS During walking, RC's peak EMG activities remained below 7% maximum voluntary isometric contraction at all times, regardless of the use of immobilizers. Eating caused mild EMG activities (14%-32%), whereas eating with elbow support resulted in significantly lower EMG activities in the supraspinatus and infraspinatus. Washing the hair standing moderately activated RC (23%-57%), whereas leaning forward decreased it to 6% to 36%. Washing the body while holding the elbow decreased infraspinatus activation to 4% from 10% when standing. Washing the face with both hands and leaning forward resulted in high-peak EMG activities in the upper subscapularis (37%). CONCLUSIONS There was no difference in RC activity level between walking with or without immobilizers. From the point of muscle contraction, an immobilizer is not mandatory. Holding the elbow with the contralateral hand while eating or washing can help decrease the load in the supraspinatus and infraspinatus.
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Jung MC, Kim SJ, Rhee JJ, Lee DH. Electromyographic activities of the subscapularis, supraspinatus and infraspinatus muscles during passive shoulder and active elbow exercises. Knee Surg Sports Traumatol Arthrosc 2016; 24:2238-43. [PMID: 25813676 DOI: 10.1007/s00167-015-3586-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 03/18/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE Postoperative exercises may increase load on repaired tendons. Differences in the activity of the rotator cuff muscles were assessed during several different types of passive shoulder and active elbow exercises. METHODS In 15 healthy subjects, passive forward flexion of the shoulder was performed using a table, pulley and rope, and a cane, and external rotation was performed using a cane and a wall. The active elbow flexion-extension exercise was also performed while holding the upper arm with the contralateral hand. Activation amplitudes of the supraspinatus, infraspinatus and subscapularis muscles were evaluated using electromyography with fine wires. RESULTS During passive forward flexion, the supraspinatus and infraspinatus muscles exhibited lower activity when using a table compared with a cane (both P < 0.01) and a pulley and rope (both P < 0.05). Flexion of <90° decreased supraspinatus activation compared with 170° (P = 0.047). During external rotation of the shoulder while using the cane and wall, there was no difference in the activity of any muscles. Electromyographic activity during the active elbow exercise was lower in the supraspinatus while holding the upper arm (P = 0.018). CONCLUSION The table sliding exercise may reduce stress on the rotator cuff during passive forward flexion more than the other exercises do. Decreasing the range of motion to less than 90° in forward flexion activated the supraspinatus less. Moreover, movement of the elbow can be performed holding the upper arm to activate the rotator cuff to a lesser extent. LEVEL OF EVIDENCE Prognostic study, Level II.
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Affiliation(s)
- Myung-Chul Jung
- Department of Industrial Engineering, Ajou University, Suwon, Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Yonsei University Health System, Yonsei University Arthroscopy and Joint Research Institute, Seoul, Korea
- Department of Orthopaedic Surgery, Graduated School of Medicine, Yonsei University, Seoul, Korea
| | - Jae-Jun Rhee
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, San 5, Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Korea
| | - Doo-Hyung Lee
- Department of Orthopaedic Surgery, Graduated School of Medicine, Yonsei University, Seoul, Korea.
- Department of Orthopaedic Surgery, School of Medicine, Ajou University, San 5, Woncheon-dong, Yeongtong-gu, Suwon, 443-721, Korea.
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Shoulder Electromyography Measurements During Activities of Daily Living and Routine Rehabilitation Exercises. J Orthop Sports Phys Ther 2016; 46:375-83. [PMID: 27049599 DOI: 10.2519/jospt.2016.6090] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Controlled laboratory study. Background The activity of the rotator cuff muscles has not previously been measured with indwelling electromyography (EMG) comparing ambulation and other movements. Knowledge of the relative contribution of these muscles during various tasks may help to guide rehabilitation progression. Objective To measure activity of the rotator cuff muscles and other shoulder muscles during normal ambulation, shirt and sling donning and doffing, and rehabilitation tasks commonly performed after rotator cuff surgery. Methods In 28 volunteers (15 men, 13 women; mean age, 32.2 years), indwelling EMG activity was measured in the supraspinatus, infraspinatus, teres minor, and subscapularis muscles during various tasks; and surface EMG activity was measured in the middle deltoid, biceps, and upper trapezius muscles. Results Using median EMG activity, in general, donning and doffing a shirt or sling recruited the rotator cuff muscles more than the other 7 tasks tested. Self-ranging motion using pulleys, especially in the scapular plane, was also consistently associated with greater recruitment of the shoulder muscles. Pendulum exercises, passive range of motion by a physical therapist, and self-ranging motion with a dowel recruited the shoulder muscles to a lesser extent. Conclusion Our results demonstrate that rehabilitation tasks such as pendulum exercises, passive range of motion by a physical therapist, and self-ranging motion with a dowel show low EMG activity, whereas pulleys in the sagittal plane and scapular plane show greater activity. Scapular plane activity was consistently higher than sagittal plane activity. Of all the tasks assessed, ambulation without a sling and donning and doffing a sling and a shirt consistently showed the highest activity. J Orthop Sports Phys Ther 2016;46(5):375-383. Epub 6 Apr 2016. doi:10.2519/jospt.2016.6090.
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The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2016; 25:521-35. [PMID: 26995456 DOI: 10.1016/j.jse.2015.12.018] [Citation(s) in RCA: 108] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 12/06/2015] [Accepted: 12/14/2015] [Indexed: 02/01/2023]
Abstract
This is a consensus statement on rehabilitation developed by the American Society of Shoulder and Elbow Therapists. The purpose of this statement is to aid clinical decision making during the rehabilitation of patients after arthroscopic rotator cuff repair. The overarching philosophy of rehabilitation is centered on the principle of the gradual application of controlled stresses to the healing rotator cuff repair with consideration of rotator cuff tear size, tissue quality, and patient variables. This statement describes a rehabilitation framework that includes a 2-week period of strict immobilization and a staged introduction of protected, passive range of motion during weeks 2-6 postoperatively, followed by restoration of active range of motion, and then progressive strengthening beginning at postoperative week 12. When appropriate, rehabilitation continues with a functional progression for return to athletic or demanding work activities. This document represents the first consensus rehabilitation statement developed by a multidisciplinary society of international rehabilitation professionals specifically for the postoperative care of patients after arthroscopic rotator cuff repair.
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Ribeiro DC, Castro MPD, Sole G, Vicenzino B. The initial effects of a sustained glenohumeral postero-lateral glide during elevation on shoulder muscle activity: A repeated measures study on asymptomatic shoulders. ACTA ACUST UNITED AC 2016; 22:101-8. [DOI: 10.1016/j.math.2015.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 09/25/2015] [Accepted: 10/24/2015] [Indexed: 10/22/2022]
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Early Incorporation of an Evidence-Based Aquatic-Assisted Approach to Arthroscopic Rotator Cuff Repair Rehabilitation: Prospective Case Study. Phys Ther 2016. [PMID: 26206216 DOI: 10.2522/ptj.20140178] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND PURPOSE Both traditional and progressive rotator cuff repair rehabilitation protocols often delay active motion of the shoulder for 6 weeks or more. The early inclusion of a comprehensive aquatic-assisted exercise program presents a unique approach to postoperative management. The purpose of this case study is to describe a comprehensive evidence-based, aquatic-assisted rehabilitation program following arthroscopic rotator cuff repair. CASE DESCRIPTION A 73-year-old woman with a nonretracted, medium-size, full-thickness tear (2.5 cm) of the supraspinatus tendon underwent arthroscopic rotator cuff repair and was referred for postoperative physical therapy. The rehabilitation program was initiated at 2 weeks postoperatively and consisted of concurrent land- and aquatic-based interventions over 6 weeks for a total of 18 physical therapy visits. OUTCOMES Improvements were made in all 5 patient-reported outcome measures that were recorded weekly over the course of care. Improvements reached or exceeded minimal detectable change levels for the Shoulder Pain and Disability Index and the Penn Shoulder Score. Her numeric pain rating scale score at rest decreased from 4/10 at the initial evaluation to 2/10 at 8 weeks postoperatively and with activity decreased from 9/10 to 6/10. Shoulder strength and range of motion values also exhibited improvement over the course of care. No adverse events occurred during the case study. DISCUSSION This case study illustrates the safe inclusion of low-stress aquatic exercises as an early adjunct to traditional land-based rotator cuff repair rehabilitation programs in small- to medium-size repairs. Further studies are needed to determine the long-term effectiveness of adding aquatic therapy to traditional postoperative programs.
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Efficacy of informed versus uninformed physiotherapy on postoperative retear rates of medium-sized and large rotator cuff tears. J Shoulder Elbow Surg 2015; 24:1413-20. [PMID: 26190666 DOI: 10.1016/j.jse.2015.05.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/11/2015] [Accepted: 05/16/2015] [Indexed: 02/01/2023]
Abstract
BACKGROUND It is important to perform the first 12 weeks of rehabilitation without risk of tearing a cuff tendon from its repair site. Our hypothesis was that performing early postoperative rehabilitation with a limitable pendulum exercise device can produce lower retear rate outcomes when it is combined with safe, informed physiotherapy compared with a standardized protocol of rehabilitation performed at home. METHODS By using an asymmetric arm support brace and an advanced accelerometer, we attempted to determine the benefits of small pendulum exercises (proposed by Long et al). This study enrolled 24 patients to use a monitoring device in standardized small pendulum exercises. Clinical outcomes and magnetic resonance images were evaluated preoperatively and 12 weeks after surgery. RESULTS While a patient performed pendulum exercises, a therapist used computer imagery to observe whether vertical acceleration was over a given threshold (identified as physiologic tremors), as a warning of and precaution associated with the increased risk of repair failure. Similar self-reported functional outcomes were reported in 2 areas. The rate of recurrent tears was significantly higher for both the medium-sized and large areas in the uninformed home rehabilitation group compared with the informed group. CONCLUSION The results of monitoring of pendulum exercises to develop informed physical therapeutic methodology were consistent with those of previously published literature. In this study, use of a monitoring device during early rehabilitation was associated with lower retear rates after rotator cuff repair.
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Hughes P, Taylor NF, Green R. Identifying shoulder testing positions and movements that isolate infraspinatus from supraspinatus. PHYSICAL THERAPY REVIEWS 2015. [DOI: 10.1179/1743288x15y.0000000012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Cools AM, Borms D, Cottens S, Himpe M, Meersdom S, Cagnie B. Rehabilitation Exercises for Athletes With Biceps Disorders and SLAP Lesions: A Continuum of Exercises With Increasing Loads on the Biceps. Am J Sports Med 2014; 42:1315-22. [PMID: 24658344 DOI: 10.1177/0363546514526692] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although rehabilitation exercises are recommended in the nonoperative and postoperative treatment of biceps-related disorders and superior labrum anterior-posterior (SLAP) lesions in overhead athletes, a progressive exercise protocol with controlled low to moderate loads on the biceps has not yet been described. PURPOSE To describe a continuum of exercises with progressive low to moderate loads on the biceps based on electromyographic (EMG) analysis. STUDY DESIGN Descriptive laboratory study. METHODS Using surface electromyography, the EMG activity of 8 muscles (upper [UT], middle [MT], and lower [LT] trapezius; serratus anterior [SA]; anterior [AD] and posterior [PD] portions of the deltoid; and biceps [BB] and triceps [TB] brachii) was measured in 32 healthy participants performing 16 commonly described shoulder rehabilitation exercises. RESULTS Of the 16 exercises, 13 (side-lying shoulder forward flexion, prone extension, seated rowing, serratus punch, knee push-up plus, internal and external rotation both in 20° and 90° of abduction, forearm supination, uppercut, and internal and external rotation diagonal) showed low (<20% maximal voluntary isometric contraction [MVIC]) EMG activity in the BB, and 3 (forward flexion in supination, full can, and elbow flexion in forearm supination) showed moderate (20%-50% MVIC) activity. None of the exercises elicited high (>50% MVIC) EMG activity. Based on the results, a ranking was calculated of the exercises, with mean EMG levels between 2.2% ± 1.24% (during internal rotation against resistance in 90° of shoulder abduction) and 35.9% ± 18.82% (during forward flexion in external rotation and supination) of MVIC. CONCLUSION This study describes a continuum of exercises with an increasing level of EMG activity in the BB. Exercises targeting the trapezius resulted in less loads on the biceps compared with exercises for the SA. In addition, exercises with an internal rotation component showed low activity in the BB. In general, the exercises meant to target the BB showed the highest levels of activity in the BB. CLINICAL RELEVANCE These results may assist the clinician in the appropriate choice of exercises in a graded rehabilitation program of biceps-related injuries.
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Affiliation(s)
- Ann M Cools
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dorien Borms
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Simon Cottens
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Marcia Himpe
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Stijn Meersdom
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Electromyographic analysis of the rotator cuff in postoperative shoulder patients during passive rehabilitation exercises. J Shoulder Elbow Surg 2013; 22:102-7. [PMID: 22560228 DOI: 10.1016/j.jse.2012.01.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 01/18/2012] [Accepted: 01/23/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND Numerous rehabilitation protocols exist for postoperative rotator cuff repairs. Because the goal of early rehabilitation is to prevent postoperative adhesions while protecting the repaired tendons, it would be advantageous to know which range-of-motion exercises allow the rotator cuff to remain the most passive in a painful, guarded, postsurgical shoulder. METHODS Twenty-six subjects who had undergone subacromial decompression, distal clavicle resection, or a combination of both procedures volunteered to participate within the first 4 days after surgery. Fine-wire electrodes were inserted into the subject's supraspinatus (SS) and infraspinatus (IS). Muscle activity was recorded at resting baseline (BL) and during 14 exercises that have been found in the passive phase of rotator cuff protocols and tested in healthy subjects. Each exercise was compared with BL activity as well as with other exercises in the same movement group. RESULTS The SS remained as passive as BL during therapist- and self-assisted external rotation, therapist-assisted elevation, pendulums, and isometric internal rotation and adduction. The IS was activated greater than BL for all 14 exercises studied. CONCLUSION Of the 14 exercises studied, 6 allowed the SS and 0 allowed the IS to remain as passive as quiet-stance BL in postsurgical subacromial decompression/distal clavicle resection patients.
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Cuff DJ, Pupello DR. Prospective randomized study of arthroscopic rotator cuff repair using an early versus delayed postoperative physical therapy protocol. J Shoulder Elbow Surg 2012; 21:1450-5. [PMID: 22554876 DOI: 10.1016/j.jse.2012.01.025] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 01/26/2012] [Accepted: 01/30/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study evaluated patient outcomes and rotator cuff healing after arthroscopic rotator cuff repair using a postoperative physical therapy protocol with early passive motion compared with a delayed protocol that limited early passive motion. MATERIALS AND METHODS The study enrolled 68 patients (average age, 63.2 years) who met inclusion criteria. All patients had a full-thickness crescent-shaped tear of the supraspinatus that was repaired using a transosseous equivalent suture-bridge technique along with subacromial decompression. In the early group, 33 patients were randomized to passive elevation and rotation that began at postoperative day 2. In the delayed group, 35 patients began the same protocol at 6 weeks. Patients were monitored clinically for a minimum of 12 months, and rotator cuff healing was assessed using ultrasound imaging. RESULTS Both groups had similar improvements in preoperative to postoperative American Shoulder and Elbow Surgeons scores (early group: 43.9 to 91.9, P < .0001; delayed group: 41.0 to 92.8, P < .0001) and Simple Shoulder Test scores (early group: 5.5 to 11.1, P < .0001; delayed group: 5.1 to 11.1, P < .0001). There were no significant differences in patient satisfaction, rotator cuff healing, or range of motion between the early and delayed groups. CONCLUSIONS Patients in the early group and delayed group both demonstrated very similar outcomes and range of motion at 1 year. There was a slightly higher rotator cuff healing rate in the delayed passive range of motion group compared with the early passive range of motion group (91% vs 85%).
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Affiliation(s)
- Derek J Cuff
- Suncoast Orthopaedic Surgery and Sports, Venice, FL 34292, USA.
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Mulligan EP, Devanna RR, Huang M, Middleton EF, Khazzam M. Factors that impact rehabilitation strategies after rotator cuff repair. PHYSICIAN SPORTSMED 2012; 40:102-14. [PMID: 23306420 DOI: 10.3810/psm.2012.11.1993] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Multiple factors influence rehabilitation strategies after rotator cuff repair. These variables may also impact the overall success of the surgical intervention. Physicians and rehabilitation specialists should be aware of prognostic indicators that can provide therapeutic guidance and offer insights into eventual clinical outcomes. The success of surgical and rehabilitative interventions is often evaluated in terms of patient-reported outcome measures, return to activity, and pain. Although these factors are somewhat interdependent, each of them independently influences the final result. This article presents a comprehensive overview of the recent literature in this area to provide insight as to the short- and long-term outcomes that patients should expect based on their unique presentations. This article examines both intrinsic and extrinsic patient factors to help therapists develop customized rehabilitation programs that optimize surgical outcomes.
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Affiliation(s)
- Edward P Mulligan
- Department of Physical Therapy, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Pabian P, Rothschild C, Schwartzberg R. Rotator cuff repair: considerations of surgical characteristics and evidence based interventions for improving muscle performance. PHYSICAL THERAPY REVIEWS 2011. [DOI: 10.1179/1743288x11y.0000000044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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