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Fahy K, Galvin R, Lewis J, McCreesh K. 'If he thought that I was going to go and hurt myself, he had another thing coming': Treatment experiences of those with large to massive rotator cuff tears and the perspectives of healthcare practitioners. Clin Rehabil 2024; 38:824-836. [PMID: 38418399 PMCID: PMC11059833 DOI: 10.1177/02692155241235338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/07/2024] [Indexed: 03/01/2024]
Abstract
OBJECTIVE To explore the treatment experiences of those diagnosed with large to massive rotator cuff tears and the perspectives of healthcare practitioners providing their care. DESIGN A qualitative descriptive study using reflexive thematic analysis. SETTING In-person focus groups were undertaken in a clinical setting (private practice [n = 1]; public outpatient [n = 2]). Semi-structured interviews were conducted online via Microsoft Teams. PARTICIPANTS Patients diagnosed with these tears (n = 12) and healthcare practitioners (n = 11). RESULTS Two interlinking themes were identified based on the care received and provided for patients with symptomatic large to massive rotator cuff tears:1) Positive treatment experiences and management: Education, clear communication and reassurance around prognosis were the foundation of positive patient-clinician care. Sub-themes of pain relief, exercise prescription and confidence in their pathway underpinned this experience. This proficiency in care was affirmed by some healthcare practitioners who spoke about the importance of confidence and experience in their management plan even in times of poor progress.2) Negative treatment experiences and management: Uncertainty, delays and exacerbation of pain flawed the patient-clinician care. Sub-themes of inappropriate pain relief, inappropriate exercise prescription and uncertainty impacted their care. Some healthcare practitioners acknowledged knowledge gaps led to uncertainty especially when choosing the next step of care and were quick to escalate care to deflect this uncertainty. CONCLUSIONS The findings suggest discordance exists between the patient's experiences and expectations when the delivery of care was by less experienced and confident healthcare practitioners in the management of this condition. This highlights the need for improved education and support for healthcare practitioners.
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Affiliation(s)
- Kathryn Fahy
- School of Allied Health, University of Limerick, Limerick, Munster, Ireland
| | - Rose Galvin
- Department of Clinical Therapies, University of Limerick Faculty of Education and Health Sciences, Limerick, Munster, Ireland
| | - Jeremy Lewis
- Therapy Department, Central London Community Healthcare National Health Service Trust, Central London Community Healthcare National Health Service Trust, London, UK
| | - Karen McCreesh
- School of Allied Health, University of Limerick Faculty of Education and Health Sciences, Limerick, Munster, Ireland
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Mazuquin B, Moffatt M, Realpe A, Sherman R, Ireland K, Connan Z, Tildsley J, Manca A, Gc VS, Foster NE, Rees J, Drew S, Bateman M, Fakis A, Farnsworth M, Littlewood C. Clinical and cost-effectiveness of individualised (early) patient-directed rehabilitation versus standard rehabilitation after surgical repair of the rotator cuff of the shoulder: protocol for a multicentre, randomised controlled trial with integrated Quintet Recruitment Intervention (RaCeR 2). BMJ Open 2024; 14:e081284. [PMID: 38580365 PMCID: PMC11002397 DOI: 10.1136/bmjopen-2023-081284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 03/08/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Despite the high number of operations and surgical advancement, rehabilitation after rotator cuff repair has not progressed for over 20 years. The traditional cautious approach might be contributing to suboptimal outcomes. Our aim is to assess whether individualised (early) patient-directed rehabilitation results in less shoulder pain and disability at 12 weeks after surgical repair of full-thickness tears of the rotator cuff compared with current standard (delayed) rehabilitation. METHODS AND ANALYSIS The rehabilitation after rotator cuff repair (RaCeR 2) study is a pragmatic multicentre, open-label, randomised controlled trial with internal pilot phase. It has a parallel group design with 1:1 allocation ratio, full health economic evaluation and quintet recruitment intervention. Adults awaiting arthroscopic surgical repair of a full-thickness tear are eligible to participate. On completion of surgery, 638 participants will be randomised. The intervention (individualised early patient-directed rehabilitation) includes advice to the patient to remove their sling as soon as they feel able, gradually begin using their arm as they feel able and a specific exercise programme. Sling removal and movement is progressed by the patient over time according to agreed goals and within their own pain and tolerance. The comparator (standard rehabilitation) includes advice to the patient to wear the sling for at least 4 weeks and only to remove while eating, washing, dressing or performing specific exercises. Progression is according to specific timeframes rather than as the patient feels able. The primary outcome measure is the Shoulder Pain and Disability Index total score at 12-week postrandomisation. The trial timeline is 56 months in total, from September 2022. TRIAL REGISTRATION NUMBER ISRCTN11499185.
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Affiliation(s)
- Bruno Mazuquin
- Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Maria Moffatt
- School of Allied Health Professios and Nursing, University of Liverpool, Liverpool, UK
| | - Alba Realpe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Rachelle Sherman
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Derby, UK
| | - Katie Ireland
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Derby, UK
| | - Zak Connan
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Derby, UK
| | - Jack Tildsley
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Derby, UK
| | - Andrea Manca
- Centre for Health Economics, York University, York, UK
| | - Vijay Singh Gc
- School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Saint Lucia, Queensland, Australia
| | - Jonathan Rees
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Steven Drew
- University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Marcus Bateman
- Derby Shoulder Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Apostolos Fakis
- Derby Clinical Trials Support Unit, Royal Derby Hospital, Derby, UK
| | | | - Chris Littlewood
- Allied Health, Social Work & Wellbeing, Faculty of Health Social Care and Medicine, Edge Hill University, Ormskirk, UK
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Stern BZ, Zubizarreta N, Anthony SG, Gladstone JN, Poeran J. Variation in Utilization of Physical Therapist and Occupational Therapist Services After Rotator Cuff Repair: A Population-Based Study. Phys Ther 2024; 104:pzae015. [PMID: 38335223 DOI: 10.1093/ptj/pzae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 10/22/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024]
Abstract
OBJECTIVE The objective of this study was to describe the utilization of physical therapist and occupational therapist services after rotator cuff repair (RCR) and examine variation in rehabilitation characteristics by profession. METHODS This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters database. Eligible patients were 18 to 64 years old and had undergone outpatient RCR between 2017 and 2020. Physical therapist and occupational therapist services were identified using evaluation and treatment codes with profession-specific modifiers ("GP" or "GO"). Factors predicting utilization of formal rehabilitation and physical therapist versus occupational therapist services were examined; and univariable and multivariable analyses of days to initiate therapy, number of visits, and episode length by profession were completed. RESULTS Among 53,497 patients with an RCR, 81.2% initiated formal rehabilitation (93.8% physical therapist, 5.2% occupational therapist, 1.0% both services). Patients in the Northeast and West (vs the South) were less likely to receive rehabilitation (odds ratio [OR] = 0.67 to 0.70) and less likely to receive occupational therapist services (OR = 0.39). Patients living in the Midwest (versus the South) were less likely to receive rehabilitation (OR = 0.79) but more likely to receive occupational therapist services (OR = 1.51). Similarly, those living in a rural (versus urban) area were less likely to utilize rehabilitation (OR = 0.89) but more likely to receive occupational therapist services (OR = 2.21). Additionally, receiving occupational therapist instead of physical therapist services was associated with decreased therapist visits (-16.89%), days to initiate therapy (-13.43%), and episode length (-13.78%). CONCLUSION Most patients in our commercially insured cohort utilized rehabilitation services, with a small percentage receiving occupational therapist services. We identified profession-specific variation in utilization characteristics that warrants further examination to understand predictors and associated outcomes. IMPACT Variation in rehabilitation utilization after RCR, including profession-specific and regional differences, may indicate opportunities to improve standardization and quality of care.
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Affiliation(s)
- Brocha Z Stern
- Leni and Peter W. May Department of Orthopaedics and Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Nicole Zubizarreta
- Leni and Peter W. May Department of Orthopaedics and Institute for Healthcare Delivery Science, Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Shawn G Anthony
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - James N Gladstone
- Leni and Peter W. May Department of Orthopaedics, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jashvant Poeran
- Leni and Peter W. May Department of Orthopaedics and Institute for Healthcare Delivery Science, Department of Population Health Science & Policy and Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Correia FD, Molinos M, Luís S, Carvalho D, Carvalho C, Costa P, Seabra R, Francisco G, Bento V, Lains J. Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial. Am J Phys Med Rehabil 2022; 101:237-249. [PMID: 33935152 PMCID: PMC8826616 DOI: 10.1097/phm.0000000000001780] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical impact of a 12-wk home-based digitally assisted rehabilitation program after arthroscopic rotator cuff repair against conventional home-based rehabilitation. DESIGN The digital therapy group performed independent technology-assisted sessions complemented with 13 face-to-face sessions, and the conventional therapy group had conventional face-to-face physical therapy (30 sessions). Primary outcome was functional change between baseline and 12 wks, measured through the Constant-Murley score. Secondary outcomes were the change in the QuickDASH Scale and shoulder range of motion. RESULTS Fifty participants enrolled; 41 completed the 12-wk program (23 digital therapy group vs. 18 conventional therapy group), and 32 (15 vs. 17) were available for the 12-mo follow-up assessment. No differences were found between groups regarding study endpoints at the end of the 12-wk program. However, follow-up results revealed the superiority of the digital therapy group for QuickDASH (P = 0.043), as well as an interaction between time and group in the Constant-Murley score (P = 0.047) in favor of the digital therapy group. CONCLUSIONS The results demonstrate that digital therapeutics can be used to achieve similar, if not superior, short- and long-term outcomes as conventional approaches after arthroscopic rotator cuff repair, while being far less human resource intensive than conventional care.Level of evidence: II.
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Alguacil-Diego IM, Cuesta-Gómez A, Contreras-González AF, Pont-Esteban D, Cantalejo-Escobar D, Sánchez-Urán MÁ, Ferre M. Validation of a Hybrid Exoskeleton for Upper Limb Rehabilitation. A Preliminary Study. Sensors (Basel) 2021; 21:7342. [PMID: 34770647 PMCID: PMC8588535 DOI: 10.3390/s21217342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 12/19/2022]
Abstract
Recovery of therapeutic or functional ambulatory capacity in patients with rotator cuff injury is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients to perform repetitive practice with large movements to maximize recovery, even immediately after the acute event. The aim of this paper is to describe the usability, acceptability and acceptance of a hybrid exoskeleton for upper-limb passive rehabilitation using the System Usability Scale (SUS) questionnaire. This equipment, called ExoFlex, is defined as a hybrid exoskeleton since it is made up of rigid and soft components. The exoskeleton mechanical description is presented along with its control system and the way motion is structured in rehabilitation sessions. Seven patients (six women and one man) have participated in the evaluation of this equipment, which are in the range of 50 to 79 years old. Preliminary evidence of the acceptance and usability by both patients and clinicians are very promising, obtaining an average score of 80.71 in the SUS test, as well as good results in a questionnaire that evaluates the clinicians' perceived usability of ExoFlex.
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Affiliation(s)
- Isabel-María Alguacil-Diego
- Physiotherapy, Occupational Therapy, Physical Medicine and Rehabilitation Department, Universidad Rey Juan Carlos, Campus de Alcorcón, Av. de Atenas, s/n, 28922 Alcorcón, Spain; (I.-M.A.-D.); (A.C.-G.)
| | - Alicia Cuesta-Gómez
- Physiotherapy, Occupational Therapy, Physical Medicine and Rehabilitation Department, Universidad Rey Juan Carlos, Campus de Alcorcón, Av. de Atenas, s/n, 28922 Alcorcón, Spain; (I.-M.A.-D.); (A.C.-G.)
| | - Aldo-Francisco Contreras-González
- Centro de Automática y Robótica (CAR) UPM-CSIC, ETS Ingenieros Industriales, Universidad Politécnica de Madrid, Calle de José Gutiérrez Abascal, 2, 28006 Madrid, Spain; (A.-F.C.-G.); (D.P.-E.); (D.C.-E.); (M.Á.S.-U.)
| | - David Pont-Esteban
- Centro de Automática y Robótica (CAR) UPM-CSIC, ETS Ingenieros Industriales, Universidad Politécnica de Madrid, Calle de José Gutiérrez Abascal, 2, 28006 Madrid, Spain; (A.-F.C.-G.); (D.P.-E.); (D.C.-E.); (M.Á.S.-U.)
| | - David Cantalejo-Escobar
- Centro de Automática y Robótica (CAR) UPM-CSIC, ETS Ingenieros Industriales, Universidad Politécnica de Madrid, Calle de José Gutiérrez Abascal, 2, 28006 Madrid, Spain; (A.-F.C.-G.); (D.P.-E.); (D.C.-E.); (M.Á.S.-U.)
| | - Miguel Ángel Sánchez-Urán
- Centro de Automática y Robótica (CAR) UPM-CSIC, ETS Ingenieros Industriales, Universidad Politécnica de Madrid, Calle de José Gutiérrez Abascal, 2, 28006 Madrid, Spain; (A.-F.C.-G.); (D.P.-E.); (D.C.-E.); (M.Á.S.-U.)
- ETS Ingeniería y Diseño Industrial, Universidad Politécnica de Madrid, Ronda de Valencia, 3, 28012 Madrid, Spain
| | - Manuel Ferre
- Centro de Automática y Robótica (CAR) UPM-CSIC, ETS Ingenieros Industriales, Universidad Politécnica de Madrid, Calle de José Gutiérrez Abascal, 2, 28006 Madrid, Spain; (A.-F.C.-G.); (D.P.-E.); (D.C.-E.); (M.Á.S.-U.)
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Anderson L, Kinsman S, Oberlander M. Postoperative Compliance and Return to Work After Rotator Cuff Repair: Value of an Interactive Online Rehabilitation Program Among Patients Treated Under Workers' Compensation. Orthopedics 2021; 44:e197-e202. [PMID: 33238010 DOI: 10.3928/01477447-20201119-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Outcomes after rotator cuff repair (RCR) typically are poorer for workers' compensation (WC) than for patients with private insurance. This study examined augmentation of the traditional rehabilitation protocol with an online exercise program. Between March 2016 and July 2018, 48 WC patients who underwent RCR were introduced to a digital rehabilitation program (application). Patients were divided into patients who used the application along with traditional physical therapy (PT) (group 1) and patients who underwent only traditional PT (group 2). Patient performance was assessed using standardized patient-reported outcome measures (PROMs), return-to-work (RTW) status, number of PT sessions, and complication/revision rate. Patients were monitored for a minimum of 1 year postoperatively. A significant improvement in RTW period was noted for group 1 patients, who resumed modified duty 10 weeks earlier than group 2 patients. A positive trend also was noted for return to full duty, with group 1 resuming full duty 7 weeks before group 2. There were no complications or reoperations in group 1 compared with 4 (16%) complications in group 2. The 2 groups underwent the same average number of PT sessions (27 sessions). Patient-reported outcome measures were captured only for group 1, which demonstrated average postoperative improvement of 3 points on a visual analog scale and 32.5 points in American Shoulder and Elbow Surgeons scores. Incorporating an online exercise program within the traditional rehabilitation protocol for WC patients undergoing RCR resulted in earlier return to work and was associated with better pain relief, greater return of function, and lower complication rate. [Orthopedics. 2021;44(2):e197-e202.].
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Littlewood C, Bateman M, Butler-Walley S, Bathers S, Bromley K, Lewis M, Funk L, Denton J, Moffatt M, Winstanley R, Mehta S, Stephens G, Dikomitis L, Foster NE. Rehabilitation following rotator cuff repair: A multi-centre pilot & feasibility randomised controlled trial (RaCeR). Clin Rehabil 2021; 35:829-839. [PMID: 33305619 PMCID: PMC8191146 DOI: 10.1177/0269215520978859] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the feasibility of a multi-centre randomised controlled trial to compare the clinical and cost-effectiveness of early patient-directed rehabilitation versus standard rehabilitation following surgical repair of the rotator cuff of the shoulder. DESIGN Two-arm, multi-centre pilot and feasibility randomised controlled trial. SETTING Five National Health Service hospitals in England. PARTICIPANTS Adults (n = 73) with non-traumatic rotator cuff tears scheduled for repair were recruited and randomly allocated remotely prior to surgery. INTERVENTIONS Early patient-directed rehabilitation (n = 37); advised to remove their sling as soon as able and move as symptoms allow. Standard rehabilitation (n = 36); sling immobilisation for four weeks. MEASURES (1) Randomisation of 20% or more eligible patients. (2) Difference in time out of sling of 40% or more between groups. (3) Follow-up greater than 70%. RESULTS 73/185 (39%) potentially eligible patients were randomised. Twenty participants were withdrawn, 11 due to not receiving rotator cuff repair. The between-group difference in proportions of participants who exceeded the cut-off of 222.6 hours out of the sling was 50% (80% CI = 29%, 72%), with the early patient-directed rehabilitation group reporting greater time out of sling. 52/73 (71%) and 52/53 (98%) participants were followed-up at 12 weeks when withdrawals were included and excluded respectively. Eighteen full-thickness re-tears were reported (early patient-directed rehabilitation = 7, standard rehabilitation = 11). Five serious adverse events were reported. CONCLUSION A main randomised controlled trial is feasible but would require allocation of participants following surgery to counter the issue of withdrawal due to not receiving surgery.
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Affiliation(s)
- Chris Littlewood
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
- Department of Health Professions, Faculty of Health, Psychology & Social Care, Manchester Metropolitan University, Manchester, Greater Manchester, UK
| | - Marcus Bateman
- Derby Shoulder Unit, University Hospitals Derby & Burton NHS Foundation Trust, Derby, UK
| | | | - Sarah Bathers
- Keele Clinical Trials Unit, School Medicine, Keele University, Staffordshire, UK
| | - Kieran Bromley
- Keele Clinical Trials Unit, School Medicine, Keele University, Staffordshire, UK
| | - Martyn Lewis
- Keele Clinical Trials Unit, School Medicine, Keele University, Staffordshire, UK
| | - Lennard Funk
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Jean Denton
- The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, UK
| | - Maria Moffatt
- Wrightington, Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Rachel Winstanley
- Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke, UK
| | - Saurabh Mehta
- Royal Stoke University Hospital, University Hospitals of North Midlands NHS Trust, Stoke, UK
| | - Gareth Stephens
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Lisa Dikomitis
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Nadine E Foster
- Primary Care Centre Versus Arthritis, School of Primary, Community and Social Care, Keele University, Staffordshire, UK
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Gu J, Dai B, Shi X, He Z. Clinical short-term outcomes of articular-sided and bursal-sided partial-thickness rotator cuff tears of less than 50% in a single surgeon series: A protocol of randomized controlled trial. Medicine (Baltimore) 2021; 100:e24965. [PMID: 33725860 PMCID: PMC7969290 DOI: 10.1097/md.0000000000024965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There have been no published randomized clinical trial to assess the clinical outcomes between the articular-sided and bursal-sided tears. Therefore, a comparative analysis of evaluating and comparing the functional outcomes following arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tearsis essential. METHODS This study is a present randomized controlled trial which is conducted in our hospital. Consecutive patients with symptomatic articular-sided or bursal-sided partial-thickness rotator cuff tears underwent arthroscopic repair between June 2020 and January 2022. The institutional review board approved the study proposal (with number 10012030), and informed consent was obtained from all patients. Inclusion criteria were existence of an articular- or bursal-sided tear involving <50% of the tendon thickness-confirmed intraoperatively and treated with arthroscopic debridement with or without other decompression surgery (acromioplasty/distal clavicle resection)-and a minimum follow-up of 2 years. All patients followed the same postoperative rehabilitation program. The patients were assessed at baseline preoperatively, and at 1 year and 2 years postoperatively. Outcome parameters were measured at each respective follow-up, which included active range of motion in forward flexion and abduction of the affected shoulder, pain score as measured on the Numeric Pain Rating Scale, as well as outcome scores in terms of the Constant-Murley Score, and Oxford Shoulder Score. RESULTS Table 1 and Table 2 describe the data indicators that this article wants to evaluate and collect. CONCLUSIONS We hypothesize that both groups of patients will show improvement in range of motion, functional outcome scores, and pain at 2 years, and that results would be similar between the two groups. TRIAL REGISTRATION This study protocol was registered in Research Registry (researchregistry6496).
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Zhang T, Chen Y, Chen C, Li S, Xiao H, Wang L, Hu J, Lu H. Treadmill exercise facilitated rotator cuff healing is coupled with regulating periphery neuropeptides expression in a murine model. J Orthop Res 2021; 39:680-692. [PMID: 32239544 DOI: 10.1002/jor.24678] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/18/2020] [Accepted: 03/12/2020] [Indexed: 02/04/2023]
Abstract
Postoperative exercise has been found able to accelerate bone-tendon (B-T) healing. In this study, we systematically compared tendon-to-bone healing in mice subjected to postoperative treadmill exercise and free cage recovery in a murine rotator cuff repair model. Specifically, C57BL/6 mice underwent unilateral supraspinatus tendon (SST) detachment and repair were randomly allocated into treadmill group and control group. Treadmill group received daily treadmill running initiated from postoperative day 7 while the control group was allowed free cage activity. Mice were euthanized at postoperative 4 and 8 weeks for synchrotron radiation micro-computed tomography (SR-μCT), histology and biomechanical tests to investigate the effect of treadmill running on B-T healing. The results indicated that treadmill running initiated at day 7 postoperatively was able to accelerate B-T healing, as evidenced by better tendon-to-bone maturation and increased mechanical property. Recent studies show that peripheral neuropeptides are closely associated with musculoskeletal tissue repair. We furtherly conducted quantitative reverse transcription-polymerase chain reaction and immunofluorescence staining to investigate the temporal-spatial expression of calcitonin gene-related peptide (CGRP), substance P (SP), and peripheral neuropeptide Y (NPY) to verify whether they are related to rotator cuff healing. Our results show increased expression of CGRP, SP, and NPY at the healing site under the effect of mechanical stimulation. In conclusion, delayed postoperative exercise with moderate strength appears to accelerate the early phase of B-T healing, a process that may prove to be linked to increased expression of periphery neuropeptides known to play a role in tissue healing.
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Affiliation(s)
- Tao Zhang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Yang Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Can Chen
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Shengcan Li
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Han Xiao
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Linfeng Wang
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
| | - Jianzhong Hu
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
- Department of Spine Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Hongbin Lu
- Department of Sports Medicine, Xiangya Hospital, Central South University, Changsha, China
- Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Changsha, China
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Yoon SH, Lee D, Li H, Kweon H, Ahn JH. Discrimination between pain and contracture in limited passive motion patients with rotator cuff tear: A STROBE-compliant cross-sectional study. Medicine (Baltimore) 2020; 99:e21391. [PMID: 32756131 PMCID: PMC7402877 DOI: 10.1097/md.0000000000021391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Either pain or contracture may limit shoulder passive range of motion (PROM) in patients with rotator cuff disease, and an appropriate treatment may be determined according to its cause. If there is no change in PROM under general anesthesia, contracture, rather than pain, may be the underlying condition. Our goal was to devise a physical examination that would help discriminate between pain and contracture in limited PROM patients with rotator cuff tear.This is a STROBE-compliant cross-sectional study. Patients with rotator cuff tears (N = 28) were scheduled for arthroscopic repair. The main outcome measure was PROM, including flexion, external rotation (ER), and abduction obtained by a blinded examiner before and after the induction of general anesthesia, and the abduction/ER ratio was calculated. In order to perform a subgroup analysis, patients were divided into 2 groups, one where abduction difference after the general anesthesia was 8°≤ (n = 22) and the other 8°> (n = 6).Patients' average age (62.6 ± 7.2 years), symptom duration (13.0 ± 10.0 months), intensity of shoulder pain on a visual analog scale (4.8 ± 2.1), and Constant-Murley functional score (63.4 ± 8.9); the ratio of gender (male: female = 12:16); and the arthroscopic findings were recorded. According to the correlation analysis, the abduction/ER ratio before general anesthesia was correlated best with the change in PROM after general anesthesia (correlation coefficient -0.74, P < .001); the correlations for abduction and flexion were -0.69 and -0.57, respectively (P < .001 and .002, respectively). The age, gender, height, weight, duration of symptoms, trauma history, visual analog score for shoulder pain, Constant-Murley functional score, size of rotator cuff tear, and biceps pathology did not differ significantly between the 2 groups in the subgroup analysis (P > .05). The only significant difference between the 2 groups was in the synovitis status (P = .04).Patients with greater abduction/ER ratio before anesthesia exhibited fewer PROM changes after anesthesia. The abduction/ER ratio was strongly and inversely correlated with PROM changes, allowing physicians to choose an appropriate treatment for limited PROM in patients with rotator cuff tears.
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Affiliation(s)
| | | | | | | | - Jung Hwan Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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Lin Y, Zhao J, Qiu H, Huang Y. Comparison of arthroscopic single-row and double-row repair in the treatment of rotator cuff tears: A protocol of cohort analysis. Medicine (Baltimore) 2020; 99:e21030. [PMID: 32702843 PMCID: PMC7373522 DOI: 10.1097/md.0000000000021030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Single-row (SR) and double-row (DR) techniques are 2 kinds of widely used approaches for the arthroscopic repair of rotator cuff. This retrospective clinical trial was performed to address the question of whether a DR rotator cuff anchor repair gives results superior to a SR anchor repair in clinical outcome scores and complication rates. METHODS This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. We retrospectively reviewed our database, which was collected prospectively. From 2014 to 2017, 264 patients underwent arthroscopic rotator cuff repair by an experienced single shoulder surgeon with the SR and DR techniques. This study was approved by the institutional review board in our hospital and was registered in the Research Registry. Outcome measures included Constant-Murley score, muscle strength, patient satisfaction, passive range of motion, and retear rates. RESULTS The hypothesis was that the DR technique would achieve better functional scores and fewer complications as compared to the SR technique in treatment of rotator cuff tears.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Yoon TH, Kim SJ, Choi CH, Yoon SP, Chun YM. An intact subscapularis tendon and compensatory teres minor hypertrophy yield lower failure rates for non-operative treatment of irreparable, massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2019; 27:3240-3245. [PMID: 30770957 DOI: 10.1007/s00167-019-05403-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 02/06/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate whether subscapularis integrity and compensatory teres, minor hypertrophy is associated with maintaining relatively good function and tolerable pain levels during non-operative treatment. METHODS This study included 108 patients with irreparable, massive rotator cuff tears involving at least two tendons and stage III or IV muscle hypotrophy and fatty infiltration on oblique sagittal magnetic resonance imaging, in which even a partial repair does not seem feasible. All supraspinatus and infraspinatus muscles were grade IV; if the subscapularis was involved, only stage III or IV was included. Patients were divided into two groups: group A consisted of 67 patients with both an intact subscapularis and teres minor hypertrophy; group B consisted of 41 patients lacking either one or both. The Visual Analogue Scale pain score, the American Shoulder and Elbow Surgeons score, the University of California at Los Angeles shoulder score, and active range of motion (ROM) were assessed. RESULTS During the follow-up period, failure of non-operative treatment was found in 29 (43%) patients in group A and 28 (68%) in group B (p = 0.012). Conversion to surgery was noted in 26 (39%) patients in group A and 27 (66%) in group B (p = 0.006). Among the remaining nonsurgical patients, there were no significant differences in clinical outcomes between the groups except ROM in internal rotation at final follow-up. CONCLUSIONS Although conservative treatment was not always successful in patients with irreparable, massive cuff tears, patients with both an intact subscapularis tendon, and teres minor hypertrophy experienced significantly lower incidences of failure and conversion to surgery, since force couple is maintained in the setting of minimal arthritis. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Tae-Hwan Yoon
- Department of Orthopaedic Surgery, Severance Hospital, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Republic of Korea
| | - Sung-Jae Kim
- Department of Orthopaedic Surgery, Severance Hospital, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Republic of Korea
| | - Chong-Hyuk Choi
- Department of Orthopaedic Surgery, Severance Hospital, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Republic of Korea
| | - Soon-Phil Yoon
- Department of Orthopaedic Surgery, Severance Hospital, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Republic of Korea
| | - Yong-Min Chun
- Department of Orthopaedic Surgery, Severance Hospital, Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Republic of Korea.
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Reinig Y, Welsch F, Hoffmann R, Müller D, Gramlich S, Fischer S, Schüttler KF, Zimmermann E, Stein T. Assessments of activities of daily living after arthroscopic SLAP repair with knot-tying versus knotless suture anchors. Arch Orthop Trauma Surg 2019; 139:981-990. [PMID: 30820694 DOI: 10.1007/s00402-019-03151-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Indexed: 01/02/2023]
Abstract
PURPOSE The clinical influence of knot-tying or knotless anchor systems for the arthroscopic repair of SLAP lesions (superior labrum lesion from anterior to posterior) remain unclear. MATERIALS AND METHODS In a retrospective cohort analysis, 61 of 78 (78.2%) patients with isolated symptomatic SLAP II lesions were examined with a minimum of 24 months after arthroscopic SLAP repair compared to a control group: 28 patients with knot-tying anchors (group I, G1; 28.95 ± 9.48 years, 23 male/5 female), 33 with knotless anchors (group II, G2; 31 ± 10.09 years, 26 male/7 female) and 140 healthy volunteers (group III, G3; 30.9 ± 8.9 years, 109 male/31 female). The clinical assessment included an examination and estimated parameters of ADL (activities of daily living), the CS (Constant score), ASES (American Shoulder and Elbow score), DASH (disability of arm-shoulder hand) and the RS (Rowe score). RESULTS The ROM analysis recorded no significant differences for the external rotation in 0° abduction (G1 63.75° ± 15.55° versus = vs G2 65.30° ± 18.15°; pERG1 vs G2 = 0.72). The clinical outcomes revealed significantly decreased pain status in G1 for the O'brien test and in G2 for the Palm-up test, whereas Yergason test showed similar pain levels (pO'brien = 0.03; ppalm up = 0.02; pyergason > 0.5). The pulley associated rotator cuff tests revealed a significantly inferior force status in G2 compared to G1 (plift-off = 0.005, pJobe = 0.02) whereas the further rotator cuff assessments were equal. In general, the intervention group showed increased pain level and functional deficits compared to the G3. The score analysis detected no significant differences with PCSG1 vs G2, PASESG1 vs G2, PDASHG1 vs G2 and PRSG1 vs G2 all > 0.05 and significant impairments compared to G3 in all scores pG1/G2 vs G3 < 0.05 (CSG1 = 88.28 ± 14.42, CSG2=92.73 ± 9.24, CSG3 = 96.2 ± 4.96; ASESG1 = 81.10 ± 21.69, ASESG2 = 85.35 ± 17.12, ASESG3 = 94.95 ± 10.39,; DASHG1= 35.75 ± 13.44, DASHG2 = 36.03 ± 17.55, DASHG3 = 27.13 ± 6.52; RSG1 = 90.71 ± 9.88, RSG2 = 88.33 ± 11.22, RSG3= 92.96 ± 11.27). CONCLUSIONS The clinical assessment revealed for both anchor systems similar outcomes but showed general underestimated impairments after the SLAP repair surgery compared to the healthy control. The clinical status only marginally differed between both techniques, wherefore the present assessment of ADL allowed no recommendation of one of these two specific surgery technique for SLAP repair.
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Affiliation(s)
- Y Reinig
- Department of Sporttraumatology-Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - F Welsch
- Department of Sporttraumatology-Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany
| | - R Hoffmann
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - D Müller
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt am Main, Frankfurt am Main, Germany
| | - S Gramlich
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - S Fischer
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - K F Schüttler
- Department of Orthopaedics and Rheumatology, University Hospital Marburg, Marburg, Germany
| | - E Zimmermann
- Department of Sports Science, University of Bielefeld, Bielefeld, Germany
| | - Thomas Stein
- Department of Sporttraumatology-Knee- and Shoulder-Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Friedberger Landstraße 430, 60389, Frankfurt am Main, Germany.
- Department of Trauma and Orthopedic Surgery, Berufsgenossenschaftliche Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany.
- Department of Sports Science, University of Bielefeld, Bielefeld, Germany.
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Miccinilli S, Bravi M, Morrone M, Santacaterina F, Stellato L, Bressi F, Sterzi S. A Triple Application of Kinesio Taping Supports Rehabilitation Program for Rotator Cuff Tendinopathy: a Randomized Controlled Trial. Ortop Traumatol Rehabil 2018; 20:499-505. [PMID: 30676323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Rotator cuff tendinopathy (RoCT) is a common pathology among adults. Kinesio-taping (KT) represents a possible rehabilitative treatment. The aim of the present study is to investigate the efficacy of a combination of three different applications of KT combined with a standardized protocol of rehabilitative exercises in reducing pain and in functional recovery in patients affected by RoCT. MATERIALS AND METHODS 21 patients were enrolled in a real group (RG) and 19 in a sham group (SG). RG received a real KT application and SG received a sham KT application. Both groups received the same rehabilitative protocol. A Numeric Rating Scale (NRS) for shoulder pain, Medical Research Council (MRC) Scales for shoulder strength assessment and Costant Murley Score (CMS) were administered before (T0) and at the end of treatment (T1). RESULTS Within-group analysis for RG at T1 showed significant improvement in: NRS at-rest (p=0.002), during-movement (p<0.001); CMS (p<0.001); MRC shoulder flexion (p=0.003), extension (p=0.005), abduction (p=0.003), adduction (p=0.007), external rotation (p=0.011), internal rotation (p=0.002), elbow flexion (p=0.008) and extension strength (p=0.011). Within-group analysis for SG at T1 showed significant improvement in: during-movement NRS (p=0.010); CMS (p<0.001). CONCLUSIONS 1. KT application combined with conventional rehabilitative treatment can facilitate immediate pain reduction during rehabilitative treatment. 2. KT application combined with conventional rehabilitative treatment can increase function recovery. 3. KT application combined with conventional rehabilitative treatment can increase strength recovery. 4. Our findings however are not strong enough to recommend the application of KT during rehabilitative treatment for RoCT. 5. These results are the basis for future prospective, randomized controlled trials of larger samples of patients.
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Affiliation(s)
- Sandra Miccinilli
- Physical and Rehabilitation Medicine Department, Campus Bio-Medico University, Rome, Italy
| | - Marco Bravi
- Physical and Rehabilitation Medicine Department, Campus Bio-Medico University, Rome, Italy
| | - Michelangelo Morrone
- Physical and Rehabilitation Medicine Department, Campus Bio-Medico University, Rome, Italy
| | - Fabio Santacaterina
- Physical and Rehabilitation Medicine Department, Campus Bio-Medico University, Rome, Italy
| | - Lugi Stellato
- Radiology Department, Campus Bio-Medico University, Rome, Italy
| | - Federica Bressi
- Physical and Rehabilitation Medicine Department, Campus Bio-Medico University, Rome, Italy
| | - Silvia Sterzi
- Physical and Rehabilitation Medicine Department, Campus Bio-Medico University, Rome, Italy
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Ruiz Ibán MA, Lorente Moreno R, Ruiz Díaz R, Álvarez Sciamanna R, Paniagua Gonzalez A, Lorente Gómez A, Díaz Heredia J. The absorbable subacromial spacer for irreparable posterosuperior cuff tears has inconsistent results. Knee Surg Sports Traumatol Arthrosc 2018; 26:3848-3854. [PMID: 30097688 DOI: 10.1007/s00167-018-5083-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 07/27/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE To evaluate the 2-year results of an absorbable subacromial spacer in patients with irreparable posterosuperior rotator cuff tears. METHODS Prospective longitudinal study of a consecutive case series of 16 subjects with irreparable tears of the posterosuperior rotator cuff in which the InSpace® subacromial spacer was arthroscopically implanted. A full clinical evaluation that included the Constant test, Simple Shoulder Test (SST) and the QuickDash questionnaire was performed preoperatively and at 12 and 24 months follow-up. The primary outcome for assessing the success of the procedure was a variable composed of a clinically relevant variation of the Constant (established in an improvement greater than 10 points) and the absence of surgical reintervention. RESULTS Fifteen subjects (11 women/4 men, median age = 69.4 years [interquartile range 7.50], range 60-80 years) completed the 2-year of follow-up. According to the main evaluation criteria, only 6 patients (40%) had a successful outcome. Five subjects required reconversion to a reverse shoulder arthroplasty (at a median of 9.8 months postoperatively) due to absence of clinical improvement or worsening of symptoms. Of the ten remaining subjects, only 6 had improvements greater than 10 points in the Constant score. Despite of this, these 10 subjects had, on average, some improvement in the Constant test (preoperative Constant: median 35.0 [27.0-52.5] vs Constant at 24 months: 53.5 [55.0-84.0], significant differences p = 0.02), in the SST (3.0 [2.0-4.0] vs 6.0 [3.25-7.75], p = 0.039) and in the QuickDASH test (37.0 [33.25-40.0] vs 27.5 [20.5-32.75], p = 0.012). CONCLUSIONS The outcomes of the implantation of the subacromial biodegradable spacer at 2-year follow-up are not satisfactory. In this small case series only 40% of patients seem to clearly benefit from surgery. One in three required revision to a reverse shoulder arthroplasty. The described technique does not seem a reasonable alternative for the management of the majority of patients with irreparable ruptures of the rotator cuff. The indications of this device should be more clearly defined. LEVEL OF EVIDENCE IV.
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Affiliation(s)
| | | | - Raquel Ruiz Díaz
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9.100, Madrid, Spain
| | | | | | | | - Jorge Díaz Heredia
- Hospital Universitario Ramón y Cajal, Cta Colmenar km 9.100, Madrid, Spain
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Bleichert S, Renaud G, MacDermid J, Watson L, Faber K, Lenssen R, Saulnier M, Phillips P, Evans T, Sadi J. Rehabilitation of symptomatic atraumatic degenerative rotator cuff tears: A clinical commentary on assessment and management. J Hand Ther 2018. [PMID: 28641732 DOI: 10.1016/j.jht.2017.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Clinical Commentary. INTRODUCTION Atraumatic rotator cuff (RC) disease, is one of the most common cause of shoulder pain, which encompasses a continuum from tendinopathy to full thickness cuff tears. Extrinsic, intrinsic and environmental factors have been implicated in the pathophysiology of this disorder, affecting the clinical presentation of symptoms including pain and irritability. Successful rehabilitation of symptomatic atraumatic degenerative rotator cuff (SADRC) tears must address the underlying mechanisms causing dysfunction and correct modifiable factors. PURPOSE OF THE STUDY The purpose of this paper is to review the shoulder complex anatomy, introduce atraumatic degenerative RC pathology, differentiate between symptomatic and asymptomatic degenerative RC tears, propose an assessment and introduce the Rotator Cuff Protocol 1 (RCP1) designed by the clinical reasoning of one of the lead authors (LW) as a rehabilitation management approach for those clients who present with SADRC tears. METHODS/RESULTS/DISCUSSION N/A for clinical commentary. CONCLUSIONS The ability to identify SADRC tears should consider shoulder anatomy, extrinsic, intrinsic and environmental factors, and the consideration for the natural history of atraumatic partial and full thickness tears in the general population. A thorough clinical history and examination, which includes shoulder symptom modification tests, allows the examiner to determine at what phase the patient may start their exercise program. The RCP1 is a program that has been used clinically by many therapists and clients over the years and research is underway to test this protocol in atraumatic rotator cuff disease including SADRC tears. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Sarah Bleichert
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Genevieve Renaud
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Joy MacDermid
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Lyn Watson
- LifeCare Prahran Sports Medicine Centre and Melbourne Orthopaedic Group, Melbourne, Australia
| | - Ken Faber
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Ross Lenssen
- LifeCare Prahran Sports Medicine Centre and Melbourne Orthopaedic Group, Melbourne, Australia
| | - Marie Saulnier
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Paul Phillips
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Tyler Evans
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Jackie Sadi
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, Ontario, Canada.
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Li S, Sun H, Luo X, Wang K, Wu G, Zhou J, Wang P, Sun X. The clinical effect of rehabilitation following arthroscopic rotator cuff repair: A meta-analysis of early versus delayed passive motion. Medicine (Baltimore) 2018; 97:e9625. [PMID: 29480870 PMCID: PMC5943887 DOI: 10.1097/md.0000000000009625] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The argument on the recommended rehabilitation protocol following arthroscopic rotator cuff repair remains to be resolved. So this meta-analysis was presented to evaluate the differences of clinical effects between the 2 distinct rehabilitation protocols after arthroscopic rotator cuff repair. METHODS The PubMed, Cochrane Library, Web of Science, and EMBASE were systematically searched. Only randomized controlled trials (RCTs) published up to July 25, 2017, comparing early passive motion (EPM) versus delayed passive motion (DPM) rehabilitation protocols following arthroscopic rotator cuff repair were identified. The primary outcomes included range of motion and healing rate, while the secondary outcomes were Constant score, American Shoulder and Elbow Society (ASES) score, and Simple Shoulder Test (SST) score. The exclusion criteria contained biochemical trials, reviews, case reports, retrospective studies, without mention about passive motion exercise, no assessment of outcomes mentioned above, and no comparison of EPM and DPM rehabilitation protocols. RESULTS Eight RCTs with 671 patients were enrolled in this study. The EPM resulted in improved shoulder forward flexion at short term, mid-term, and long-term follow-ups. The EPM group was superior to the DPM group in terms of external rotation (ER) at short-term and mid-term follow-ups. However, the DPM performed better long-term ASES score. These 2 protocols were equivalent in terms of ER at long term, ASES score at mid-term, SST score, Constant score, and healing rate. After excluding 2 RCTs that examined only small- and medium-sized tears, the pooled results of healing rate decreased from 82.4% to 76.6% in the EPM and 86.9% to 85.9% in the DPM. CONCLUSION The meta-analysis suggests that the EPM protocol results in superior ROM recovery after arthroscopic rotator cuff repair but may adversely affect the shoulder function, which should be supported by further research. The healing rate at long-term follow-up is not clearly affected by the type of rehabilitation, but the EPM protocol might result in lower rates of tendon healing in the shoulder with large-sized tendon tears.
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Visonà E, Vio S, Franceschi G, Maron A, Corona K, Cerciello S, Merolla G, Berizzi A, Aldegheri R. Orthopedic resident's learning curve for arthroscopic subscapularis tendon repair: short-term clinical and radiographic outcomes. Musculoskelet Surg 2017; 101:145-151. [PMID: 28756508 DOI: 10.1007/s12306-017-0485-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 06/08/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Arthroscopic subscapularis (SSC) repair is a technically demanding procedure with a long learning curve. As effective completion of resident's practical experience remains controversial, a prospective clinical study was performed to assess the functional and anatomical outcomes of subscapularis (SSC) arthroscopic repair by orthopedic residents. The pathological anatomy of the tears, the surgical approach and the difficulties encountered at the beginning of the learning curve were reported. MATERIALS AND METHODS Between June 2009 and June 2010, 30 patients with rotator cuff tear were preoperatively evaluated with clinical exam, Constant and UCLA scores. Surgery was performed under arthroscopy by a team of three orthopedic surgeons in training. A SSC tear, if present, was recorded and treated. The same clinical exam and functional scores were repeated at minimum 6 months of follow-up. Subscapularis strength recovery and tendon healing were investigated with arthromagnetic resonance imaging. RESULTS A SSC tear was observed in 11 cases out of 30 and treated arthroscopically. The clinical scores improved in all patients: the average Constant score increased from 34 ± 14 to 77 ± 11 and the UCLA score from 11 ± 5 to 29 ± 3. The SSC tests were negative in all patients with the exception of one. Tendon healing was observed in 10 out of 11 cases. CONCLUSIONS Arthroscopic SSC repair performed by educated residents is possible and leads to good clinical and anatomical results. Surgery duration progressively improved as the learning curve advanced. LEVEL OF EVIDENCE Level 2.
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Affiliation(s)
- E Visonà
- Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 2, Padua, Italy.
- Ospedali Riuniti Padova Sud - ULSS 6 EUGANEA, Via Albere 30, Schiavonia, PD, Italy.
| | - S Vio
- Radiologia I, Ospedale di Padova, Via Giustiniani 2, Padua, Italy
| | - G Franceschi
- Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 2, Padua, Italy
- Policlinico Abano Terme, Piazza C. Colombo 1, Abano Terme, Padova, Italy
| | - A Maron
- Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 2, Padua, Italy
- Ospedali Riuniti Padova Sud - ULSS 6 EUGANEA, Via Albere 30, Schiavonia, PD, Italy
| | - K Corona
- Dipartimento di Scienza per la Salute, Università del Molise, Via De Sanctis, 86100, Campobasso, Italy
| | - S Cerciello
- Casa di Cura Villa Betania, Via Piccolomini 27, 00165, Rome, Italy
- Marrelli Hospital, Via Gioacchino da Fiore, 0962, Crotone, Italy
| | - G Merolla
- Unità di Chirurgia della Spalla e del Gomito, Ospedale D. Cervesi, Cattolica, RN, Italy
| | - A Berizzi
- Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 2, Padua, Italy
| | - R Aldegheri
- Clinica Ortopedica, Università degli Studi di Padova, Via Giustiniani 2, Padua, Italy
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de Oliveira FCL, Pairot de Fontenay B, Bouyer LJ, Desmeules F, Roy JS. Effects of kinesiotaping added to a rehabilitation programme for patients with rotator cuff tendinopathy: protocol for a single-blind, randomised controlled trial addressing symptoms, functional limitations and underlying deficits. BMJ Open 2017; 7:e017951. [PMID: 28947462 PMCID: PMC5623568 DOI: 10.1136/bmjopen-2017-017951] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 07/19/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Rotator cuff tendinopathy (RCTe) is the most frequent cause of shoulder pain, resulting in considerable losses to society and public resources. Muscle imbalance and inadequate sensorimotor control are deficits often associated with RCTe. Kinesiotaping (KT) is widely used by clinicians for rehabilitation of RCTe. While previous studies have examined the immediate effects of KT on shoulder injuries or the effects of KT as an isolated method of treatment, no published study has addressed its mid-term and long-term effects when combined with a rehabilitation programme for patients with RCTe. The primary objective of this randomised controlled trial (RCT) will be to assess the efficacy of therapeutic KT, added to a rehabilitation programme, in reducing pain and disabilities in individuals with RCTe. Secondary objectives will look at the effects of KT on the underlying factors involved in shoulder control, such as muscular activity, acromiohumeral distance (AHD) and range of motion (ROM). METHODS AND ANALYSIS A single-blind RCT will be conducted. Fifty-two participants, randomly allocated to one of two groups (KT or no-KT), will take part in a 6-week rehabilitation programme. The KT group will receive KT added to the rehabilitation programme, whereas the no-KT group will receive only the rehabilitation programme. Measurements will be taken at baseline, week 3, week 6, week 12 and 6 months. Primary outcomes will be symptoms and functional limitations assessed by the Disabilities of the Arm, Shoulder and Hand questionnaire. Secondary outcomes will include shoulder ROM, AHD at rest and at 60° of abduction, and muscle activation during arm elevation. The added effects of KT will be assessed through a two-way analysis of variance for repeated measures. ETHICS AND DISSEMINATION Ethics approval was obtained from the Ethics Committee of Quebec Rehabilitation Institute of the Centre Integrated University Health and Social Services. Results will be disseminated through international publications in peer-reviewed journals, in addition to international conference presentations. TRIAL REGISTRATION NUMBER Protocol was registered at ClinicalTrials.gov (NCT02881021) on 25 August 2016. The WHO Trial Registration Data Set can also be found as an online supplementary file.
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Affiliation(s)
- Fábio Carlos Lucas de Oliveira
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS-CN, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Benoît Pairot de Fontenay
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS-CN, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada
| | - Laurent Julien Bouyer
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS-CN, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada
| | - François Desmeules
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Canada
- Faculty of Medicine, School of Rehabilitation, University of Montreal, Montreal, Canada
| | - Jean-Sébastien Roy
- Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), CIUSSS-CN, Quebec, Canada
- Department of Rehabilitation, Faculty of Medicine, Université Laval, Quebec, Canada
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21
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Saltzman BM, Zuke WA, Go B, Mascarenhas R, Verma NN, Cole BJ, Romeo AA, Forsythe B. Does early motion lead to a higher failure rate or better outcomes after arthroscopic rotator cuff repair? A systematic review of overlapping meta-analyses. J Shoulder Elbow Surg 2017; 26:1681-1691. [PMID: 28619382 DOI: 10.1016/j.jse.2017.04.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 04/14/2017] [Accepted: 04/16/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aims of the study were as follows: to perform a systematic review of meta-analyses comparing "early motion" and "delayed motion" after arthroscopic rotator cuff repair; to provide a framework to analyze the best available evidence to develop recommendations; and to identify gaps where suggestions could be made for future investigations. METHODS Literature searches were performed to identify meta-analyses examining arthroscopic rotator cuff repair with early-motion vs. delayed-motion rehabilitation protocols. Clinical data were extracted, and meta-analysis quality was assessed using the Quality of Reporting of Meta-analyses and Oxman-Guyatt scales. RESULTS Nine meta-analyses met inclusion criteria. No clear superiority was noted in clinical outcome scores for early-motion or delayed-motion rehabilitation. Results of tendon healing were found to be either no different or in favor of delayed motion, but no differences were noted in rotator cuff tear recurrence rates postoperatively. The majority of meta-analyses found significantly better range of motion with early motion up to a year postoperatively for forward elevation and up to 6 months for external rotation, but significant differences were not reported for functional improvements and strength at 12 months postoperatively. Subgroup analyses suggested that larger preoperative tear sizes have significantly greater retear rates with early-motion rehabilitation. CONCLUSIONS The current highest level of evidence suggests that early-motion rehabilitation after rotator cuff repair results in superior postoperative range of motion up to 1 year. Whereas early motion and delayed motion after cuff repair may lead to comparable functional outcomes and retear rates, concern exists that early motion may result in greater retear rates, particularly with larger tear sizes.
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Affiliation(s)
- Bryan M Saltzman
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - William A Zuke
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Beatrice Go
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Randy Mascarenhas
- Department of Orthopaedic Surgery, University of Texas Health Sciences Center at Houston, Houston, TX, USA
| | - Nikhil N Verma
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian J Cole
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Anthony A Romeo
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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22
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Cole BJ, Cotter EJ, Wang KC, Davey A. Patient Understanding, Expectations, and Satisfaction Regarding Rotator Cuff Injuries and Surgical Management. Arthroscopy 2017; 33:1603-1606. [PMID: 28499920 DOI: 10.1016/j.arthro.2017.03.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/04/2017] [Accepted: 03/02/2017] [Indexed: 02/02/2023]
Abstract
Rotator cuff injuries are among the most common in orthopaedics, with rotator cuff repair surgery consistently reported as one of the most commonly performed orthopaedic procedures. Patient satisfaction is becoming an increasingly important outcome metric as health care continues to evolve with regard to quality measures affecting physician reimbursement. Evidence supports that postoperative patient satisfaction, an important quality outcome metric, is highly influenced by preoperative patient expectations, which are in turn governed by patient knowledge and understanding. Many authors have delineated patient-, injury-, and surgery-specific variables associated with high preoperative expectations and satisfaction after rotator cuff surgery. Specifically, large rotator cuff tears, subscapularis tears, persistence of postoperative pain and dysfunction, worker's compensation cases, lower education level, and preoperative disability have been seen more frequently in patients reporting poor satisfaction. Others have reported variables associated with higher patient satisfaction such as being married, employed, and of older age at the time of surgery (>55 years old) predictive of higher satisfaction. Patient education preoperatively regarding details about the surgery and the postoperative plan both immediately after the procedure and for rehabilitation are critical in helping set patients' preoperative expectations that have a known effect on patients' subjective clinical outcomes.
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Affiliation(s)
- Brian J Cole
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A..
| | - Eric J Cotter
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Kevin C Wang
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Annabelle Davey
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois, U.S.A
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23
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Ranalletta M, Rossi LA, Atala NA, Bertona A, Maignon GD, Bongiovanni SL. Arthroscopic in Situ Repair of Partial Bursal Rotator Cuff Tears Without Acromioplasty. Arthroscopy 2017; 33:1294-1298. [PMID: 28336229 DOI: 10.1016/j.arthro.2017.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 12/08/2016] [Accepted: 01/04/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate functional outcomes and complications in a consecutive group of patients with partial bursal rotator cuff tears (PBRCTs) treated with insitu repair without acromioplasty. METHODS Seventy-four patients who had undergone an arthroscopic single row in situ repair for bursal-sided rotator cuff tears were evaluated. Clinical assessment consisted of glenohumeral range of motion measurement, the American Shoulder and Elbow Surgeons score, and the University of California at Los Angeles score. Pain was recorded using a visual analog scale. Postoperative complications were also assessed. RESULTS Mean age was 55.2 years (±6.3) with a minimum of 2-year follow-up. After arthroscopic repair, all active range of motion parameters improved significantly (P < .0001). The American Shoulder and Elbow Surgeons scores improved from 42.5 to 86.1; the University of California at Los Angeles scores improved from 15.8 to 31.4, and the visual analog scale scores improved from 6.6 to 0.7 (P < .0001). Only 3 patients developed a postoperative adhesive capsulitis that responded to physical therapy. CONCLUSIONS In the midterm follow-up (42 months), arthroscopic in situ repair of PBRCTs without acromioplasty is a reliable procedure that produces significant functional improvements and pain relief. LEVEL OF EVIDENCE Level IV, therapeutic case series.
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24
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Marik TL, Roll SC. Effectiveness of Occupational Therapy Interventions for Musculoskeletal Shoulder Conditions: A Systematic Review. Am J Occup Ther 2017; 71:7101180020p1-7101180020p11. [PMID: 28027039 PMCID: PMC5182015 DOI: 10.5014/ajot.2017.023127] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
People with musculoskeletal disorders of the shoulder commonly experience pain, decreased strength, and restricted range of motion (ROM) that limit participation in meaningful occupational activities. The purpose of this systematic review was to evaluate the current evidence for interventions within the occupational therapy scope of practice that address pain reduction and increase participation in functional activities. Seventy-six studies were reviewed for this study-67 of Level I evidence, 7 of Level II evidence, and 2 of Level III evidence. Strong evidence was found that ROM, strengthening exercises, and joint mobilizations can improve function and decrease pain. The evidence to support physical modalities is moderate to mixed, depending on the shoulder disorder. Occupational therapy practitioners can use this evidence to guide daily clinical decision making.
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Affiliation(s)
- Tambra L Marik
- Tambra L. Marik, OTD, OTR/L, CHT, is Hand Therapy Elective Track Director, Rocky Mountain University for Health Professions, Provo, UT, and Staff Therapist, ATI Physical Therapy, Tacoma, WA;
| | - Shawn C Roll
- Shawn C. Roll, PhD, OTR/L, RMSKS, FAOTA, is Assistant Professor, Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles
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25
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Murphy J, Gray A, Cooper C, Cooper D, Ramsay C, Carr A. Costs, quality of life and cost-effectiveness of arthroscopic and open repair for rotator cuff tears: an economic evaluation alongside the UKUFF trial. Bone Joint J 2016; 98-B:1648-1655. [PMID: 27909127 DOI: 10.1302/0301-620x.98b12.bjj-2016-0121.r1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/03/2016] [Indexed: 11/05/2022]
Abstract
AIMS A trial-based comparison of the use of resources, costs and quality of life outcomes of arthroscopic and open surgical management for rotator cuff tears in the United Kingdom NHS was performed using data from the United Kingdom Rotator Cuff Study (UKUFF) randomised controlled trial. PATIENTS AND METHODS Using data from 273 patients, healthcare-related use of resources, costs and quality-adjusted life years (QALYs) were estimated at 12 months and 24 months after surgery on an intention-to-treat basis with adjustment for covariates. Uncertainty about the incremental cost-effectiveness ratio for arthroscopic versus open management at 24 months of follow-up was incorporated using bootstrapping. Multiple imputation methods were used to deal with missing data. RESULTS There were no significant differences between the arthroscopic and open groups in terms of total mean use and cost of resources or QALYs at any time post-operatively. Open management dominated arthroscopic management in 59.8% of bootstrapped cost and effect differences. The probability that arthroscopic management was cost-effective compared with open management at a willingness-to-pay threshold of £20 000 per QALY gained was 20.9%. CONCLUSION There was no significant overall difference in the use or cost of resources or quality of life between arthroscopic and open management in the trial. There was uncertainty about which strategy was most cost-effective. Cite this article: Bone Joint J 2016;98-B:1648-55.
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Affiliation(s)
- J Murphy
- University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK
| | - A Gray
- University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK
| | - C Cooper
- University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK
| | - D Cooper
- University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - C Ramsay
- University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - A Carr
- University of Oxford, Windmill Road, Headington, Oxford OX3 7LD, UK
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26
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Aleem AW, Syed UAM, Wascher J, Zoga AC, Close K, Abboud JA, Cohen SB. Functional outcomes after bilateral arthroscopic rotator cuff repair. J Shoulder Elbow Surg 2016; 25:1668-73. [PMID: 27066966 DOI: 10.1016/j.jse.2016.01.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/15/2016] [Accepted: 01/22/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND Arthroscopic repair of rotator cuff tears is a common procedure performed by orthopedic surgeons. There is a well-known incidence of up to 35% of bilateral rotator cuff tear disease in patients who have a known unilateral tear. The majority of the literature focuses on outcomes after unilateral surgery. The purpose of this study was to determine if there are clinical differences in shoulders of patients who underwent staged bilateral rotator cuff repairs during their lifetime. METHODS A retrospective review of all patients who underwent staged bilateral arthroscopic rotator cuff surgery at our institution was performed. All patients had at least 2 years of follow-up. Clinical outcome scores including the American Shoulder and Elbow Surgeons (ASES), Single Assessment Numeric Evaluation, and Rowe measures were obtained. A subset of patients returned for clinical and ultrasound evaluation performed by an independent fellowship-trained musculoskeletal radiologist. RESULTS Overall, 110 shoulders in 55 patients, representing 68% of all eligible patients, participated. No clinical or statistical difference was found in any outcome measure. ASES scores averaged 86.5 (36.7-100) in the dominant shoulder compared with 89.6 (23.3-100) in the nondominant shoulder (P = .42). Ultrasound was available on 34 shoulders and showed complete healing rate of 88%. The shoulders with retearing of the rotator cuff (12%) demonstrated clinically relevant lower ASES scores (72.5) compared with shoulders with confirmed healed repairs (86.2; P = .2). DISCUSSION Patients who undergo staged bilateral rotator cuff repair can expect to have similarly good clinical outcomes regardless of hand dominance or chronologic incidence with excellent healing rates in both shoulders.
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Affiliation(s)
- Alexander W Aleem
- The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Usman Ali M Syed
- The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jocelyn Wascher
- The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Adam C Zoga
- The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Koby Close
- The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Joseph A Abboud
- The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Steven B Cohen
- The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA.
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27
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Pichonnaz C, Milliet J, Farron A, Luthi F. [Update on the postsurgical shoulder rotator cuff rehabilitation]. Rev Med Suisse 2016; 12:1278-1283. [PMID: 28665563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Primary care physicians play a crucial role in rehabilitation following rotator cuff surgery. This synthesis paper aims to address essential issues of postsurgical rehabilitation, based on recent recommendations. The rehabilitation comprises 4 phases, which are determined by the tendon healing process.For each phase, this article presents the stage of tendon healing, the allowed mechanical constraints, the exercise and physiotherapy modalities, the possible activities and the potential complications. Information and counseling to support the patient implication in the rehabilitation are also detailed. This article contributes to an enhanced comprehension of the healing process, which is a prerequisite for appropriate follow-up and efficient complication detection.
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Affiliation(s)
- Claude Pichonnaz
- Haute école de santé Vaud (HESAV), Beaumont 21, 1011 Lausanne
- Service de chirurgie orthopédique et de traumatologie, CHUV, 1011 Lausanne
| | - José Milliet
- Service de chirurgie orthopédique et de traumatologie, CHUV, 1011 Lausanne
| | - Alain Farron
- Service de chirurgie orthopédique et de traumatologie, CHUV, 1011 Lausanne
| | - François Luthi
- Service de médecine physique et de réadaptation, Département de l'appareil locomoteur, CHUV et Université de Lausanne, 1011 Lausanne
- Clinique romande de réadaptation, Service de réadaptation de l'appareil locomoteur, Av. Grand-Champsec 90, 1950 Sion
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28
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Visonà E, Paladini P, Merolla G, Cerciello S, Porcellini G. Strength recovery after arthroscopic anterosuperior cuff repair: analysis of a consecutive series. Musculoskelet Surg 2015; 99 Suppl 1:S37-S42. [PMID: 25957552 DOI: 10.1007/s12306-015-0369-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 03/06/2015] [Indexed: 06/04/2023]
Abstract
PURPOSE The purpose of this study was to look at the functional outcomes of arthroscopic repair of anterosuperior rotator cuff tears. METHODS Sixty-one patients who underwent arthroscopic repair of anterosuperior cuff tears were retrospectively reviewed. At a minimum 6 months of follow-up, shoulder functional outcome scores including the Constant score (CS), simple shoulder test (SST) and visual analogic scale (VAS) were collected. Strength recovery for supraspinatus and subscapularis was investigated. RESULTS All patients (mean age 59 ± 7) were available at a mean follow-up of 18 ± 7 months. The average CS improved from 30.8 ± 10.2 preoperatively to 76.5 ± 12.0 postoperatively, average SST from 2.6 ± 2.0 to 8.8 ± 2.9 and average VAS pain scale from 3.8 ± 1 to 0.5 ± 0.5 (p < 0.0001). Strength at belly-press and Jobe tests significantly improved (p < 0.0001). All patients with the exception of one were satisfied with the intervention. CONCLUSIONS Arthroscopic repair of anterosuperior rotator cuff tears provides a significant improvement in pain relief and shoulder function. Strength recovery is demonstrated in medium correlation with tendon healing.
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Affiliation(s)
- E Visonà
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, RN, Italy.
- ULSS 17, Ospedale di Este, via San Fermo 10, Este, PD, Italy.
| | - P Paladini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, RN, Italy
| | - G Merolla
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, RN, Italy
| | - S Cerciello
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, RN, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Porcellini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, RN, Italy
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Gumina S, Candela V, Passaretti D, Mariani L, Orsina L. Does immobilization position after arthroscopic rotator cuff repair impact work quality or comfort? Musculoskelet Surg 2014; 98 Suppl 1:55-9. [PMID: 24659204 DOI: 10.1007/s12306-014-0327-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 02/14/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to quantify subjective discomfort and decrease in working performance in patients submitted to arthroscopic rotator cuff repair. METHODS We enrolled 101 asymptomatic administrative employees (mean age 55). Subjects were asked to write a text using Microsoft Word and to make a table using Microsoft Excel, with and without shoulder braces which kept the right shoulder in neutral (brace A) and internal rotation (brace B). Total time needed to complete the tests and number of mistakes committed were annotated. Furthermore, a questionnaire to assess the subjective and interpersonal discomfort caused by the braces was compiled. Data were submitted to statistical analysis. RESULTS When any brace is worn, both times and mistakes are higher than those registered without brace (p < 0.02). Both times and mistakes are higher for brace B in comparison with brace A (p < 0.02). Subjects wearing brace B had a severe/very severe discomfort degree three times higher than that registered in subjects wearing brace A. Finally, 91 % of subjects preferred brace A to brace B. DISCUSSION If the choice of the brace is not supported by biological or clinical advantages, we recommend to use the brace that keeps the arm at the side, since it ensures better working performance and lower discomfort. It also received the greatest satisfaction of the respondents. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- S Gumina
- Department of Orthopaedics and Traumatology, University Sapienza, Piazzale Aldo Moro No.5, 00185, Rome, Italy.
- Department of Mathematics, University Sapienza, Rome, Italy.
| | - V Candela
- Department of Orthopaedics and Traumatology, University Sapienza, Piazzale Aldo Moro No.5, 00185, Rome, Italy
- Department of Mathematics, University Sapienza, Rome, Italy
| | - D Passaretti
- Department of Orthopaedics and Traumatology, University Sapienza, Piazzale Aldo Moro No.5, 00185, Rome, Italy
- Department of Mathematics, University Sapienza, Rome, Italy
| | - L Mariani
- Department of Orthopaedics and Traumatology, University Sapienza, Piazzale Aldo Moro No.5, 00185, Rome, Italy
- Department of Mathematics, University Sapienza, Rome, Italy
| | - L Orsina
- Department of Orthopaedics and Traumatology, University Sapienza, Piazzale Aldo Moro No.5, 00185, Rome, Italy
- Department of Mathematics, University Sapienza, Rome, Italy
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