Rehabilitation of the Rotator Cuff: An Evaluation-Based Approach

Millett, Peter J.; Wilcox, Reg B.; O’Holleran, James D.; Warner, Jon J.P.

doi:10.5435/00124635-200610000-00002

Cited by 139 publications

(88 citation statements)

References 39 publications

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“…Pendular exercises and self-assisted shoulder flexion are common passive exercises that have been previously reported in a rehabilitation protocol (Millett, Wilcox, O'Holleran, & Warner, 2006) and were chosen to represent the passive phase of rehabilitation. As electromyographic (EMG) activity is low with these exercises, they were considered representative of passive exercise (Dockery, Wright, & LaStayo, 1998;Long et al, 2010;McCann, Wootten, Kadaba, & Bigliani, 1993).…”

Section: Methodsmentioning

confidence: 99%

Rotator cuff repair protocols: A survey of current New Zealand practice

Harman¹,

Olds²

2017

NZJP

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Rehabilitation following surgical rotator cuff repair may enable return to pre-injury function. Optimal recovery is facilitated by the use of post-operative protocols that enhance communication between the surgeon and physiotherapist. The purpose of this study was to describe the rotator cuff repair rehabilitation protocols currently used in New Zealand. Orthopaedic surgeons practising in New Zealand were contacted to determine their current rehabilitation protocols. Length of immobilisation and exercise progression following surgical repair were analysed across weekly timeframes from the day of surgery until nine months post-operatively. The response rate was 55% with protocols received from 31 surgeons. Post-surgical rotator cuff protocols currently in use in New Zealand are predominantly determined by weekly time periods which vary from surgeon to surgeon. Immobilisation was most commonly recommended for four to six weeks, pendular exercises were started the week of surgery, active exercises commenced at six weeks, followed by resisted exercises at twelve weeks. Few protocols based the rehabilitation upon tissue quality and size of rotator cuff tear. Level of detail regarding sets and repetitions of exercises also differed between protocols. Variability across protocols was evident regarding the recommended activity level and time period from surgery. Consideration of tissue quality, size of the tear and strength of the repair is recommended to facilitate optimal results.

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Section: Methodsmentioning

confidence: 99%

Rotator cuff repair protocols: A survey of current New Zealand practice

Harman¹,

Olds²

2017

NZJP

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“…Many surgeons allow patients to begin gentle passive motion within a day of surgery, but active motion is generally restricted to prevent retear of the rotator cuff. 30 Nevertheless, Galatz et al 15 reported retearing of the rotator cuff after surgical repair in over 75% of patients with large tears. While not all patients waist and allows the arm to swing like a pendulum, moving in circles generated by trunk motion.…”

Section: Activation Of the Shoulder Musculature During Pendulummentioning

confidence: 99%

Activation of the Shoulder Musculature During Pendulum Exercises and Light Activities

Long¹,

Thiele²,

Skendzel³

et al. 2010

Journal of Orthopaedic & Sports Physical Therapy

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Study Design Prospective, single-group, repeated-measures design. Objectives To evaluate electromyographic (EMG) signal amplitude in the supraspinatus, infraspinatus, and deltoid muscles during pendulum exercises and light activities in a group of healthy subjects. Background There are numerous rehabilitation protocols used after rotator cuff repair. One of the most commonly used exercises in these protocols is the pendulum. Patients can easily perform these exercises incorrectly, and may also perform light activities of daily living without knowing that they may be putting excessive stress on the repair. The effect of improperly performed pendulum exercises and light activities after rotator cuff repair is unknown. Methods Muscle activity was recorded in 13 subjects performing pendulum exercises incorrectly and correctly in both large (51-cm) and small (20-cm) diameters, and while typing, drinking, and brushing their teeth. Results Incorrect and correct large pendulums and drinking elicited more than 15% maximum voluntary isometric contraction in the supraspinatus and infraspinatus. The supraspinatus EMG signal amplitude was greater during large, incorrectly performed pendulums than during those performed correctly. Both correct and incorrect large pendulums resulted in statistically higher muscle activity in the supraspinatus than the small pendulums. Conclusion Larger pendulums may require more force than is desirable early in rehabilitation after rotator cuff repair. J Orthop Sports Phys Ther 2010;40(4):230–237. doi:10.2519/jospt.2010.3095

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“…Rotator cuff tear arthropathy (CTA) and glenohumeral osteoarthritis (OA) are age-related chronic diseases of the shoulder that often leave patients in debilitating pain and at functional loss [1]. CTA was first described by Neer et al in 1983 as a complex shoulder syndrome that occurs after a massive rotator cuff tear [2].…”

Section: Introductionmentioning

confidence: 99%

Fatty Infiltration of Rotator Muscles: A Comparison of Cuff Tear Arthropathy and Glenohumeral Osteoarthritis

Scott¹,

Glowacki²,

Higgins³

2016

International Journal of Orthopaedics

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BACKGROUND:Rotator cuff tear arthropathy (CTA) and glenohumeral osteoarthritis (OA) are age-related chronic diseases of the shoulder representing debilitating, painful conditions with functional loss. Surgical intervention provides the most reliable treatment, but studies have shown that prognosis is contingent upon a variety of factors, one of the most reliable of which is fatty infiltration of the rotator cuff muscles. This study tests the hypothesis that fatty infiltration (FI) is increased in CTA subjects compared with OA subjects. METHODS: CTA subjects (n = 22, age 71.9 ± 7.8 years) and OA subjects (n = 22, age 62.9 ± 9.6 years) were evaluated for extent of fatty infiltration by Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) imaging using Goutallier's classification system and a novel scoring system of % FI. RESULTS: Goutallier classification showed that FI of the supraspinatus and infraspinatus rotator cuff muscles in CTA subjects was greater than those in OA subjects (p = 0.0001, p = 0.003, respectively). The % FI method revealed similar results (p = 0.003, p = 0.0008, respectively). Neither classification system revealed significant differences in FI for the subscapularis or teres minor cuff muscles (Goutallier: p = 0.123, p=0.890; % FI: p = 0.142, p = 0.666, respectively). Analysis using age-matched controls revealed similar results. There was a strong correlation in scores for the two classification systems (Spearman r = 0.96, p < 0.0001). CONCLUSION: Extent of fatty infiltration of the rotator cuff muscles in subjects suffering from rotator cuff tear arthropathy is significantly greater than in subjects with osteoarthritis. Level of evidence: Level IV, Case Controlled.

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Rehabilitation of the Rotator Cuff: An Evaluation-Based Approach

Cited by 139 publications

References 39 publications

Rotator cuff repair protocols: A survey of current New Zealand practice

Rotator cuff repair protocols: A survey of current New Zealand practice

Activation of the Shoulder Musculature During Pendulum Exercises and Light Activities

Fatty Infiltration of Rotator Muscles: A Comparison of Cuff Tear Arthropathy and Glenohumeral Osteoarthritis

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