Rotator cuff rehabilitation: current theories and practice

Osborne, Jeffrey; Gowda, Ashok; Wiater, Brett P.; Wiater, J. Michael

doi:10.1080/00913847.2016.1108883

Cited by 61 publications

(48 citation statements)

References 79 publications

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“…[4][5][6][7][8][9][10][11] Initial conservative management consists of activity modification, nonsteroidal anti-inflammatory drugs, and corticosteroid injections. 4 In nonoperative cases, physical therapy is also employed to strengthen shoulder and scapular musculature and to address postural disturbances that may be responsible for patient symptoms. 4 Postoperatively, physical therapy is similarly utilized to minimize joint stiffness and to strengthen the surrounding musculature.…”

Section: Introductionmentioning

confidence: 99%

Evaluating strategies and outcomes following rotator cuff tears

et al. 2018

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Introduction: Rotator cuff tear surgical repair techniques have significantly progressed. However, tendon retear following primary repair persistently occurs at high rates. Rehabilitation protocols, surgical fixation techniques, biologic therapy with scaffolds, platelet-rich plasma, and even stem cell applications are under study to promote adequate tendon healing. Methods: A nonsystematic query of the PubMed database was conducted in July 2016 utilizing the search terms ''rotator cuff repair,'' ''tear,'' ''rehabilitation,'' ''scaffold,'' ''platelet-rich plasma,'' and ''stem cell'' to identify, analyze, and summarize relevant studies. Conclusion: Individualized rehabilitation protocols may be the best approach for small to medium sized tears. Surgical fixation will continue to be debated as modifications to single-row technique and increases in suture number have improved tensile strength. Double-row repairs have been associated with higher costs. Transosseous equivalent technique exhibits comparable subjective and objective outcomes to single-and double-row repair at two-year follow-up. Biocompatible scaffold augmentation has showed inconsistent short-term results. Platelet-rich plasma has lacked uniformity in treatment preparation, administration, and outcome measurement with mixed results. Few human studies have suggested decreased retear rates and improved repair maintenance following bone marrow-derived mesenchymal stem cell augmentation. This review reiterated the necessity of additional high-quality, large-sample studies to develop any final verdict regarding efficacy.

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Section: Introductionmentioning

confidence: 99%

Evaluating strategies and outcomes following rotator cuff tears

et al. 2018

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“…Although RTC injuries are common in young athletes with acute injuries or repetitive overhead motions, the incidence of RTC tears tremendously increases with age-related degenerative changes. [1][2][3][4] Treatment of RTC tears is typically individualized based on a variety of factors, such as age; size, severity, and location of the tear; comorbidities; activity level; degree of impairment; and patient expectations. 1 Both nonoperative and operative treatments are effectively used for pain relief and restoration of shoulder range of motion (ROM) after an RTC tear.…”

mentioning

confidence: 99%

“…[1][2][3][4] Treatment of RTC tears is typically individualized based on a variety of factors, such as age; size, severity, and location of the tear; comorbidities; activity level; degree of impairment; and patient expectations. 1 Both nonoperative and operative treatments are effectively used for pain relief and restoration of shoulder range of motion (ROM) after an RTC tear. 5,6 Regardless of whether nonoperative or operative intervention is used, rehabilitation of the RTC tendons or muscles and surrounding shoulder girdle plays an essential role in improvement of shoulder function, pain, and overall quality of life.…”

mentioning

confidence: 99%

“…5,6 Regardless of whether nonoperative or operative intervention is used, rehabilitation of the RTC tendons or muscles and surrounding shoulder girdle plays an essential role in improvement of shoulder function, pain, and overall quality of life. 1,7 The primary goals of postoperative rehabilitation are protection of the healing process and prevention of joint stiffness and muscle atrophy. 8 Passive range of motion (PROM) in the early postoperative stages is typically performed to the patient's tolerance, not pushing to increase ROM at end ranges but using gentle oscillations to decrease muscular tightness, guarding, and pain.…”

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confidence: 99%

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A Review of Online Rehabilitation Protocols Designated for Rotator Cuff Repairs

Coda

Cheema

Hermanns

et al. 2020

Arthroscopy, Sports Medicine, and Rehabilitation

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Purpose: To compare publicly available rehabilitation protocols designated for rotator cuff (RTC) repairs published online by academic residency programs and private practice institutions. Methods: A systematic electronic search using the Fellowship and Residency Electronic Interactive Database Access System (FREIDA) was performed for RTC repair rehabilitation protocols. Private practice programs with published rehabilitation protocols that were discovered during the Google search were also included for review, but no comprehensive search for private practice protocols was performed. The main exclusion criteria consisted of noneEnglish-language protocols and protocols without any of the time-based components in question. Included protocols were assessed independently based on the specified RTC tear size (small [1 cm], medium [1-4 cm], large or massive [5 cm], or no mention of size). Protocols were compared based on the inclusion, exclusion, and timing of certain rehabilitation components. Results: A total of 96 rehabilitation protocols were included for review, from 39 academic institutions and 28 private practice programs. Specific instructions for concomitant biceps tenodesis were included in 26 protocols (27.1%). Of the 96 protocols, 88 (91.7%) did not place restrictions on early postoperative passive range of motion (PROM) of the shoulder. Isolated PROM with restrictions on active range of motion was most commonly recommended for the first 4 or 6 weeks postoperatively (80.2%). Use of a sling or immobilizer was most frequently recommended for the first 4 or 6 weeks postoperatively (78.1%). Wide variation was noted in recommendations for returning to resistance strengthening, with the highest incidence being 27 protocols recommending returning at 12 weeks (28.1%); this further varied based on the size of the tear. A total of 21 protocols (21.9%) recommended the use of cryotherapy postoperatively. Conclusions: Although certain rehabilitation components were common, such as duration of PROM and sling or immobilizer use, a large degree of variation remains among published rehabilitation protocols after RTC repair, and this variability is still seen even when subdividing by the size or severity of the RTC tear. Clinical Relevance: Rehabilitation after RTC repair is crucial to patient outcomes. This study summarizes the variability among online rehabilitation protocols for RTC repair in the United States and emphasizes the importance of appropriate rehabilitation after RTC surgery.

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“…Rotator cuff injury affects 30% to 40% of the population over the age of 60 years and has a significant impact on medical expenses [7]. Repairs for rotator cuff injury continue to increase, and physical therapy for this is important [8,9]. In addition, assessment of pain after the repair using a pain scale, such as the visual analog scale and range of motion (ROM) is important [10].…”

Section: Introductionmentioning

confidence: 99%

Osteokinematic analysis during shoulder abduction using the C-arm

Lee

Kim²,

Lee

et al. 2017

PTRS

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Objective: Despite reliable evidence of abnormal scapular motions increases, there is not yet sufficient evidence of abnormal humeral translations. This study aims to analyze the motion of the humeral head toward the scapula when the shoulder is actively abducted using the C-arm. Design: A case report. Methods: The participant was a healthy man without any limitation and pain during shoulder movement. The participant's shoulder was abducted; this movement in the frontal plane was measured using a C-arm (anterior-posterior view) and was analyzed with computer-aided design. The starting posture was 15°, and as the participant abducted his shoulder measurements were taken and analyzed at 30°, 60°, 90°, 120°, 150°, and ending at 165°. A line was drawn perpendicularly to the line connecting the humeral head axis to the glenoid, and another line was drawn perpendiculary to the line connecting the scapular axis to the glenoid. The distance between the two lines measured is defined as the e value. Results: At the starting posture (15°), the central axis of the humeral head was located 1.92 mm inferior to the central axis of the scapula. The humeral head was superiorly translated from the starting posture to 120°, and then, showed an inferior translation to the ending posture (165°). Conclusions:The results of this study showed that the humeral head moved upward from the starting posture (15°) up to 120° indicating, superior translation, and it moved downward when the posture was past 120°, indicating inferior translation.

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Rotator cuff rehabilitation: current theories and practice

Cited by 61 publications

References 79 publications

Evaluating strategies and outcomes following rotator cuff tears

Evaluating strategies and outcomes following rotator cuff tears

A Review of Online Rehabilitation Protocols Designated for Rotator Cuff Repairs

Osteokinematic analysis during shoulder abduction using the C-arm

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