Saturday, January 9, 2016

Rotator cuff tears - can an exercise program improve the workings of the shoulder?

Effects of exercise therapy for the treatment of symptomatic full-thickness supraspinatus tears on in vivo glenohumeral kinematics.

These authors investigated the effectiveness of a 12 week exercise program in improving kinematics (smaller translations and increased subacromial space) and patient self-assessed comfort and function.

The five subjects (3 women and 2 men; mean age, 60.2 ± 7.6 years) with a symptomatic small, degenerative full-thickness rotator cuff tear isolated to the supraspinatus tendon and a greater percentage of supraspinatus muscle than fat (Goutallier grade 2 or less) . Dynamic stereoradiography system was used to determine the glenohumeral translation during abduction in the coronal plane.

After therapy humeral translation on the glenoid was reduced as shown below for a single patient before therapy (left) and after therapy (right). The contact center is represented by a black circle, and the path followed by the contact center throughout the range of abduction is represented by the white line. 

Clinical parameters were also improved

Comment: This is a small series providing some encouragement for the non-operative management of degenerative rotator cuff tears. When the cuff tear is not acute, it is reasonable to offer the patient a rehabilitation program to see if they are satisfied with the results. 

We have observed that the some of the deltoid and residual cuff muscle weakness observed in patients with chronic cuff tears is due to disuse and is reversible with gentle progressive strengthening. Similarly, the stiffness that can be limiting for individuals with chronic tears can often be lessened by a gentle progressive strengthening program. This study excluded patients with 'severe capsular tightness', yet these may be some of the best candidates for non-operative treatment.

Finally, it is reasonable that a period of 'prehabilitation' before cuff surgery may be helpful in conditioning both the shoulder and the patient.