Friday, January 3, 2014

How to rehabilitate a rotator cuff repair: tears < 3 cm. What does it say about the $3.44 billion?

Rehabilitation Following Arthroscopic Rotator Cuff Repair: A Prospective Randomized Trial of Immobilization Compared with Early Motion

In a group of 124 having arthroscopic double row repair of cuff tears <30 mm in width, these authors compared two rehabilitation programs: (1) a traditional rehabilitation program with early range of motion* or (2) an immobilization group with delayed range of motion for six weeks**.

At three months active elevation and external rotation were better in the traditional rehabilitation group, but no significant differences were seen in functional scores, active motion, and shoulder strength between rehabilitation groups at later time points. Functional outcomes plateaued at six or twelve months except for the relative Constant score, which improved up to twenty-four months following surgery. Ninety-two percent of the tears were healed, with no difference between rehabilitation protocols. There was no comparison of the clinical outcomes between the healed and unhealed shoulders.

The authors concluded on one hand that immobilization did not appear to lead to greater risks of shoulder stiffness and on the other hand early motion did not appear to impair tendon healing.

*Immediately post op: Pendulum exercises and elbow, wrist, and hand AROM
1-6 wk Therapist-supervised PROM of shoulder
6-12 wk AAROM and AROM of shoulder
3-4 mo Initiate cuff, deltoid, and scapular stabilizer strengthening
 >4 mo Full activities between 4 and 6 mos on basis of individual progress

**Immediately post op: Elbow, wrist and hand AROM
1-6 wk Shoulder immobilized
6-12 wk Therapist-supervised PROM
3-4 mo Initiate AAROM and AROM of shoulder
>4 mo Initiate cuff, deltoid, and scapular stabilizer strengthening; full activities between 5 and 6 mo on basis of individual progress

For example in the $3.44 billion paper the long term retear rate after all cuff repairs was assumed to be 2%, whereas in the current paper the retear rate was 8%. This is particularly important because the tears in the current study were optimal for repair: small tears in young patients (average age 55years) - a group not representative of the general population of rotator cuff tears.
In the $3.44 billion paper it was assumed that workers lost an average of twenty-eight additional days as a result of rotator cuff repair compared with those undergoing non-operative treatments, whereas in the current paper full activities were not resumed until 4-6 months after surgery.

This reality check suggests that if the assumptions were corrected, the optimistic math of the $3.44 billion paper would be substantially tempered.

Consultation for those who live a distance away from Seattle.

Check out the new Shoulder Arthritis Book - click here.

Click here to see the new Rotator Cuff Book

To see the topics covered in this Blog, click here

Use the "Search" box to the right to find other topics of interest to you.

You may be interested in some of our most visited web pages including:shoulder arthritis, total shoulder, ream and runreverse total shoulderCTA arthroplasty, and rotator cuff surgery as well as the 'ream and run essentials'