What does rehabilitation after rotator cuff repair look like for the average patient in the UK? A study by UK researchers in Sheffield conducted an electronic survey to find out. Authors Littlewood and Bateman sent links to an electronic survey by email, Twitter and Facebook to physiotherapists and surgeons involved in the treatment of rotator cuff repairs. 100 valid responses were received from professionals matching the criteria for inclusion. Any duplicate responses or similar results between professionals located at the same clinic were eliminated to reduce bias.
A new study published in Journal of the American Medical Association (JAMA) explores the treatment of displaced fractures of the proximal humerus. Patients included in the study had unclear indications for surgery where a surgeon considered surgery, but the fracture did not have to meet surgical criteria by Neer (1 cm or 45° angulation of displacement). For study participants, surgical and non-surgical treatment with a sling did not show a clinically significant difference in treatment outcome.
We previously published a blog post about a study by Baumgarten et al which compared Pulley Exercises to a well-known rehabilitative exercise, Jackins exercise. Here we discuss the rehabilitation exercises used in the study, paying special attention to the pulley exercise treatment.
A study published by Kukkonen et al. sought to compare conservative treatment with 2 surgical interventions for patients with atraumatic, small rotator cuff tears. The article found that the conservative treatment, physiotherapy, had similar outcomes to acromioplasty or acromioplasty and rotator cuff repair at 1 year based on Constant score, but physiotherapy had significantly less direct and indirect cost. Due to these results, the authors propose that physiotherapy should be the primary treatment for small, non-traumatic rotator cuff tears.
A Swedish study from Linköping University focusing on subacromial impingement syndrome has found a specific exercise program that helped 80% of compliant patients seeking arthroscopic subacromial decompression avoid surgery. The study compared a group given exercises targeting strength of the rotator cuff and scapula stabilizers to a group given non-specific neck and shoulder movement exercises. Measures included Constant-Murley shoulder assessment score, Hospital Anxiety and Disability (HAD) score, Disabilities of arm, shoulder and hand score, Health related quality of life measured with EQ-5D (European Quality of Life- 5 Dimension score) and Visual analogue scale.
A blind, randomized and controlled study comparing a home exercise program, group exercise and individual physiotherapy found that group exercise may be the treatment with the best patient outcomes for patients with Frozen Shoulder (adhesive capsulitis). While all groups improved over the 12 month course of the study, group exercise supervised by a physiotherapist and individual physiotherapy had the largest improvements in Hospital Anxiety and Disability score, and group exercise had the largest gains in the Constant Score.
A group of 9 European and Australian Shoulder Physiotherapy experts published a consensus report on the physiotherapy treatment of Shoulder pain. Points of agreement were using physical assessment to determine treatment, opposed to imaging, and a focus on few active exercises with quality movement of the arm not causing presenting pain and frequent reassessment to ensure the correct treatment is being used for the patient.
A randomized study of 53 patients undergoing post-operative rehabilitation after rotator cuff repair by arthroscopy shows a statistically significant improvement when using either Jackins or pulley exercises after an initial 6 week period of Passive Range of Motion exercises. The study worked with the hypothesis that pulley exercises would lead to inferior patient outcomes. The hypothesis was nullified as patients using the pulley exercises have not shown inferior outcomes in WORC, SST, ASES Shoulder score or SANE scores. In this study, Jackins and shoulder pulley exercises had equivalent outcomes for patients after rotator cuff repair rehabilitation.
Here is a great tutorial video on how to use a Pul Ez Shoulder Pulley from RangeMaster!
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