Abstract
BackgroundRotator cuff rupture is associated with dysfunction, pain and muscular weakness related to the upper extremity. Some evidence exists to support the beneficial effect of exercises but there is lack of evidence of which exercises imply the best effect and how physiotherapy should be administered. Therefore, the purpose of this study was to examine the effect of a neuromuscular exercise program for patients with irreparable rotator cuff rupture.MethodsBased on sample-size calculations thirty patients with chronic irreparable rotator cuff tears (of at least m. supraspinatus and m. infraspinatus) was consecutively included. Twenty-four patients completed the five months training to restore function with focus on centering the humeral head in the glenoid cavity trough strengthening m. deltoideus anterior and m. teres minor. The primary outcome measure was Oxford Shoulder Score which was completed at baseline, 3 and 5 months follow-up. One-way, repeated-measure ANOVA was used if data was normally distributed. Secondary outcome measures included EQ-5D, range of motion, strength and muscle activity. Paired t-test and Wilcoxon Signed Ranks Test was used to the appropriate outcomes.ResultsImprovements was seen for both primary and secondary outcomes from baseline to follow-up. Oxford Shoulder Score improved from 25.6 (SD 8.1) at baseline to 33.8 (SD 8.7) at 3 months (p = 0.004) and 37.2 (SD 8.2) at five months (p < 0.001). Range of motion in abduction significantly increased by 34.4° (95 % CI: 11.6–57.2). Strength measured in flexion 45, flexion 90 and abduction also significantly increased at 5 months by 10.2 (95 % CI: 0.8–19.6), 7.0 (95 % CI: 0.0–14.0) and 12.3 (95 % CI: 3.4–21.3) respectively. The remaining outcomes for range of motion and strengths only showed small and non-significant changes. Furthermore patients reported higher levels of quality of life and reduced level of pain after five months.ConclusionFollowing a five months exercise protocol patients with irreparable rotator cuff tears showed increased function in their symptomatic shoulder, reduced pain and increased quality of life. This study therefore supports the use of exercise therapy in patients with irreparable rotator cuff rupture.Trial registrationThis study is approved by The National Committee on Health Research Ethics (N-20120040) and registered retrospectively at ClinicalTrials.gov in April 2016 (NCT02740946).Electronic supplementary materialThe online version of this article (doi:10.1186/s12891-016-1116-6) contains supplementary material, which is available to authorized users.
Highlights
Rotator cuff rupture is associated with dysfunction, pain and muscular weakness related to the upper extremity
Ainsworth and Lewis [3] concluded in a systematic review (2007), that only some evidence exists to support the use of exercises in treating patient with full thickness rotator cuff tears, but there is a lack of evidence of which exercises imply the best effect and how physiotherapy should be administered [3, 4]
As describes in the literature pain reported on visual analogue scale (VAS) was considered ordinal and a Wilcoxon Signed Ranks Test was used [20]
Summary
Rotator cuff rupture is associated with dysfunction, pain and muscular weakness related to the upper extremity. Ainsworth and Lewis [3] concluded in a systematic review (2007), that only some evidence exists to support the use of exercises in treating patient with full thickness rotator cuff tears, but there is a lack of evidence of which exercises imply the best effect and how physiotherapy should be administered [3, 4]. On the other hand Collin et al investigated the effect of a rehabilitation program for patients with irreparable massive rotator cuff tears in a prospective intervention study, but found no indication for strengthening m. In agreement with the literature Collin et al indicate that there are no consensus regarding nonoperative treatment modalities such as methods, duration and indications [8]
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