Gerald A Ferrer1,2, R Matthew Miller1,2, Jason P Zlotnicki1,3, Scott Tashman3, James J Irrgang3,4, Volker Musahl1,2,3, Richard E Debski5,6,7. 1. Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA. 2. Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA. 3. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. 4. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA, USA. 5. Orthopaedic Robotics Laboratory, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA, 15219, USA. genesis1@pitt.edu. 6. Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA. genesis1@pitt.edu. 7. Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA. genesis1@pitt.edu.
Abstract
PURPOSE: Rotator cuff tears are a significant clinical problem, with exercise therapy being a common treatment option for patients. Failure rates of exercise therapy may be due to the failure to improve glenohumeral kinematics. Tears involving the supraspinatus may result in altered glenohumeral kinematics and joint instability for internal/external rotation with the arm at the side because not all muscles used to stabilize the glenohumeral joint are functioning normally. The objective of the study is to assess in vivo glenohumeral kinematic changes for internal/external rotation motions with the arm at the side of patients with a symptomatic full-thickness supraspinatus tear before and after a 12-week exercise therapy programme. METHODS: Five patients underwent dynamic stereoradiography analysis before and after a 12-week exercise therapy protocol to measure changes in glenohumeral kinematics during transverse plane internal/external rotation with the arm at the side. Patient-reported outcomes and shoulder strength were also evaluated. RESULTS: No patient sought surgery immediately following exercise therapy. Significant improvements in isometric shoulder strength and patient-reported outcomes were observed (p < 0.05). No significant changes in glenohumeral kinematics following physical therapy were found. CONCLUSION: Isolated supraspinatus tears resulted in increased joint translations compared to healthy controls from the previous literature for internal/external rotation with the arm at the side. Despite satisfactory clinical outcomes following exercise therapy, glenohumeral kinematics did not change. The lack of changes may be due to the motion studied or the focus of current exercise therapy protocols being increasing shoulder strength and restoring range of motion. Current exercise therapy protocols should be adapted to also focus on restoring glenohumeral kinematics to improve joint stability since exercise therapy may have different effects depending on the motions of daily living. LEVEL OF EVIDENCE: Prognostic study, Level II.
PURPOSE: Rotator cuff tears are a significant clinical problem, with exercise therapy being a common treatment option for patients. Failure rates of exercise therapy may be due to the failure to improve glenohumeral kinematics. Tears involving the supraspinatus may result in altered glenohumeral kinematics and joint instability for internal/external rotation with the arm at the side because not all muscles used to stabilize the glenohumeral joint are functioning normally. The objective of the study is to assess in vivo glenohumeral kinematic changes for internal/external rotation motions with the arm at the side of patients with a symptomatic full-thickness supraspinatus tear before and after a 12-week exercise therapy programme. METHODS: Five patients underwent dynamic stereoradiography analysis before and after a 12-week exercise therapy protocol to measure changes in glenohumeral kinematics during transverse plane internal/external rotation with the arm at the side. Patient-reported outcomes and shoulder strength were also evaluated. RESULTS: No patient sought surgery immediately following exercise therapy. Significant improvements in isometric shoulder strength and patient-reported outcomes were observed (p < 0.05). No significant changes in glenohumeral kinematics following physical therapy were found. CONCLUSION: Isolated supraspinatus tears resulted in increased joint translations compared to healthy controls from the previous literature for internal/external rotation with the arm at the side. Despite satisfactory clinical outcomes following exercise therapy, glenohumeral kinematics did not change. The lack of changes may be due to the motion studied or the focus of current exercise therapy protocols being increasing shoulder strength and restoring range of motion. Current exercise therapy protocols should be adapted to also focus on restoring glenohumeral kinematics to improve joint stability since exercise therapy may have different effects depending on the motions of daily living. LEVEL OF EVIDENCE: Prognostic study, Level II.
Authors: Michael J Bey; Cathryn D Peltz; Kristin Ciarelli; Stephanie K Kline; George W Divine; Marnix van Holsbeeck; Stephanie Muh; Patricia A Kolowich; Terrence R Lock; Vasilios Moutzouros Journal: Am J Sports Med Date: 2011-07-07 Impact factor: 6.202
Authors: Cathryn D Peltz; Jeffrey A Haladik; Scott E Hoffman; Michael McDonald; Nicole Ramo; Vasilios Moutzouros; Michael J Bey Journal: Am J Orthop (Belle Mead NJ) Date: 2014-05
Authors: Luke T Mattar; Adam J Popchak; William J Anderst; Volker Musahl; James J Irrgang; Richard E Debski Journal: J Shoulder Elbow Surg Date: 2022-01-26 Impact factor: 3.507