Open, mini-open, and all-arthroscopic rotator cuff repair surgery: indications and implications for rehabilitation.

Rush University, Department of Orthopaedic Surgery, Chicago, IL, USA.
Journal of Orthopaedic and Sports Physical Therapy (Impact Factor: 2.38). 03/2009; 39(2):81-9. DOI: 10.2519/jospt.2009.2918
Source: PubMed

ABSTRACT Rotator cuff tears lead to debilitating shoulder dysfunction and impairment. The goal of rotator cuff repair is to eliminate pain and improve function with increased shoulder strength and range of motion. The clinical outcomes of the surgical methods of rotator cuff repair (open, mini-open, and all-arthroscopic cuff repair) vary, as each method provides an array of advantages and disadvantages. Although the open surgical technique has long been considered the gold standard of rotator cuff repair, surgeons are becoming more adept at decreasing patient morbidity through decreased surgical trauma from an all-arthroscopic approach. In addition to a surgery-specific rotator cuff rehabilitation program, effective communication, and coordination of care by the physical therapist and surgeon are essential in optimal patient education and outcomes. In the ideal situation, a very well-educated therapist who has great communication with the treating surgeon can mobilize the shoulder early, re-establish scapulothoracic function safely and minimize the risk of stiffness and retear, while facilitating return to function. Treatment options can be individualized according to patient age, size and chronicity of tear, surgical approach, and fixation method. We recommend that patients who have undergone an all-arthroscopic rotator cuff repair undergo an accelerated postoperative rehabilitation program. A rational approach to therapy involves early, safe motion to allow optimal tendon healing, yet maintenance of joint mobility with minimal stress. As the field of orthopedics and, particularly, rotator cuff repair continues to develop with new technologies, the patient, physical therapist, and doctor need to work together to ensure optimal outcomes and patient satisfaction. LEVEL OF EVIDENCE: Therapy, Level 5.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Restoring optimal strength and biomechanics of a pathologic shoulder knowledge of activity patterns of healthy glenohumeral muscles is mandatory. Yet, data on normal shoulder muscle activity are not always conclusive. The study was undertaken (a) to evaluate muscle activity patterns in the healthy shoulder using surface and fine-wire electromyography (EMG), and (b) to assess method's suitability in the clinical setting especially regarding painfulness and practicability. Surface and fine-wire EMG was performed on 11 healthy subjects (2f/9m, Ø age 28 years) to assess 14 muscles including rotator cuff muscles during 8 planar standardised shoulder movements (abduction, forward flexion, internal and external rotation in neutral, 45° and 90° abduction). Pain was assessed using the visual analogue scale before testing, after inserting the fine-wire electrodes, after maximal voluntary contraction, before and after exercises, and after electrode removal. The most important finding regarding EMG activity patterns in the healthy shoulder was that the subscapularis activity was found to play a major role in abduction and forward flexion. Furthermore, this study was able to show that EMG measurements, especially fine-wire EMG, is prone to high failure rates (up to 32 %); however, pain was not a limiting factor. The present study (1) revealed a new insight, especially finding the subscapularis activity playing a major role in abduction and forward flexion of the healthy shoulder; and (2) motion analysis system and the use of fine-wire electrodes were prone to failure; however, pain was not a limiting factor. Basic Science, Electrodiagnostic Study.
    Archives of Orthopaedic and Trauma Surgery 02/2015; DOI:10.1007/s00402-015-2180-3 · 1.36 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The aim of the present study was to analyse and describe muscle function, quality of life and functional capacity before and after shoulder instability surgery. Twenty-six women aged 34 (± 14) years and 95 men aged 32 (± 10) years participated in this study. All patients were on the waiting list or had undergone shoulder instability surgery. The study was performed with a cross-sectional design and patients were examined pre-operatively, 6-month post-operatively or 7-year post-operatively. Handgrip strength measurement, active range of motion (AROM), isometric shoulder muscle strength measurement, health-related quality of life measured by Western Ontario Shoulder Instability Index (WOSI©) and shoulder function using the Constant Score were evaluated. The mean AROM in flexion for women in all groups ranged from 162° (± 16) to 169° (± 12), and for men from 157° (± 19) to 162° (± 12). The mean AROM in abduction ranged from 170° (± 25) to 177°(± 5) for women and from 177° (± 8) to 179° (± 24) for men. The mean AROM in external rotation ranged from 89° (± 14) to 95° (± 14) for women and from 83° (± 21) to 85° (± 12) for men. Men were significantly stronger and had a larger AROM on the non-injured side compared with the injured side, whereas differences were found between non-injured and injured side for women only in AROM. The scores from the WOSI© for all the patients were far from normative values suggesting that the patient's subjective experience does not fully reflect the physical examination. The results from the present study can guide the physiotherapist to give patients realistic expectations of shoulder function concerning AROM and muscle strength.
    Advances in Physiotherapy 02/2012; 14(1). DOI:10.3109/14038196.2012.660988
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Rotator cuff tear is a common problem either after trauma or after degenerative tear in old age group. Arthroscopic repair is the current concept of rotator cuff repair. Here, we are trying to evaluate the functional outcome after arthroscopic repair of full thickness rotator cuff tear (single row) in Indian population. Materials and methods Twenty five patients (14 males and 11 females) who underwent arthroscopic repair of full thickness rotator cuff tear at a single institution were included in the study. Postoperatively patient's shoulder was rated according to UCLA score, pain was graded according to the visual analog score. The range of motion was analysed and documented. Results The mean age of the patients were 50.48 years. The preoperative VAS score mode was 7 and post operative VAS was 1 (p value <0.001). The UCLA grading was good in 80% (n = 20), fair in 12% (n = 3), excellent in 8% (n = 2) and poor results were seen in none of the patients. The mean UCLA improved from a score of 15.84 to 30.28 with a p value <0.001. Mean postoperative forward flexion was 161.6°, mean abduction was 147.6° and mean external rotation was 45.4°. Conclusion Arthroscopic repair is a good procedure for full thickness rotator cuff tear with minimal complications. The newer double row repair claims to be biomechanically superior with faster healing rates without functional advantages, hence we used a single row repair considering the Indian population and the cost effectiveness of the surgery with good to excellent results.
    06/2014; DOI:10.1016/j.jcot.2014.05.008

Full-text (2 Sources)

Available from
Jun 5, 2014