The Effect of Rotator Cuff Tear Size on Shoulder Strength and Range of Motion

Nicholas Institute of Sports Medicine and Athletic Trauma, Lenox Hill Hospital, New York, NY 10021, USA.
Journal of Orthopaedic and Sports Physical Therapy (Impact Factor: 3.01). 03/2005; 35(3):130-5. DOI: 10.2519/jospt.2005.35.3.130
Source: PubMed


Prospective cohort study.
To determine the effect of rotator cuff tear size on shoulder strength and range of motion.
Patients with rotator cuff pathology typically present with weakness and motion loss in various motions. The extent to which the presence of a rotator cuff tear and the size of the tear affect strength and range of motion is not well understood.
Sixty-one patients scheduled for surgery, with a diagnosis of a rotator cuff tear and/or subacromial impingement, underwent examination for shoulder pain, function, range of motion, and strength. The extent of rotator cuff pathology was documented during subsequent surgery (presence of tear, tear size, tear thickness).
There were 10 massive tears, 15 large tears, 13 medium tears, 12 small tears, and 11 rotator cuffs without a tear. Patients had marked weakness in abduction strength at 90 degrees and 10 degrees of abduction, in external rotation strength at 90 degrees, and in the "full can test" (all, P<.0001). Marked range of motion losses in shoulder flexion and external rotation at 0 degrees and 90 degrees abduction (all, P<.001) were also observed. Abduction strength deficit at 10 degrees was affected by rotator cuff tear size (P<.0001). Twenty of 25 patients with large or massive tears had deficits greater than 50%, compared with only 1 of 11 patients with no tear, 2 of 12 patients with a small tear, and 5 of 13 patients with a medium tear (P<.0001). Other strength and range of motion deficits or indices of pain and function were unaffected by tear size.
Weakness of greater than 50% relative to the contralateral side in shoulder abduction at 10 degrees of abduction was indicative of a large or massive rotator cuff tear.

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Article: The Effect of Rotator Cuff Tear Size on Shoulder Strength and Range of Motion

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    • "Supraspinatus tendon tears have a high prevalence and often affect active members of society (Reilly, Macleod, Macfarlane, Windley, & Emery, 2006; Sobel & Winters, 1996). Its consequences are most apparent during active arm abduction and elevation, expressed in pain and loss of arm force ranging from 0% to over 50% (McCabe, Nicholas, Montgomery, Finneran, & McHugh, 2005; Seida et al., 2010). "
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    ABSTRACT: The debate on the clinical and functional role of the Supraspinatus in relation to the Deltoid necessitates experimental assessment of their contributions to arm elevation. Our goal was to evaluate the responses of both muscles to increased elevation moment loading. Twenty-three healthy volunteers applied 30N elevation forces at the proximal and distal humerus, resulting in small and large glenohumeral elevation moment tasks. The responses of the Deltoid and Supraspinatus were recorded with surface and fine-wire electromyography, quantified by (EMGdistal-EMGproximal), and normalized by the summed activations (EMGdistal+EMGproximal) to RMuscle ratios. Deltoid activity increased with large elevation moment loading (RDE=.11, 95%-CI [.06-.16]). Surprisingly, there was no significant average increase in Supraspinatus activation (RSSp=.06, 95%-CI [-.08 to .20]) and its response was significantly more variable (Levene's test, F=11.7, p<.001). There was an inverse association between the responses (ß=-1.02, 95%-CI [-2.37 to .32]), indicating a potential complementary function of the Supraspinatus to the Deltoid. The Deltoid contributes to the glenohumeral elevation moment, but the contribution of the Supraspinatus is variable. We speculate there is inter-individual or intra-muscular function variability for the Supraspinatus, which may be related to the frequently reported variations in symptoms and treatment outcome of Supraspinatus pathologies.
    Human movement science 11/2013; 33(1). DOI:10.1016/j.humov.2013.08.010 · 1.60 Impact Factor
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    • "The same study showed that stopping the elevation at 90° angle resulted in falling of the arm, which proves that the activity of the supraspinatus muscle continues until reaching 90° angle and then gradually fades. Further experiments allowed the researchers to observe , on the basis of the EMG record, that in the consecutive phase of elevation the activity of the infraspinatus and teres minor muscles was increasing [18], [19], [25]. This results form the fact that external rotation of the arm is necessary for achieving the maximum physiological range of motion. "
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    ABSTRACT: The aim of this study was to assess the changes of the bioelectric activity of the selected muscles and their impact on the functioning of the shoulder joint in people with impingement syndrome. The study covered 58 subjects aged between 24 and 85, who were treated for impingement syndrome in the years 2004-2006. The average duration of the disease was 40 months. The following muscles were tested for bioelectric activity using surface myography: deltoid, supraspinatus, infraspinatus, latissimus dorsi, greater pectoral and biceps brachii on the healthy and the diseased sides. A significant drop in activity of the deltoid and the infraspinatus muscles on the diseased side was observed. The following muscles showed comparable activity on both sides: the supraspinatus, latissimus dorsi and the greater pectoral muscle. The activity of the biceps brachii muscles grew during resisted movements. The drop in the activity of the deltoid and the infraspinatus muscles on the affected side is an important factor responsible for changes of the active mobility of the shoulder and for the development of instability of the shoulder joint. A similar activity of the latissimus dorsi, greater pectoral and biceps brachii muscles on both sides indicates a development of the compensatory mechanisms and the role of those muscles in the dynamic stabilisation of the shoulder joint.
    Acta of bioengineering and biomechanics / Wroclaw University of Technology 02/2009; 11(1):37-45. · 0.89 Impact Factor
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    • "The importance of objective measurements of strength and range of motion when evaluating shoulders is evidenced by the frequency with which they are reported in the literature [2,4,6-9]. Objective assessment of strength provides information on integrity of the rotator cuff [10] and is used to gauge the recovery of muscle function following intervention [11,12]. Normative data is required for comparison to grade the extent of recovery. "
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    ABSTRACT: Different measurements are used to assess shoulder function, including range of motion, strength, functional performance and self-report function. To understand disablement, it is necessary to understand the relationship between impairments and function in persons without shoulder problems. This study was conducted to enhance existing comparative data in subjects without upper extremity pathology, and to assess the relationships between impairments (range of motion, strength) and self-reported or measured function/disability. The impact of age, gender and dominance was determined. Two-hundred ninety-four subjects with unaffected shoulders were recruited. The subjects (mean age: 37 years old) were divided into three subgroups, 18-39, 40-59, and over 60 years of age. During a single session, at least two of the following variables were measured: self-reported function (shoulder disability scales), range of motion, isometric rotational strength, or upper limb functional performance (FIT-HaNSA). Two-way analysis of variance was used to determine, for each variable, the effects of age and gender. The relationship between the outcomes was established using Pearson product correlations. Men were significantly stronger than women for all age categories. There was an age-related decline in strength in men in the over-60 age category. Significant negative correlations between strength and range of motion were demonstrated (-0.22 <r < -0.32). Women had a significantly higher range of motion than men for external rotation in the 40-59 age category. Furthermore, the subjects in the over-60 age category experienced a decrease of range of motion. There was minimal disability reported in all age groups on self-report scales. Only the Simple Shoulder Test demonstrated significant decreases in the over-60 age category and correlated with age (r = -0.202). Self-reported disability was low in individuals without upper extremity problems, although recruitment of such individuals was difficult in the older age groups due to the high prevalence of shoulder pathology. A low correlation between self-report disability and strength/range of motion in these unaffected subjects reflects the lack of disability reported by all subjects without pathology despite normal variations in strength and motion.
    Sports Medicine Arthroscopy Rehabilitation Therapy & Technology 02/2009; 1(1):4. DOI:10.1186/1758-2555-1-4
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