title: The effect of neuromuscular electrical stimulation of the infraspinatus on shoulder external rotation force production after rotator cuff repair surgery.
abstract: BACKGROUND
  Muscle weakness, particularly of shoulder external rotation, is common after rotator cuff repair surgery. Neuromuscular electrical stimulation has been shown to be an effective adjunct in the enhancement of muscle recruitment.
  
  
  OBJECTIVE
  Shoulder external rotation peak force can be enhanced by neuromuscular electrical stimulation after rotator cuff repair surgery.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Thirty-nine patients (20 men, 19 women) who had undergone rotator cuff repair surgery were tested a mean of 10.5 days after surgery. Testing consisted of placing patients supine with the shoulder in 45 degrees of abduction, neutral rotation, and 15 degrees of horizontal adduction. Neuromuscular electrical stimulation was applied to the infraspinatus muscle belly and inferior to the spine of the scapula. Placement was confirmed by palpating the muscle during a resisted isometric contraction of the external rotators. Patients performed 3 isometric shoulder external rotation contractions with and without neuromuscular electrical stimulation, each with a 5-second hold against a handheld dynamometer. Neuromuscular electrical stimulation was applied at maximal intensity within comfort at 50 pulses per second, symmetrical waveform, and a 1-second ramp time. The 3 trials under each condition were recorded, and an average was taken. The order of testing was randomized for each patient tested. A paired samples t test was used to determine significant differences between conditions (P < .05). Each group was also divided based on age, rotator cuff tear size, number of days postoperative, and neuromuscular electrical stimulation intensity. Analysis of variance models were used to determine the influence of these variables on external rotation force production (P < .05).
  
  
  RESULTS
  Peak force production was significantly greater (P < .001) when tested with neuromuscular electrical stimulation (3.75 kg) as opposed to without neuromuscular electrical stimulation (3.08 kg) for all groups tested. There was no significant difference based on the size of the tear, age of the patient, number of days after surgery, or level of neuromuscular electrical stimulation intensity.
  
  
  CONCLUSIONS
  Peak shoulder external rotation force was significantly increased by 22% when tested with neuromuscular electrical stimulation after rotator cuff repair surgery. Neuromuscular electrical stimulation significantly increased force production regardless of the age of the patient, size of the tear, intensity of the current, or the number of days postoperative.
  
  
  CONCLUSIONS
  Neuromuscular electrical stimulation may be used concomitantly with exercises to enhance the amount of force production and potentially minimize the inhibition of the rotator cuff after repair surgery.
authors.affiliation: Massachusetts General Hospital Sports Medicine Service, Boston, MA 02215, USA. mreinold@redsox.com
authors.forename: Michael M
authors.initials: MM
authors.lastname: Reinold
authors.forename: Leonard C
authors.initials: LC
authors.lastname: Macrina
authors.forename: Kevin E
authors.initials: KE
authors.lastname: Wilk
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Dugas
authors.forename: E Lyle
authors.initials: EL
authors.lastname: Cain
authors.forename: James R
authors.initials: JR
authors.lastname: Andrews