Enhanced function and quality of life following 5 months of exercise therapy for patients with irreparable rotator cuff tears - an intervention study.
Rotator 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.



Based 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.



Improvements 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.



Following 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.



This study is approved by The National Committee on Health Research Ethics (N-20120040) and registered retrospectively at ClinicalTrials.gov in April 2016 ( NCT02740946 ).
Department of Physio and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark.|Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark.
Birgitte Hede
BH
Christensen
Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark.|Department of Neurology, Region Hospital Viborg, Viborg, Denmark.
Kathrine Skov
KS
Andersen
Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark. sten.rasmussen@rn.dk.|Department of Clinical Medicine, Aalborg University, Aalborg, Denmark. sten.rasmussen@rn.dk.|Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark. sten.rasmussen@rn.dk.
Sten
S
Rasmussen
Department of Physio and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark.
Elizabeth Lykholt
EL
Andreasen
Department of Physio and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark.
Lotte Mejlvig
LM
Nielsen
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.|Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
Steen Lund
SL
Jensen
D000368:Aged; D000369:Aged, 80 and over; D001182:Arthroscopy; D002908:Chronic Disease; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D053580:Muscle Strength; D018482:Muscle, Skeletal; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D011788:Quality of Life; D016059:Range of Motion, Articular; D020127:Recovery of Function; D012189:Retrospective Studies; D017006:Rotator Cuff / Q000000981:diagnostic imaging / Q000503:physiopathology; D000070636:Rotator Cuff Injuries / Q000628:therapy*; D012785:Shoulder Joint / Q000502:physiology*; D016896:Treatment Outcome; D014463:Ultrasonography
Conservative management; Exercise therapy; Rehabilitation; Rotator cuff rupture; Tendon injuries