title: Effects of Rotator Cuff Pathology and Physical Therapy on In Vivo Shoulder Motion and Clinical Outcomes in Patients With a Symptomatic Full-Thickness Rotator Cuff Tear.
abstract: BACKGROUND
  Physical therapy (PT) is often prescribed for patients with rotator cuff tears. The extent to which PT influences strength, range of motion (ROM), and patient-reported outcomes has been studied extensively, but the effect of PT on in vivo joint kinematics is not well understood.
  
  
  OBJECTIVE
  To assess the influence of symptomatic rotator cuff pathology and the effects of PT on shoulder motion, strength, and patient-reported outcomes.
  
  
  METHODS
  Controlled laboratory study.
  
  
  METHODS
  Twenty-five patients with a symptomatic rotator cuff tear and 25 age-matched asymptomatic control subjects were recruited. Shoulder motion was measured using a biplane radiography imaging system, strength was assessed with a Biodex dynamometer, and patient-reported outcomes were assessed using the Western Ontario Rotator Cuff Index and visual analog scale (VAS) pain scores. Data were acquired from the patients before and after 8 weeks of physical therapy. Data were acquired at 1 time point for the control subjects.
  
  
  RESULTS
  Compared with the control subjects, patients with a symptomatic rotator cuff tear had significantly worse pain/function scores (P< .01); less ROM (P< .01); lower abduction (ABD), external rotation (ER), and internal rotation (IR) strength (P< .01); less scapulothoracic posterior tilt (P= .05); and lower glenohumeral joint elevation (P< .01). Physical therapy resulted in improved pain/function scores (P< .01), increased ROM (P< .02), increased scapulothoracic posterior tilt (P= .05), increased glenohumeral joint elevation (P= .01), and decreased acromiohumeral distance (AHD) (P= .02).
  
  
  CONCLUSIONS
  Compared with age-matched controls, patients had worse pain/function scores, less ROM, and lower ABD, ER, and IR strength. Patients also had less scapulothoracic anteroposterior tilt, less glenohumeral joint elevation, and an altered glenohumeral joint contact path. PT resulted in improved pain/function scores, increased ROM, greater posterior scapulothoracic tilt, increased glenohumeral joint elevation, an increased range of superoinferior joint contact, and a lower mean AHD. Of these differences, PT only returned scapulothoracic tilt to control levels.
  
  
  CONCLUSIONS
  This study documents the effects of PT on shoulder motion and conventional clinical outcomes. It is expected that understanding how changes in joint motion are associated with conventional clinical outcomes will lead to improved nonoperative interventions for patients with rotator cuff tears.
authors.affiliation: Bone and Joint Center, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Baumer
authors.affiliation: Department of Physical Therapy, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Derek
authors.initials: D
authors.lastname: Chan
authors.affiliation: Bone and Joint Center, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Veronica
authors.initials: V
authors.lastname: Mende
authors.affiliation: Bone and Joint Center, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Jack
authors.initials: J
authors.lastname: Dischler
authors.affiliation: Bone and Joint Center, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Roger
authors.initials: R
authors.lastname: Zauel
authors.affiliation: Department of Radiology, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Marnix
authors.initials: M
authors.lastname: van Holsbeeck
authors.affiliation: Department of Radiology, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Siegal
authors.affiliation: Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: George
authors.initials: G
authors.lastname: Divine
authors.affiliation: Department of Orthopaedic Surgery, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Moutzouros
authors.affiliation: Bone and Joint Center, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bey
keywords: biomechanics of tendon; motion analysis/kinesiology; physical therapy/rehabilitation; rotator cuff; shoulder