RESUMEN
This study compared the clinical outcomes following mini-open rotator cuff repair (MORCR) between early mobilisation and usual care, involving initial immobilisation. In total, 189 patients with radiologically-confirmed full-thickness rotator cuff tears underwent MORCR and were randomised to either early mobilisation (n = 97) or standard rehabilitation (n = 92) groups. Patients were assessed at six weeks and three, six, 12 and 24 months post-operatively. Six-week range of movement comparisons demonstrated significantly increased abduction (p = 0.002) and scapular plane elevation (p = 0.006) in the early mobilisation group, an effect which was not detectable at three months (p > 0.51) or afterwards. At 24 months post-operatively, patients who performed pain-free, early active mobilisation for activities of daily living showed no difference in clinical outcomes from patients immobilised for six weeks following MORCR. We suggest that the choice of rehabilitation regime following MORCR may be left to the discretion of the patient and the treating surgeon.
Asunto(s)
Ambulación Precoz , Lesiones del Manguito de los Rotadores , Manguito de los Rotadores/cirugía , Traumatismos de los Tendones/cirugía , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Cuidados Posoperatorios/métodos , Rango del Movimiento Articular , Articulación del Hombro/fisiopatología , Dolor de Hombro/etiología , Dolor de Hombro/cirugía , Traumatismos de los Tendones/fisiopatología , Traumatismos de los Tendones/rehabilitación , Resultado del TratamientoRESUMEN
UNLABELLED: Comparisons of outcomes after rotator cuff repair between Worker's Compensation Board (WCB) recipients and nonrecipients generally do not consider patient, injury, and shoulder characteristics. We compared preoperative differences between WCB recipients and nonrecipients and determined the impact on their 6-month postoperative outcome. We evaluated a prospective cohort of 141 patients with full-thickness rotator cuff tears, 36 of whom (26%) were WCB recipients, preoperatively and 3 and 6 months after rotator cuff repair. Their mean age was 54.0 +/- 10.4 years (standard deviation) and 102 (72%) patients were male. Shoulder range of motion, Western Ontario Rotator Cuff (WORC) index, and American Shoulder and Elbow Surgeons' score were used to evaluate outcomes. We performed regression analyses to control for baseline differences in age, baseline scores, smoking status, symptom duration, injury type, and associated biceps disorder between WCB recipients and nonrecipients. WCB recipients were younger and more likely to smoke, have a traumatic injury, and undergo surgery within 6 months of injury. WCB recipients had lower recovery for all outcomes when these differences were not considered but when differences were accounted for, only 6-month WORC scores were lower in WCB recipients. Clinicians should consider preoperative characteristics before concluding WCB recipients experience less recovery after surgical repair. LEVEL OF EVIDENCE: Level I, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Asunto(s)
Artroscopía/estadística & datos numéricos , Lesiones del Manguito de los Rotadores , Indemnización para Trabajadores , Adulto , Factores de Edad , Femenino , Humanos , Modelos Lineales , Masculino , Persona de Mediana Edad , Análisis Multivariante , Ontario , Satisfacción del Paciente , Pronóstico , Rango del Movimiento Articular , Manguito de los Rotadores/cirugía , Rotura , Articulación del Hombro/fisiopatología , Resultado del TratamientoRESUMEN
OBJECTIVE: Surface and intramuscular electromyography was used to investigate shoulder muscle activity in subjects with multidirectional instability (MDI). METHODS: Subjects (seven MDI, 11 control) performed repetitive shoulder abduction/adduction, flexion/extension and internal/external rotation movements on an isokinetic dynamometer. The activity of the deltoid, infraspinatus, supraspinatus, latissimus dorsi, and pectoralis major muscles were recorded using double-differential surface and intramuscular fine-wire electrodes. A repeated measures analysis of variance evaluated group differences in the amplitude, onset, termination and duration of the muscle activity. RESULTS: Significant activation parameter differences for the supraspinatus, infraspinatus, posterior deltoid and pectoralis major muscles were found in the subjects with MDI. The rotator cuff and posterior deltoid muscles demonstrated abbreviated periods of activity when performing internal/external rotation, despite activation amplitudes that were similar to the controls. In contrast, the activation of the pectoralis major differed from the control group in both the amplitude and time domains when performing shoulder extension. CONCLUSIONS: MDI is associated with atypical patterns of muscle activity that occur even when highly constrained movements are used to elicit the activity. SIGNIFICANCE: In addition to glenohumeral hyperlaxity, the results suggest that dysfunctional neuromuscular control of the rotator cuff is also a contributing factor to the pathoetiology of MDI.