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

Birgitte Hede Christensen, Kathrine Skov Andersen, Sten Rasmussen, Elizabeth Lykholt Andreasen, Lotte Mejlvig Nielsen, Steen Lund Jensen, Birgitte Hede Christensen, Kathrine Skov Andersen, Sten Rasmussen, Elizabeth Lykholt Andreasen, Lotte Mejlvig Nielsen, Steen Lund Jensen

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Trial registration: This study is approved by The National Committee on Health Research Ethics (N-20120040) and registered retrospectively at ClinicalTrials.gov in April 2016 ( NCT02740946 ).

Keywords: Conservative management; Exercise therapy; Rehabilitation; Rotator cuff rupture; Tendon injuries.

Figures

Fig. 1
Fig. 1
Exercises protocol. a-d shows the exercises for m. deltoideus anterior in different stages. First with external support (a), then changes in the starting position and thereby the load and gravity of the exercise (c-d) and finally external weight could be applied. From the positions illustrated the patients performed flexion. e-f shows the exercises for m. teres minor again challenging the patient by changing the starting position and adding external load. From the positions illustrated the patient performed external rotation. Consent to the use of the images has been obtained from the subject
Fig. 2
Fig. 2
Scores on the Oxford Shoulder Score from baseline, 3 and 5 months. Data are presented as mean and standard deviations. * significant difference from baseline. ϯ significant difference from 3 months

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