Mentoring Minutes: Exercises for Post Op Rotator Cuff Repair

Source:

A Systematic Review of Electromyography Studies in Normal Shoulders to Inform Postoperative Rehabilitation Following Rotator Cuff Repair Journal of Orthopaedic; Sports Physical Therapy 2017 47:12, 931-944 

Notes:

  • This review identified passive and active-assisted exercises that may beappropriate in the early stages after rotator cuff repair

  • Investigate EMG activity during shoulder exercises to identify those with < 15% MVIC to limit excessive loading in early postoperative stages because retears in the first 3-6 months can be up to

  • A successful outcome after surgery often depends on the size of the tear; tissue quality; the location, type, and chronicity of the tear; previous and/or concomitant surgery; and individual patient factors such as smoking, body mass, and physical activity

  • Used 20 studies (out of 2000)- included 43 different passive or active assisted exercises, and limited it to 9 that met cut off for loading supra and infra under 15%;

  • The bulk of passive ROM exercises demonstrated activation levels below the cutoff, and active-assisted exercises using the asymptomatic limb to move the operated limb also generated low-level activation in both the supraspinatus and infraspinatus. However, active-assisted exercises using a bar or a pulley to elevate the operated limb tended to generate over 15% MVIC, suggesting that their use early in rehabilitation may be inappropriate. The pendulum exercise, a passive exercise commonly employed early in rehabilitation, demonstrated low levels of supraspinatus and infraspinatus activation, suggesting that it may be appropriate for inclusion as an early-stage exercise after rotator cuff repair. However, it has been shown that incorrectly performed pendulums, especially large pendulums, generated more supraspinatus muscle activity in the shoulder than smaller, correctly performed pendulum exercises

  • Supine and incline press-ups did not generate muscle activation levels above our cutoff of 15% MVIC, 

  • Supra: Bar assisted ER (supine or stand), wall assisted ER; supine press up (opp arm assist) , washcloth press up (hands close apart); towel slides (flex, scap); pendulums (small); prone scap retraction; scap protraction on ball

  • Infra: forward bow, towel slides, scap protraction on ball, supine self assisted; prone scap retract, washcloth press up (hands close apart), pendulums, supine bar assisted ER.

Prevalence

Screen+Shot+2018-10-24+at+8.01.30+PM.jpg
  • Primary shoulder dislocate peaks in the second and sixth decade

  • 98% of cases, shoulder displaces anteriorly

  • 2% of cases, shoulder displaces posteriorly

  • 95% of first-time shoulder dislocations result from either a forceful collision, falling on an outstretched arm or a sudden wrenching movement

  • 5% of dislocations have an atraumatic origin (minor incidents such as raising the arm or moving during sleep

  • 70% of people who have dislocated can expect to dislocate again within 2 years of the initial injury

  • Younger and older subjects have a comparable incidence of primary shoulder dislocation

  • Incidence of recurrent dislocation is much more frequent in adolescent population

  • Dislocation reported to recur in:

    • 66% to 100% of people aged 20 years or under

    • 13% to 63% of people aged between 20 and 40 years old

    • 0% to 16% of people aged 40 years or older