Effects of exercise therapy for the treatment of symptomatic full-thickness supraspinatus tears on in vivo glenohumeral kinematics

• Published in: Journal of shoulder and elbow surgery Vol. 25; no. 4; pp. 641 - 649
• Main Authors: Miller, R. Matthew, Popchak, Adam, Vyas, Dharmesh, Tashman, Scott, Irrgang, James J., Musahl, Volker, Debski, Richard E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2016
• Subjects: Adult; Biomechanical Phenomena; biomechanics; Exercise Therapy; Female; glenohumeral joint; Humans; Joint Instability - diagnostic imaging; Joint Instability - physiopathology; Joint Instability - therapy; kinematics; Male; Middle Aged; Muscle Strength; Orthopedics; Prognosis; Radiostereometric Analysis; Rotator Cuff - diagnostic imaging; Rotator Cuff - physiopathology; Rotator Cuff Injuries; rotator cuff tear; Shoulder; Shoulder Joint - diagnostic imaging; Shoulder Joint - physiopathology; Tendon Injuries - diagnostic imaging; Tendon Injuries - physiopathology; Tendon Injuries - therapy; glenohumeral joint; exercise therapy; rotator cuff tear; Shoulder; Basic Science Study; kinematics; biomechanics; Kinesiology
• ISSN: 1058-2746; 1532-6500; 1532-6500
• DOI: 10.1016/j.jse.2015.08.048

The high incidence of rotator cuff disease combined with high failure rates for nonoperative treatment of full-thickness rotator cuff tears underlines the importance of improving nonoperative management of rotator cuff tears. The study objective was to assess changes in in vivo glenohumeral kinematics of patients with a symptomatic full-thickness supraspinatus tear before and after a 12-week exercise therapy program. It was hypothesized that successful exercise therapy would result in improved kinematics (smaller translations and increased subacromial space). Five patients were recruited for the study and underwent dynamic stereoradiography analysis before and after a 12-week exercise therapy protocol to measure changes in glenohumeral joint translations and subacromial space during coronal plane abduction. Strength and patient-reported outcomes (American Shoulder and Elbow Surgeons; Disabilities of the Arm, Shoulder and Hand; Western Ontario Rotator Cuff Index) were also evaluated. After therapy, no subject went on to receive surgery. It was found that the contact path length of the humerus translating on the surface of the glenoid was reduced by 29% from 67.2% ± 36.9% glenoid height to 43.1% ± 26.9% glenoid height (P = .036) after therapy. Minimum acromiohumeral distance showed a small increase from 0.9 ± 0.6 mm to 1.3 ± 0.8 mm (P = .079). Significant improvements in strength and patient-reported outcomes were also observed (P < .05). Successful exercise therapy for treatment of small full-thickness supraspinatus tears results in improvements in glenohumeral joint kinematics and patient-reported outcomes through increases in rotator cuff muscle strength and joint stability. This study may enable identification of prognostic factors that predict the response of a patient with a rotator cuff tear to exercise therapy.