Article

The increasing demand for rotator cuff (RC) repair patients to return
to work as soon as they are physically able has led to exploration of when this
is feasible. Current guidelines from our orthopedic surgery clinic recommend a
return to work at 9 weeks postoperation. To more fully define capacity to return
to work, the current study was conducted using a unique series of quantitative
tools. To date, no study has combined 3-dimensional (3D) motion analysis with
electromyography (EMG) assessment during activities of daily living (ADLs),
including desk tasks, and commonly prescribed rehabilitation exercise. OBJECTIVE:
To apply a quantitative, validated upper extremity model to assess the kinematics
and muscle activity of the shoulder following repair of the supraspinatus RC
tendon compared to that in healthy shoulders.
DESIGN: A prospective,
cross-sectional comparison study. SETTING: All participants were evaluated during
a single session at the Medical College of Wisconsin Department of Orthopaedic
Surgery's Motion Analysis Laboratory. PARTICIPANTS:
Ten participants who were
9-12 weeks post-operative repair of a supraspinatus RC tendon tear and 10
participants with healthy shoulders (HS) were evaluated. METHODS: All
participants were evaluated with 3D motion analysis using a validated upper
extremity model and synchronized EMG. Data from the 2 groups were compared using
multivariate Hotelling T2 tests with post hoc analyses based on Welch t-tests.
MAIN OUTCOME MEASUREMENTS: Participants' thoracic and thoracohumeral joint
kinematics, temporal-spatial parameters, and RC muscle activity were measured by
applying a quantitative upper extremity model during 10 ADLs and 3 rehabilitation
exercises. These included tasks of hair combing, drinking, writing, computer
mouse use, typing, calling, reaching to back pocket, pushing a door open, pulling
a door closed, external rotation, internal rotation, and rowing. RESULTS: There
were significant differences of the thoracohumeral joint motion in only a few of
the tested tasks: comb maximal flexion angle (P = .004), pull door
internal/external rotation range of motion (P = .020), reach abduction/adduction
range of motion (P = .001), reach flexion/extension range of motion (P = .001),
reach extension minimal angle (P = .025), active external rotation maximal angle
(P = .012), and active external rotation minimal angle (P = .004). The thorax
showed significantly different kinematics of maximal flexion angle during the
call (P = .011), mouse (P = .007), and drink tasks (P = .005) between the 2
groups. The EMG data analysis showed significantly increased subscapularis
activity in the RC repair group during active external rotation. CONCLUSIONS:
Although limited abduction was expected due to repair of the supraspinatus
tendon, only a single ADL (reaching to back pocket) had a significantly reduced
abduction range of motion. Thoracic motion was shown to be used as a compensatory
strategy during seated ADLs. Less flexion of the thorax may create passive
shoulder flexion at the thoracohumeral joint in efforts to avoid active flexion.
The RC repair group participants were able to accomplish the ADLs within the same
time frame and through thoracohumeral joint kinematics similar to those in the
healthy shoulder group participants. In summary, this study presents a
quantification of the effects of RC repair and rehabilitation on the ability to
perform ADLs. It may also point to a need for increased rehabilitation focus on
either regaining external rotation strength or range of motion following RC
repair to enhance recovery and return to the workforce.
LEVEL OF EVIDENCE: III.
CI - Copyright (c) 2017 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS