The Effects of Physiotherapy on the ROM of Rotary Cuff Repair
Introduction
Rotator cuff injuries (RCI) are those that have a direct
impact on shoulder range of motion (ROM) (Houck et al. 2017). Individuals with
rotator cuff related injuries have trouble with abduction and flexion of the
shoulder (Houck et al. 2017). RCI can be divided into two categories; partial
and complete tears (Zhang et al. 2017). In a partial tear the tear is either on
the synovial-side or bursal-side (Zhang et al. 2017). Complete tears can be
separated into transverse or longitudinal tears (Zhang et al. 2017). Pain can
result from a shoulder abduction of 70-120 degrees. If left untreated RCI can
reduce the overall quality of one’s life.
There remains a debate of which rehabilitative method works
best at improving overall range of motion after arthroscopic repair. The ever-growing
cost in medical expenses makes rehabilitations options such as physical therapy
out of reach for many without healthcare. Other options include independent
home exercise prescribed by a physical therapist or rehabilitation professional
(Poala J. 2013). This method would allow for a patient to schedule fewer
in-patient appointments with a physical therapist while working independently
on rehabilitation rotator cuff exercises at home reducing overall medical cost.
The
purpose of this study is to identify the most effective physical therapy
rehabilitation methods on the ROM of rotary cuff repair patients.
Studies
used in this researched met the inclusion criteria if they were published no
earlier than 2013 or later. It includes only studies dealing with
physiotherapy. It includes only studies whose subjects sustained rotary cuff
injury. Includes only studies written in English. Including only studies that
take place in rehabilitation settings. Database used for research was Cal U
Manderino Library and Google Scholar. Words search included; physiotherapy.
Rotator cuff repair, physical therapy.
Di Paola, John (2013) Limited physical
therapy utilization protocol
does
not affect impairment and disability in Workers’ Compensation patients after
rotator cuff repair:
a
short-term follow-up study. J Shoulder
Elbow Surgery
John Di
Paola is an Orthopedic Surgeon who founded Occupational Orthopedics, a company
that provides healthcare to injured workers. Dr. Di Paola attended Oregon
Health Science University and performed two years of residency training in
General Surgery and four years of additional Orthopedic surgery residency. Dr.
Di Paola has spoken at numerous regional and national meetings, teaching other
specialist about treating injured workers. Dr. Di Paola grew his passion of
treating the working class from being a blue color worker himself while paying
for medical school.
Dr. Di
Paola’s study, Limited physical therapy
utilization protocol does not affect impairment and disability in Workers
Compensation patients after rotator cuff repair, researches the effects of
independent rehabilitation protocol on impairment rate after rotator cuff
repair. This study is of much relevance to the topic that I have chosen for my
research paper because it gives insight to the effects of different methods of
physical therapy on patients with rotator cuff repairs. Dr. Di Paola’s study followed
71 post rotator cuff repair patients serrating into two groups. Group A
consisted of patients who would use traditional physical therapy rehabilitation
methods in order to increase range of motion and decrease impairment. Group B
consisted of patients prescribed with an independent rehabilitation program
where they were given exercise to work on at home. By using both a
observational group and controlled group the author allows himself the ability
to compare groups and determine whether his hypothesis is indeed accurate or
not. The study proves that use of an independent rehabilitation program
produced a reduction in physical therapy utilization without any negative
effects on impairment or disability rate. This initial study by Dr. Di Paola
proves that independent rehabilitation programs can be efficient and effective
at improving ROM of patients with rotator cuff repair.
Zhang, J., Bai, D, Yang, J., Luan Y, Zhao,
C. (2017) Early motion versus immobilization for arthroscopic repair in the
treatment of large size rotator cuff tears. Biomedical
Research
The purpose
of the study by Zhang et. Al (2017) was to study the differences in effects of
different rehabilitation methods on patients with rotator cuff repairs. This
relevant to my research because it gives significant data on the effects of traditional
physical therapy methods versus independent rehabilitation methods. One hundred
thirty-two rotator cuff tear cases were collected and divided into two group. By
using a large number of patients, the author can determine the reliability and
accuracy of the study. The observational group, consisting of sixty-six
patients, started exercises twenty-four hours post-surgery while the controlled
group stayed immobilized. The study
concluded that early mobilization decreases the likelihood of stiffness after
rotator cuff repair.
Pitulainen, K., Hakkinen, A., Salo, P. (2014) Does adding
a 12-month exercise programme to usual care after a rotator cuff repair effect
disability and quality of life at 12 months? A randomized controlled trial. Clinical Rehabilitation
The purpose of this study is to
compare 12 months of independent home-based program with traditional clinical
physical therapy. This study is directly related to my research paper because
it compares different methods of physical therapy and its effects on rotator
cuff repairs. Sixty-seven, patients, whose average age was fifty-four, were
separated into a experimental group and usual care group. The experimental
group was given home muscle strengthening exercises to perform over the course
of twelve months while the usual care group saw a physical therapist for twelve
months. The study concluded that both the home strengthening exercise and usual
care program were equally as effective at improving disability and quality of
life. In comparison with Dr. Di Paola’s study earlier reviewed, both the
findings of Di Paola and Pitulainen agree that an independent
rehabilitation program is just as effective as in-patient clinical physical
therapy.
Conclusion
u
Reference
Houck, D. A,
Kraeutler, M. J, Schuette H. B, McCarty, E. C, Bravman, J. T. (2017) Early
Versus Delayed Motion After Rotator Cuff Repair. Clinical Sports Medicine Update.
Poala,
J. D. (2013) Limited physical therapy utilization protocol does not affect
impairment and disability in workers’ compensation patients after rotator cuff
repair: a short-term follow-up study. Journal
of Shoulder and Elbow Survey
Zhang J. Bai, D,
Yang, J, Luan, Y, Zhao, C (2017) Early motion versus immobilization for
arthroscopic repair in the treatment of large size rotator cuff tears. Biomedical Research
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