Rotator Cuff Surgery: Post Rehab ROM and Recovery of Function. Letter to Editor on a Research on Range of Motion Recovery Post Rotator Cuff Repair.
My letter is first the summary of research is below. March 8, 2010 Jerry wrote:
Dear Ortho Super Site
Fascinating findings. I wonder if it is my failure and that of my profession (Physical Therapy), failure to fully restore motion. The body can readily compensate, and make fools of me readily. I have every confidence that this study reduced compensation such as throughout the trunk, etc. whenever one goes to surgery such as for a torn rotator cuff, I ponder "where did the rest of tre insulting energy dissipate?" As the shoulder is inextricably linked with the rest of the body, treating the whole to help the part seems reasonable. I once had a reduction of left shoulder flexion and traced it to a non-painful inferior fixation of the 7th rib anteriorly. Restoring superior glide, perhaps by resolving long-term intercostal muscle guarding restored full shoulder flexion. Another easy example would be, leg length inequality provoking pelvic asymmetry and altering length-tension of the latissimus dorsi that connects shoulder to pelvis. Many other relations exist, such as loss of the small albeit relevant accessory motions such as in the AC and SC joints, scapular mobility, thoracic spine extension coupled with shoulder elevation, etc. Restoring them has much to do with muscle function and overall motion, given that they are inextricably linked, especially via the neural articular elements: mechanoreceptors Type I, II, III, IV, in which ligament and capsule tension and movement contributes to modulation of muscle function. Thank you for a remarkable study which perhaps serves as a wake up call to rehab professionals who participate in the post operative care.
Sincerely Yours,
Jerry Hesch, MHS, PT
Posted on the ORTHO SuperSite March 8, 2010
Shoulder strength, not function, fully restored after surgery, study says
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NEW ORLEANS — Shoulder motion, when compared to the patient's opposite shoulder, remains significantly different after rotator cuff surgery, according to an orthopedic investigator.
The findings presented also point toward shoulder strength being restored, according to Michael Bey, PhD, who spoke at the 56th Annual Meeting of the Orthopaedic Research Society, here.
3-D view
Bey and his colleagues at the Henry Ford Hospital used X-rays providing a 3-D view of motion to assist them in comparing the shoulder motion of 14 patients who had arthroscopic surgical repair of tendon tears. A key requirement for patients to be involved in the surgery was an opposite shoulder that showed no signs of difficulty.
The investigators analyzed the motion of both shoulders at 3, 12 and 24 months after surgery, looking for differences in motion and strength.
“We found that the motion pattern of the repaired shoulder is significantly different than the patient's opposite shoulder,” Bey stated in a release. “These differences in shoulder motion seem to persist over time in some patients.”
Shoulder strength
Bey pointed out in his presentation, however, that while shoulder motion may be impacted shoulder strength was found to return to normal with time.
“The data certainly seems to suggest that shoulder strength improves over time after surgery,” Bey told Orthopedics Today. “A precautionary notice, though, is that there is a wide range of outcomes.”
Bey also noted that the findings could point toward normal shoulder motion not being absolutely necessary for a satisfactory clinical outcome, as patients expressed their satisfaction after no longer experiencing shoulder pain.
· Reference:
Bey M, Kline S, Ciarelli K, et al. In-vivo joint mechanics, shoulder strength, and their interaction after rotator cuff repair: 2-year follow-up. Paper 77. Presented at the 56th Annual Meeting of the Orthopaedic Research Society. March 6-9, 2010. New Orleans.
Dear Ortho Super Site
Fascinating findings. I wonder if it is my failure and that of my profession (Physical Therapy), failure to fully restore motion. The body can readily compensate, and make fools of me readily. I have every confidence that this study reduced compensation such as throughout the trunk, etc. whenever one goes to surgery such as for a torn rotator cuff, I ponder "where did the rest of tre insulting energy dissipate?" As the shoulder is inextricably linked with the rest of the body, treating the whole to help the part seems reasonable. I once had a reduction of left shoulder flexion and traced it to a non-painful inferior fixation of the 7th rib anteriorly. Restoring superior glide, perhaps by resolving long-term intercostal muscle guarding restored full shoulder flexion. Another easy example would be, leg length inequality provoking pelvic asymmetry and altering length-tension of the latissimus dorsi that connects shoulder to pelvis. Many other relations exist, such as loss of the small albeit relevant accessory motions such as in the AC and SC joints, scapular mobility, thoracic spine extension coupled with shoulder elevation, etc. Restoring them has much to do with muscle function and overall motion, given that they are inextricably linked, especially via the neural articular elements: mechanoreceptors Type I, II, III, IV, in which ligament and capsule tension and movement contributes to modulation of muscle function. Thank you for a remarkable study which perhaps serves as a wake up call to rehab professionals who participate in the post operative care.
Sincerely Yours,
Jerry Hesch, MHS, PT
Posted on the ORTHO SuperSite March 8, 2010
Shoulder strength, not function, fully restored after surgery, study says
Submit a Comment
NEW ORLEANS — Shoulder motion, when compared to the patient's opposite shoulder, remains significantly different after rotator cuff surgery, according to an orthopedic investigator.
The findings presented also point toward shoulder strength being restored, according to Michael Bey, PhD, who spoke at the 56th Annual Meeting of the Orthopaedic Research Society, here.
3-D view
Bey and his colleagues at the Henry Ford Hospital used X-rays providing a 3-D view of motion to assist them in comparing the shoulder motion of 14 patients who had arthroscopic surgical repair of tendon tears. A key requirement for patients to be involved in the surgery was an opposite shoulder that showed no signs of difficulty.
The investigators analyzed the motion of both shoulders at 3, 12 and 24 months after surgery, looking for differences in motion and strength.
“We found that the motion pattern of the repaired shoulder is significantly different than the patient's opposite shoulder,” Bey stated in a release. “These differences in shoulder motion seem to persist over time in some patients.”
Shoulder strength
Bey pointed out in his presentation, however, that while shoulder motion may be impacted shoulder strength was found to return to normal with time.
“The data certainly seems to suggest that shoulder strength improves over time after surgery,” Bey told Orthopedics Today. “A precautionary notice, though, is that there is a wide range of outcomes.”
Bey also noted that the findings could point toward normal shoulder motion not being absolutely necessary for a satisfactory clinical outcome, as patients expressed their satisfaction after no longer experiencing shoulder pain.
· Reference:
Bey M, Kline S, Ciarelli K, et al. In-vivo joint mechanics, shoulder strength, and their interaction after rotator cuff repair: 2-year follow-up. Paper 77. Presented at the 56th Annual Meeting of the Orthopaedic Research Society. March 6-9, 2010. New Orleans.
