Klintberg Ingrid Hultenheim, Gunnarsson Ann-Christine, Svantesson Ulla, Styf Jorma, Karlsson Jòn
Department of Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
Clin Rehabil. 2009 Jul;23(7):622-38. doi: 10.1177/0269215509102952. Epub 2009 May 29.
To describe the clinical changes following two different physiotherapy treatment protocols after rotator cuff repair.
A prospective, randomized pilot study with a two-year follow-up.
Five women and nine men, 55 (40-64) years old, were included.
The progressive group (n = 7) started with dynamic, specific muscle activation of the rotator cuff the day after surgery as well as passive range of motion. After four weeks of immobilization the loading to the rotator cuff increased and in a progressive manner throughout the rehabilitation. In the traditional group (n = 7) the rotator cuff was protected from loading. Patients were immobilized for six weeks and started with passive range of motion the day after surgery. No specific exercises to the rotator cuff were introduced during this period.
A clinical evaluation was made preoperatively, 3, 6, 12 and 24 months after surgery. Pain rating during activity and at rest, patient satisfaction, active range of motion and muscle strength, Constant score, hand in neck, hand in back and pour out of a pot, as well as Functional Index of the Shoulder were used.
At two years follow-up, the progressive group and traditional group scored pain during activity visual analogue scale (VAS) 2/0 mm and pain at rest 0/0 mm, respectively. The groups attained 170/175 degrees in active abduction in standing and 70/90 degrees in passive external rotation while lying in supine. Using Constant score, the groups attained 82/77 points respectively.
The present study showed that the progressive protocol produced no adverse effects compared with the traditional protocol.
描述肩袖修复术后两种不同物理治疗方案后的临床变化。
一项为期两年随访的前瞻性随机试点研究。
纳入了5名女性和9名男性，年龄55（40 - 64）岁。
渐进组（n = 7）术后第一天开始进行肩袖动态、特定肌肉激活以及被动活动范围训练。固定四周后，肩袖的负荷逐渐增加，且在整个康复过程中呈渐进性增加。传统组（n = 7）的肩袖避免负荷。患者固定六周，术后第一天开始进行被动活动范围训练。在此期间未进行针对肩袖的特定锻炼。
术前、术后3、6、12和24个月进行临床评估。使用活动和休息时的疼痛评分、患者满意度、主动活动范围和肌肉力量、Constant评分、手摸颈、手摸背和从壶中倒水动作，以及肩部功能指数。
在两年随访时，渐进组和传统组活动时疼痛的视觉模拟量表（VAS）评分分别为2/0 mm和休息时疼痛0/0 mm。两组站立位主动外展分别达到170/175度，仰卧位被动外旋分别达到70/90度。使用Constant评分，两组分别达到82/77分。
本研究表明，与传统方案相比，渐进方案没有产生不良影响。
