Miller R Matthew, Popchak Adam, Vyas Dharmesh, Tashman Scott, Irrgang James J, Musahl Volker, Debski Richard E
Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, PA, USA; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, PA, USA.
Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
J Shoulder Elbow Surg. 2016 Apr;25(4):641-9. doi: 10.1016/j.jse.2015.08.048. Epub 2015 Nov 24.
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.
肩袖疾病的高发病率以及全层肩袖撕裂非手术治疗的高失败率凸显了改善肩袖撕裂非手术治疗方法的重要性。本研究的目的是评估有症状的全层冈上肌撕裂患者在进行为期12周的运动治疗计划前后，其体内盂肱关节运动学的变化。研究假设是成功的运动治疗将改善运动学（更小的平移和增加的肩峰下间隙）。
招募了5名患者参与本研究，并在为期12周的运动治疗方案前后进行动态立体放射摄影分析，以测量冠状面外展期间盂肱关节平移和肩峰下间隙的变化。还评估了力量和患者报告的结果（美国肩肘外科医师协会；上肢、肩部和手部功能障碍；安大略西部肩袖指数）。
治疗后，没有患者继续接受手术。研究发现，治疗后，肱骨在肩胛盂表面平移的接触路径长度从肩胛盂高度的67.2%±36.9%减少了29%，降至肩胛盂高度的43.1%±26.9%（P = 0.036）。最小肩峰肱骨头距离从0.9±0.6毫米略有增加至1.3±0.8毫米（P = 0.079）。力量和患者报告的结果也有显著改善（P < 0.05）。
成功的运动治疗可通过增加肩袖肌肉力量和关节稳定性，改善小的全层冈上肌撕裂患者的盂肱关节运动学和患者报告的结果。本研究可能有助于识别预测肩袖撕裂患者对运动治疗反应的预后因素。
