Boland Katy, Smith Claire, Bond Helena, Briggs Sarah, Walton Julia
Upper Limb Department, Wrightington Hospital, Wigan, UK.
J Clin Orthop Trauma. 2021 Apr 18;18:13-19. doi: 10.1016/j.jcot.2021.04.007. eCollection 2021 Jul.
Rotator cuff related disorders (RCRD) are common. Exercise-based rehabilitation can improve outcomes, yet uncertainty exists regarding the characteristics of these exercises. This scoping review paper summarises the key characteristics of the exercise-based rehabilitation of rotator cuff related disorders (RCRD). An iterative search process was used to capture the breadth of current evidence and a narrative summary of the data was produced. 57 papers were included. Disagreement around terminology, diagnostic standards, and outcome measures limits the comparison of the data. Rehabilitation should utilise a biopsychosocial approach, be person-centred and foster self-efficacy. Biomedically framed beliefs can create barriers to rehabilitation. Pain drivers in RCRSD are unclear, as is the influence of pain during exercise on outcomes. Expectations and preferences around pain levels should be discussed to allow the co-creation of a programme that is tolerated and therefore engaged with. The optimal parameters of exercise-based rehabilitation remain unclear; however, programmes should be individualised and progressive, with a minimum duration of 12 weeks. Supervised or home-based exercises are equally effective. Following rotator cuff repair, rehabilitation should be milestone-driven and individualised; communication across the MDT is essential. For individuals with massive rotator cuff tears, the anterior deltoid programme is a useful starting point and should be supplemented by functional rehabilitation, exercises to optimise any remaining cuff and the rest of the kinetic chain. In conclusion, exercise-based rehabilitation improves outcomes for individuals with a range of RCRD. The optimal parameters of these exercises remain unclear. Variation exists across current physiotherapy practice and post-operative rehabilitation protocols, reflecting the wide-ranging spectrum of individuals presenting with RCRD. Clinicians should use their communication and rehabilitation expertise to plan an exercise-based program in conjunction with the individual with RCRSD, which is regularly reviewed and adjusted.
肩袖相关疾病（RCRD）很常见。基于运动的康复治疗可以改善治疗效果，但这些运动的特点仍存在不确定性。这篇范围综述论文总结了肩袖相关疾病（RCRD）基于运动的康复治疗的关键特征。采用迭代搜索过程来获取当前证据的广度，并对数据进行了叙述性总结。纳入了57篇论文。术语、诊断标准和结局测量方面的分歧限制了数据的比较。康复治疗应采用生物心理社会方法，以患者为中心并增强自我效能感。生物医学框架下的观念可能会给康复治疗带来障碍。RCRSD中的疼痛驱动因素尚不清楚，运动期间疼痛对治疗效果的影响也不明确。应讨论对疼痛水平的期望和偏好，以便共同制定一个可耐受且患者愿意参与的方案。基于运动的康复治疗的最佳参数仍不清楚；然而，方案应个性化且循序渐进，最短持续时间为12周。监督下的运动或家庭运动同样有效。肩袖修复后，康复治疗应以里程碑为导向并个性化；多学科团队之间的沟通至关重要。对于巨大肩袖撕裂的患者，前三角肌训练方案是一个有用的起点，应辅以功能康复、优化剩余肩袖及其他动力链部分的运动。总之，基于运动的康复治疗可改善一系列RCRD患者的治疗效果。这些运动的最佳参数仍不清楚。当前物理治疗实践和术后康复方案存在差异，反映了患有RCRD的个体范围广泛。临床医生应利用其沟通和康复专业知识，与RCRSD患者共同制定一个基于运动的方案，并定期进行审查和调整。
