Search

Background: Abnormal posture is known to affect the efficacy of exercise therapy for musculoskeletal diseases. However, no studies to date have examined the effect of exercise programs should take into account the posture of the upper body in patients with rotator cuff disease. This study aimed to assess how rotator cuff and corrective exercises impact shoulder function and muscle strength post-arthroscopic rotator cuff repair surgery, providing tailored rehabilitation programs for patients with forward posture., Methods: Ninety male patients who underwent arthroscopic rotator cuff repair participated in this study. The patients were randomly divided into three groups corrective exercise group (CEG, n = 29), rotator cuff exercise group (REG, n = 27), and control group (CG, n = 28). Each group was instructed to apply different exercise programs to correct posture and enhance rotator cuff strength. All patients were checked by the American Shoulder and Elbow Surgeons (ASES) score, Constant score and muscle strength, and range of motion preoperatively and postoperatively at 6 months and 1 year., Results: ASES shoulder function scores showed significant difference between the three groups (p = 0.002, F = 7.03), indicating that the corrective exercise program was more beneficial than rotator cuff exercises (p = 0.009, F = 3.78). A significant intergroup difference in mean Constant score was also noted (p = 0.025, F = 3.86), while a statistically significant interaction between time and group was observed (p = 0.032, F = 2.96)., Conclusions: These results suggested that a corrective exercise program can improve shoulder muscle strength and function after rotator cuff repair in male patients with a forward shoulder posture., (© 2024. The Author(s).)

Background: Arthroscopic rotator cuff repair with biceps rerouting (ABR) has emerged as a reliable option for treating large posterosuperior rotator cuff tears (RCTs). This study aims to compare functional and structural outcomes of early vs. delayed motion rehabilitation protocols following ABR., Methods: A total of 101 patients with semirigid, large, posterosuperior RCTs undergoing ABR were randomized into 2 groups: group I (early motion) with 53 patients (34 females, 19 males) and group II (delayed motion) with 48 patients (31 females, 17 males). In group I, the mean age was 63.9 years (range, 46-79), and in group II, it was 65.4 years (range, 43-78). The mean follow-up periods for group I and group II were 16.2 and 15.5 months, respectively. Preoperative and postoperative assessments were conducted at 3, 6, and 12 months, with structural integrity assessed with magnetic resonance imaging at a minimum follow-up of 12 months. Statistical analyses were performed to compare outcomes between the 2 groups., Results: Both groups demonstrated significant improvements in visual analog scale score (group I: 4.0-1.6, group II: 3.7-1.4, P = .501), University of California-Los Angeles shoulder score (group I: 21.5-31.4, group II: 22.4-30.6, P = .331), and acromiohumeral interval (group I: 8.2 mm-9.1 mm, group II: 8.6 mm-9.5 mm, P = .412), with no statistically or clinically meaningful differences. Active range of movements (ROM) were not significantly different between groups, except for active forward flexion at 3 months (group I: 140.1°, group II: 119.2°, P = .006), that was not shown to be translated clinically into differences in function or healing between the groups in this study. Notably, retear rates were similar between groups (group I: 22.6%, group II: 20.8%, P = .826)., Conclusion: This study's findings reveal no clinically discernible differences in active range of motion at 1-year follow-up between patients who underwent ABR for semirigid, large, posterosuperior RCTs and were assigned to either early or delayed motion protocols. Notably, the early motion group demonstrated a plateau in maximum range of movement improvement as early as 3 months postsurgery. Based on these results, implementing an early motion protocol is recommended as an effective approach in the postoperative rehabilitation following ABR., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Rotator cuff tears are a common shoulder injury that significantly impacts patients' daily lives and work abilities. Although surgical treatment methods for rotator cuff tears have been continuously improved with advances in medical technology, postoperative rehabilitation remains challenging. Therefore, finding effective rehabilitation treatments is crucial for improving patient prognosis and enhancing quality of life. This study will aim to systematically evaluate the impact of low-intensity pulsed ultrasound (LIPUS) on postoperative rehabilitation of rotator cuff tears, comprehensively assessing the efficacy and safety of LIPUS in postoperative recovery., Methods: This protocol will search multiple databases including PubMed/MEDLINE, Embase, Cochrane Library, CNKI, Scopus, and Web of Science to identify randomized controlled trials related to LIPUS for postoperative rehabilitation of rotator cuff tears. The search will encompass literature published from the inception of the databases up to April 2024. Methodological quality assessment and data extraction will be conducted using the Cochrane Handbook for Systematic Reviews of Interventions and PRISMA guidelines. Meta-analysis will be performed on appropriate studies using either random-effects or fixed-effects models, and subgroup analyses will be conducted to explore potential heterogeneity. Studies meeting the inclusion criteria will be included in the analysis. All analyses will be performed using Stata version 16.0., Results: The incidence of rotator cuff tear rates will be assessed by imaging techniques such as MRI or ultrasound. Pain intensity will be scored using standardized pain assessment scales, such as the Visual Analog Scale (VAS). Improved range of motion (ROM) in shoulder flexion, abduction, and rotation. Functional outcomes will be evaluated using effective measures such as Constant-Murley scores (CMS) and shoulder joint scores by American Shoulder and Elbow Surgeons (ASES). Adverse events associated with LIPUS therapy, including skin irritation, increased pain, or any other complications. Subgroup analysis will also be carried out if possible., Discussion and Conclusion: Following the meta-analysis, we will assess the overall effect of LIPUS on postoperative rehabilitation of rotator cuff tears, and further explore its impact on aspects such as pain relief, functional improvement, and postoperative complications. It is anticipated that this study will provide comprehensive evidence regarding the role of LIPUS in postoperative rehabilitation of rotator cuff tears, guiding clinical practice and future research. The resultant manuscript will be submitted for publication in a peer-reviewed journal., Protocol Registration Number: CRD42024530798., Competing Interests: On behalf of all authors, we declare that we have no competing interests that could be perceived to bias this work. Specifically: Financial Support: The project was supported by the National Natural Science Foundation of China (82172423), the Bejing Municipal Natural Science Foundation (7222209), and the Clinical queue construction project of Peking University Third Hospital (BYSYDL2022006). This funding source had no role in the design of the study, the collection, analysis, or interpretation of data, the writing of the manuscript, or the decision to submit the manuscript for publication. Any other funding sources received for this work are also declared in the Funding Information section of the submission form. Non-Financial Competing Interests: None of the authors have any non-financial competing interests to disclose that could be perceived to influence the objectivity or validity of this work. This includes any affiliations, patents, products in development or marketed products, etc., that could be considered relevant to the submitted manuscript. Author Contributions: The authors have all contributed to the work in accordance with the ICMJE authorship criteria. Any conflicts of interest related to author contributions have been resolved and are not deemed to bias the research. We confirm that this statement is accurate and complete to the best of our knowledge, and any funding sources listed in the Funding Information section of the submission form are also declared in this Financial Disclosure statement., (Copyright: © 2024 Xue et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The effectiveness of telemedicine in aiding rehabilitation exercises among patients with rotator cuff (RC) disorders remains unknown. Therefore, this meta-analysis aimed to assess the effectiveness of telemedicine in patients with RC disorders., Methods: Randomized clinical trials (RCTs) on the effectiveness of telemedicine in patients with RC disorders were summarized through a meta-analysis. A systematic search for these RCTs was conducted in PubMed, Cochrane, Embase, and Web of Science databases up to July 2024. Statistical analysis was performed using Stata 16. Publication bias was estimated with the funnel plot and Egger's test., Results: Ten studies involving 497 participants (telemedicine group = 248 and conventional group = 249) were enrolled, with follow-up durations ranging from 8 weeks to 48 weeks. Functional outcomes measured by the Constant-Murley score were markedly improved after treatment in the telemedicine group compared to the conventional group. Moreover, compared to conventional treatment, telemedicine significantly improved shoulder function evaluated by Quick Disabilities of the Arm, Shoulder, and Hand Score, relieved pain assessed by visual analog scale pain score, and improved range of motion after treatment and in the final follow-up period., Conclusion: Telemedicine has demonstrated potential in alleviating pain and enhancing shoulder function and motion in patients with RC injuries. It may be a feasible intervention for rehabilitation exercises. Further research with a large sample size and standardized treatment is warranted to validate these findings., (© 2024. The Author(s).)

OBJECTIVE: To evaluate the efficacy of exercise interventions with differing frequency, intensity, type, and time (FITT) on shoulder pain and disability in people with rotator cuff-related shoulder pain (RCRSP). DESIGN: Intervention systematic review with meta-analyses. LITERATURE SEARCH: Electronic searches were conducted up to May 2023. STUDY SELECTION CRITERIA: Randomized controlled trials (RCTs) comparing the effects of exercise interventions differing in prescription according to the FITT principle, in people with RCRSP. DATA SYNTHESIS: Separate meta-analyses comparing exercise type (specific versus nonspecific exercise) and intensity (high versus low) were conducted. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to evaluate the certainty of evidence. RESULTS: Twenty-two RCTs (n = 1281) were included. There was moderate-certainty evidence that motor control exercise programs, when compared to nonspecific exercise programs, significantly reduced disability in the short (SMD: -0.29; 95% CI: -0.51, -0.07; n = 323; 7 RCTs) and medium terms (SMD: -0.33; 95% CI: -0.57, -0.09; n = 286; 5 RCTs), but not pain in the short term (SMD: -0.19; 95% CI: -0.41, 0.03; n = 323; 7 RCTs). Uncertainties remained regarding other exercise types (eccentric and scapula-focused exercise programs) versus nonspecific exercise programs, and exercise intensity due to low- to very low-certainty evidence. No trials were identified that compared different frequencies or times. CONCLUSION: For adults with RCRSP, motor control exercise programs were probably slightly superior to nonspecific exercise programs. However, it is unclear if the effects were due to motor control exercise or to other program characteristics such as progression and tailoring. J Orthop Sports Phys Ther 2024;54(8):499-512. Epub 7 June 2024. doi:10.2519/jospt.2024.12453 .

Background: There is limited consensus on the optimal time to initiate supervised physical rehabilitation after a rotator cuff repair (RCR). We examined whether timing of initiating supervised physical rehabilitation was associated with repeat RCR or development of adhesive capsulitis within 12 months postoperatively in an observational cohort of commercially insured adults., Methods: This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters Database. We included adults aged 18-64 who underwent a unilateral outpatient RCR between 2017 and 2020 and initiated supervised physical rehabilitation 1-90 days postoperatively. Multivariable logistic regression models examined the adjusted association between time of initiating supervised physical rehabilitation (1-13, 14-27, 28-41, and 42-90 days postoperatively) and each of the primary outcomes: repeat RCR and capsulitis. In a sensitivity analysis, time to rehabilitation was alternatively categorized using a data-driven approach of quartiles (1-7, 8-16, 17-30, and 31-90 days postoperatively). We report adjusted odds ratios (OR)., Results: Among 33,841 patients (86.7% arthroscopic index RCR), the median time between index RCR and rehabilitation initiation was 16 days (interquartile range 7-30), with 39.9% initiating rehabilitation at 1-13 days. Additionally, 2.2% underwent repeat RCR within 12 months, and 12-month capsulitis was identified in 1.9% of patients. There were no significant associations between timing of initiating rehabilitation and 12-month repeat RCR (OR 0.85-0.93, P = .18-.49) or 12-month capsulitis (OR 0.83-0.94, P = .22-.63). Lack of associations between timing and outcomes was supported in sensitivity analyses., Conclusions: Timing of initiating rehabilitation was not significantly associated with adverse outcomes after RCR. The finding of no increased odds of repeat RCR or capsulitis with the earliest timing may support earlier initiation of rehabilitation to accelerate return to daily activities. Findings should be replicated in another dataset of similarly-aged patients., (Copyright © 2024 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

OBJECTIVE: To summarize the FITT (frequency, intensity, time, type), components of exercise programs included in randomized controlled trials (RCTs) that compared 2 or more programs for managing rotator cuff-related shoulder pain (RCRSP). DESIGN: Scoping review. LITERATURE SEARCH: Electronic searches were conducted up to May 2023. STUDY SELECTION CRITERIA: RCTs comparing the effects of 2 or more types of exercise programs, differing in prescription according to the FITT principle, in people with RCRSP. DATA SYNTHESIS: We extracted data from each trial report so that we could answer items 1 to 10 and 13 to 15 from the Consensus on Exercise Reporting Template (CERT). Descriptive analysis of the exercise programs was performed by summarizing and presenting the FITT characteristics, and other relevant CERT characteristics (material, provider, delivery, tailoring). RESULTS: FITT characteristics from 46 exercise programs included in 22 trials were extracted. The exercise programs were divided into 4 categories (defined in accordance to the original authors' description and proposed rationale): motor control (n = 8), scapula-focused (n = 7), eccentric (n = 8), and nonspecific exercise programs (n = 28). Five programs were allocated to 2 different categories. The different program types had similar parameters. Exercise programs frequency ranged from 2 to 7 times per week, dose ranged from 1 to 3 sets and 4 to 30 repetitions per sets, and exercise program duration ranged from 4 to 16 weeks. CONCLUSION: There was considerable variability in the parameters used to prescribe exercises for RCRSP. Clinicians seeking guidance on FITT parameters derived from trials should do so cautiously because there was no one-size-fits-all approach. J Orthop Sports Phys Ther 2024;54(8):513-529. Epub 4 June 2024. doi:10.2519/jospt.2024.12452 .

Objective: This trial examines the efficacy of the pain neuroscience education on clinical outcomes in patients with arthroscopic rotator cuff repair., Design: A total of 36 participants undergoing arthroscopic rotator cuff repair were assigned to either the experimental group ( n = 18) or control group ( n = 18) in this randomized study. A 6-wk-long conventional physiotherapy program was administered for both groups. In addition, a pain neuroscience education protocol was administered for the experimental group for a whole period of 6 wks (1 session/week, 15-60 mins per session). The primary outcomes were to compare pretreatment and posttreatment scores of the experimental versus control groups on the pain and disability. Our secondary outcomes included the comparisons of scores on the catastrophizing, anxiety, depression, kinesiophobia, and quality of life. The participants were assessed both at baseline and posttreatment., Results: The improvement in pain catastrophizing, anxiety, depression, and kinesiophobia was greater in the experimental group ( P < 0.05). The improvement was similar in both groups in terms of the rest of outcome measures., Conclusions: This study showed that the pain neuroscience education improved only psychological aspects of the chronic pain in arthroscopic rotator cuff repair. Therefore, adding pain neuroscience education to the conventional program might be useful to improve pain catastrophizing, anxiety, depression, and kinesiophobia in patients with arthroscopic rotator cuff repair., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: Competing interests: None declared.

Objective: To identify tendon transfer surgeries and postsurgical physical therapy interventions in people with massive rotator cuff (RC) tears., Methods: The literature search was conducted in the MEDLINE, Science Direct, Scopus, Web of Science, and PEDro databases from inception to September 2022. Studies with patients diagnosed with massive RC tears undergoing tendon transfers that reported physical therapy interventions after surgery were included. Two reviewers pooled the data into ad hoc summary tables with the following information: authors, year, study characteristics (sample size, tendon transfer surgical used, approach type, preoperative risk, deficit addressed, additional surgical interventions), and physical therapy interventions (early stage, intermediate stage, and advanced stage)., Results: Forty-four articles (59.0% case series) were included, with a total sample of 1213 participants. The most frequently used surgery was the isolated tendon transfer of the latissimus dorsi (49.1%). Most of the studies reported three main stages of physical therapy interventions after tendon transfer surgery: early stage (lasting 5-6 weeks), intermediate stage (started at 7-12 weeks), and advanced stage (started at 12 weeks). Physical therapy interventions included passive, active-assisted, resisted therapeutic exercise, and hydrotherapy., Conclusions: The evidence regarding physical therapy interventions after RC tendon transfer surgery is limited to the number and duration of the stages and general characteristics without specifying the type and dose of the interventions. Future research with high methodological quality should integrate more detailed rehabilitation protocols to better guide therapeutic decisions after RC transfer surgery., (© 2023 American Academy of Physical Medicine and Rehabilitation.)

Background: Rotator cuff tears are prevalent shoulder injuries, significantly affecting shoulder stabilization and patient quality of life. Despite rehabilitation efforts post-arthroscopic surgery, the efficacy of scapular-focused exercises remains uncertain with limited supportive evidence., Purpose: This study aimed to compare the immediate and short-term effects of emphasizing scapulothoracic joint rehabilitation in addition to conventional physiotherapy on pain, range of motion (ROM), function, quality of life, and treatment effectiveness in patients after shoulder arthroscopic rotator cuff tendon repair (ARCR)., Study Design: Two arms, parallel-group, randomized controlled trial, with concealed allocation METHODS: This parallel-group randomized controlled trial, with concealed allocation, was conducted in a clinic setting on 28 participants aged 30-75 years, exhibiting progressive degenerative full-thickness tears of rotator cuff muscles and undergoing ARCR, provided the tear size was small or medium. Participants were randomly allocated to receive 21 sessions of conventional rehabilitation (n = 14) or comprehensive rehabilitation (with a focus on scapula training; n = 14) in 12 weeks (reporting of intervention complied with Consensus on Exercise Reporting Template (CERT) and Template for Intervention Description and Replication (TIDieR) Guideline). Pain (as primary outcome), ROM, functional disability, quality of life, and treatment effectiveness were assessed both pre- and post-intervention, along with a 3-month follow-up. Participants, assessors, and statistician were blinded to group assignment. For the reporting of the RCT, the Consolidated Standards of Reporting Trials (CONSORT) has been used., Results: Trial was completed with 28 participants and no dropouts. The analysis of variance revealed statistically significant group-by-time interaction (p < 0.05) for all outcome measures except for active ROMs (p > 0.05). Multiple comparison analysis showed statistically significant between-group differences (p < 0.05) at 3-month follow-up with large effect size (>0.8 Hedges' g) for all outcomes (mean differences: visual analog scale: 1.3, American Shoulder and Elbow Surgeons: -17.3, Shoulder Pain and Disability Index: 17.6, Western Ontario Rotator Cuff: -19.5, QuickDASH: 17.8), except for extension ROM (passive ROM: confidence interval = -25.4 to 0.56; active ROM: confidence interval = -20.0 to 6.0). The differences in American Shoulder and Elbow Surgeons and Western Ontario Rotator Cuff were also clinically significant based on their minimally clinical important difference cutoff points. For the Global Rating of Change scale, more participants stated "much improved" in the comprehensive group than in the conventional. No adverse effects were reported., Conclusions: Comprehensive rehabilitation, compared to conventional physiotherapy, has shown a statistically and clinically significant difference in improving pain, ROM, functional disability, quality of life, and treatment effectiveness in patients after ARCR., Competing Interests: Declaration of competing interest None of the authors have any financial or other interests relating to the manuscript to be submitted for publication in the Journal of Hand Therapy., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To explore the treatment experiences of those diagnosed with large to massive rotator cuff tears and the perspectives of healthcare practitioners providing their care., Design: A qualitative descriptive study using reflexive thematic analysis., Setting: In-person focus groups were undertaken in a clinical setting (private practice [ n  = 1]; public outpatient [ n  = 2]). Semi-structured interviews were conducted online via Microsoft Teams., Participants: Patients diagnosed with these tears ( n  = 12) and healthcare practitioners ( n  = 11)., Results: Two interlinking themes were identified based on the care received and provided for patients with symptomatic large to massive rotator cuff tears:1) Positive treatment experiences and management: Education, clear communication and reassurance around prognosis were the foundation of positive patient-clinician care. Sub-themes of pain relief, exercise prescription and confidence in their pathway underpinned this experience. This proficiency in care was affirmed by some healthcare practitioners who spoke about the importance of confidence and experience in their management plan even in times of poor progress.2) Negative treatment experiences and management: Uncertainty, delays and exacerbation of pain flawed the patient-clinician care. Sub-themes of inappropriate pain relief, inappropriate exercise prescription and uncertainty impacted their care. Some healthcare practitioners acknowledged knowledge gaps led to uncertainty especially when choosing the next step of care and were quick to escalate care to deflect this uncertainty., Conclusions: The findings suggest discordance exists between the patient's experiences and expectations when the delivery of care was by less experienced and confident healthcare practitioners in the management of this condition. This highlights the need for improved education and support for healthcare practitioners., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

OBJECTIVE: To assess the effect of aligning patients' preferences with specific rehabilitation delivery modes on rehabilitation outcomes. DESIGN: A secondary analysis of a randomized controlled trial. METHODS: The study cohort comprised 208 patients referred for physiotherapy rehabilitation after nonsurgical or surgical interventions for rotator cuff injury, shoulder impingement, or acromioclavicular osteoarthritis. Participants were randomly assigned to 1 of 3 rehabilitation modalities: (1) group-based exercise, (2) individual exercise, or (3) home exercise. In this study, participants were categorized into 2 groups: "matched preference" and "unmatched preference." The primary outcome measure was change in function, measured with the shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH). Secondary outcome measures were change in pain, assessed using the Numeric Rating Scale (NRS), mental well-being measured with the World Health Organization Five Well-Being Index (WHO-5), health-related quality of life assessed using the EuroQol-5 Domain questionnaire (EQ-5D), fear avoidance assessed using the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ), and overall treatment satisfaction. Outcomes were assessed at 3 and 6 months. RESULTS: The primary outcome measure, QuickDASH, showed no significant differences between groups at either 3 months (-3.0 [-8.2 to 2.3]) or 6 months (0.5 [-5.7 to 6.7]). Additionally, no significant differences were observed in the secondary outcome measures. CONCLUSION: Matching patients' preferences for specific rehabilitation delivery modes did not seem to effect rehabilitation outcomes. J Orthop Sports Phys Ther 2024;54(6):1-9. Epub 26 March 2024. doi:10.2519/jospt.2024.12314 .

Objective: We compared the effects of early and delayed rehabilitation on the function of patients after rotator cuff repair by meta-analysis to find effective interventions to promote the recovery of shoulder function., Methods: This meta-analysis was registered in PROSPERO (CRD42023466122). We manually searched the randomized controlled trials (RCTs) in the Cochrane Library, Pubmed, Cochrane Library, EMBASE, the China National Knowledge Infrastructure (CNKI), the China VIP Database (VIP), and the Wanfang Database to evaluate the effect of early and delayed rehabilitation after arthroscopic shoulder cuff surgery on the recovery of shoulder joint function. Review Manager 5.3 software was used to analyze the extracted data. Then, the PEDro scale was employed to appraise the methodological quality of the included research., Results: This research comprised nine RCTs and 830 patients with rotator cuff injuries. According to the findings of the meta-analysis, there was no discernible difference between the early rehabilitation group and the delayed rehabilitation group at six and twelve months after the surgery in terms of the VAS score, SST score, follow-up rotator cuff healing rate, and the rotator cuff retear rate at the final follow-up. There was no difference in the ASES score between the early and delayed rehabilitation groups six months after the operation. However, although the ASES score in the early rehabilitation group differed significantly from that in the delayed rehabilitation group twelve months after the operation, according to the analysis of the minimal clinically important difference (MCID), the results have no clinical significance., Conclusions: The improvement in shoulder function following arthroscopic rotator cuff surgery does not differ clinically between early and delayed rehabilitation. When implementing rehabilitation following rotator cuff repair, it is essential to consider the paradoxes surrounding shoulder range of motion and tendon anatomic healing. A program that allows for flexible progression based on the patient's ability to meet predetermined clinical goals or criteria may be a better option., Competing Interests: The authors declare there are no competing interests., (©2024 Chen et al.)

Introduction: Despite the high number of operations and surgical advancement, rehabilitation after rotator cuff repair has not progressed for over 20 years. The traditional cautious approach might be contributing to suboptimal outcomes. Our aim is to assess whether individualised (early) patient-directed rehabilitation results in less shoulder pain and disability at 12 weeks after surgical repair of full-thickness tears of the rotator cuff compared with current standard (delayed) rehabilitation., Methods and Analysis: The rehabilitation after rotator cuff repair (RaCeR 2) study is a pragmatic multicentre, open-label, randomised controlled trial with internal pilot phase. It has a parallel group design with 1:1 allocation ratio, full health economic evaluation and quintet recruitment intervention. Adults awaiting arthroscopic surgical repair of a full-thickness tear are eligible to participate. On completion of surgery, 638 participants will be randomised. The intervention (individualised early patient-directed rehabilitation) includes advice to the patient to remove their sling as soon as they feel able, gradually begin using their arm as they feel able and a specific exercise programme. Sling removal and movement is progressed by the patient over time according to agreed goals and within their own pain and tolerance. The comparator (standard rehabilitation) includes advice to the patient to wear the sling for at least 4 weeks and only to remove while eating, washing, dressing or performing specific exercises. Progression is according to specific timeframes rather than as the patient feels able. The primary outcome measure is the Shoulder Pain and Disability Index total score at 12-week postrandomisation. The trial timeline is 56 months in total, from September 2022., Trial Registration Number: ISRCTN11499185., Competing Interests: Competing interests: All authors declare support from the National Institute of Health and Care Research for the present manuscript. AM is non-executive director of the ISPOR. JLR is Past President of the British Elbow and Shoulder Society (2021-2023). SD reports education consultancy contracts with Stryker, Smith and Nephew and Arthrex for teaching and training. SD is the president of the British Elbow and Shoulder Society (2023–2025)., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Objective: The objective of this study was to describe the utilization of physical therapist and occupational therapist services after rotator cuff repair (RCR) and examine variation in rehabilitation characteristics by profession., Methods: This retrospective cohort study used the IBM MarketScan Commercial Claims and Encounters database. Eligible patients were 18 to 64 years old and had undergone outpatient RCR between 2017 and 2020. Physical therapist and occupational therapist services were identified using evaluation and treatment codes with profession-specific modifiers ("GP" or "GO"). Factors predicting utilization of formal rehabilitation and physical therapist versus occupational therapist services were examined; and univariable and multivariable analyses of days to initiate therapy, number of visits, and episode length by profession were completed., Results: Among 53,497 patients with an RCR, 81.2% initiated formal rehabilitation (93.8% physical therapist, 5.2% occupational therapist, 1.0% both services). Patients in the Northeast and West (vs the South) were less likely to receive rehabilitation (odds ratio [OR] = 0.67 to 0.70) and less likely to receive occupational therapist services (OR = 0.39). Patients living in the Midwest (versus the South) were less likely to receive rehabilitation (OR = 0.79) but more likely to receive occupational therapist services (OR = 1.51). Similarly, those living in a rural (versus urban) area were less likely to utilize rehabilitation (OR = 0.89) but more likely to receive occupational therapist services (OR = 2.21). Additionally, receiving occupational therapist instead of physical therapist services was associated with decreased therapist visits (-16.89%), days to initiate therapy (-13.43%), and episode length (-13.78%)., Conclusion: Most patients in our commercially insured cohort utilized rehabilitation services, with a small percentage receiving occupational therapist services. We identified profession-specific variation in utilization characteristics that warrants further examination to understand predictors and associated outcomes., Impact: Variation in rehabilitation utilization after RCR, including profession-specific and regional differences, may indicate opportunities to improve standardization and quality of care., (© The Author(s) 2024. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To determine the reproducibility of exercise therapy interventions in randomized controlled trials for rotator cuff-related shoulder pain (RCRSP)., Data Sources: Data sources included Medline, Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials, and SPORTDiscus from studies published from database inception to April 23, 2022., Study Selection: Randomized controlled trials studying the use of exercise therapy for RCRSP., Data Extraction: Two reviewers extracted exercise reporting details from all studies using the Template for Intervention Description and Replication (TIDieR) and the modified Consensus on Exercise Reporting Template (CERT). The same 2 reviewers assessed risk of bias of all studies using Cochrane Risk of Bias Tool version 2.0., Data Synthesis: For 104 studies meeting inclusion criteria, the average number of items reported on the TIDieR was 5.27 (SD 2.50, range 1-12 out of 12) and 5.09 (SD 4.01, range 0-16 out of 16) on the CERT. Improved reporting over time was seen on both the TIDieR and CERT dating back to 1993 and through April 23, 2022. When comparing groups of studies published before and after the TIDieR (2014) and CERT (2016) were established, a statistically significant increase in median scores was noted on the TIDieR (P=.02) but not the CERT (P=.31). Quality of exercise therapy reporting was highest in studies with "low risk" of bias, and lowest in studies with "high risk" of bias on the RoB-2., Conclusion: Overall exercise reporting in trials for RCRSP is incomplete despite the development of the TIDieR and CERT checklists. This has implications for translating evidence into practice., (Copyright © 2023 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To compare the effectiveness of pain neuroscience education (PNE) versus biomedical education (BME) in a rehabilitation program following arthroscopic rotator cuff repair (ARCR) in patients with chronic shoulder pain., Methods: Twenty-nine patients who participated in a rehabilitation program were randomly assigned to either an experimental PNE group (N = 16) or a control BME group (N = 13). Measurements included pain intensity at rest and in movement, pain catastrophizing, kinesiophobia, disability and health-related quality of life (HRQoL). Outcomes were evaluated at baseline and at 4 and 8 weeks after the intervention., Results: A main effect for time was observed for: intensity of pain at rest (p < .01); pain with movement (p < .01); pain catastrophizing (p < .01); kinesiophobia (p < .01); disability (p < .01); and HRQoL (p < .01). No group interactions were significant for any variable, except for pain with movement, which favored the PNE group (p = .03). Large effect sizes (ranging from d = 0.79 to d = 2.65) were found for both interventions in all outcomes., Conclusion: A rehabilitation program including either PNE or BME are equally effective in improving rest pain, pain catastrophizing, kinesiophobia, disability, and HRQoL in patients after ARCR, except for pain at movement in favor of the PNE group. The inclusion of PNE in the rehabilitation program appears to lead to clinically meaningful improvements in pain at rest in short term when treating patients with ARCR.

Background: To date, no conclusions have been reached regarding the type of brace worn after arthroscopic rotator cuff repair. To this end, a systematic review and meta-analysis of randomized controlled trials (RCTs) were conducted., Methods: According to the updated guidelines of the Preferred Reporting Items of Systematic Review and Meta-Analysis, all related literature in PubMed, Embase, and Cochrane Central Register of Controlled Trials, from their establishment to March 1, 2022, were searched systematically. Outcome measures included the Constant score, Western Ontario Rotator Cuff (WORC) index, visual analog scale (VAS) score, shoulder joint range of motion (ROM), and failure events of rotator cuff healing. The Cochrane risk of bias tool was used to evaluate the quality of RCT., Results: Two independent reviewers (Chen, Wu) reviewed 275 articles, of which only five met the inclusion criteria, and four were included in the meta-analysis, with a total of 302 patients. The overall risk of bias was high in two RCTs, unclear in one, and low in two. Considering the clinical outcomes, the Constant score (P = .08 mean deviation [MD], 3.06; 95% confidence interval [CI], -0.42 to 6.53), WORC (P = .23; MD, 3.32; 95%CI, -2.15 to 8.79), VAS score (P = .09; MD -1.27; 95%CI, -2.75 to 0.21), ROM (P = .1; MD, 4.75; 95%CI, -0.98 to 10.48), and failure events of rotator cuff healing (P = .78; odds ratio [OR], 0.86; 95%CI, 0.32 to 2.37) did not significantly differ between the abduction brace and simple sling after arthroscopic rotator cuff repair., Conclusion: The findings of this systematic review and meta-analysis suggest that wearing abduction braces after rotator cuff repair neither improved the Constant score, VAS, and WORC scores, and ROM of the shoulder joint, nor did it reduce the risk of re-tearing. Therefore, a simple sling may be a better option in terms of cost effectiveness. It is expected that studies with larger and more homogeneous samples will help verify our results., (Copyright © 2023. Published by Elsevier Inc.)

Background: Operative repair of a rotator cuff tear requires up to 12 weeks of post-operative (post-op) home-based rehabilitation. Maintaining patients' compliance in the post-op rehabilitation program is a pivotal component for generating successful outcomes. By developing a post-op rehabilitation-oriented digital healthcare system and applying it in patients who had undergone rotator cuff repair, we aim to increase the efficacy of the rehabilitation program and raise patients' compliance levels. Here, we present a protocol developed for comparing the efficacy of rehabilitation using a newly developed augmented reality (AR)-based digital healthcare system with that of conventional rehabilitation for post-op rehabilitation of rotator cuff repair., Methods: This study will recruit a total of 115 patients who had undergone rotator cuff repair within 3 days after surgery. Patients will be randomly allocated to rehabilitation using an AR-based digital healthcare system (digital group) or conventional rehabilitation (conventional group). Patients in both groups will perform brochure-based exercises from the immediate post-op period to post-op 6 weeks. From post-op 6 weeks to 12 weeks, patients in the digital group will use the AR-based system for post-op exercises, whereas patients in the conventional group will continue brochure-based rehabilitation exercises. The primary outcome will be scores on the Simple Shoulder Test at post-op 12 weeks. Secondary outcomes include numeric rating scale scores for pain, measures of range of motion and muscle strength of the affected shoulder, grip strength of the affected arm, scores on the Disabilities of the Arm, Shoulder and Hand test, the Shoulder Pain and Disability Index, and the EuroQoL-5D-5L quality-of-life measure. Analyses will be conducted using an intention-to-treat approach., Discussion: This study will examine the effectiveness of an AR-based digital healthcare system for post-op rehabilitation in the patients after rotator cuff repair. The study will add evidence for the application of digital healthcare systems in post-op rehabilitation., Trial Registration: ClinicalTrials.gov NCT04511377. Registered on 10 August 2020., (© 2022. The Author(s).)

Aims: To analyse the clinical practice of Italian physiotherapists within the framework of postoperative rehabilitation of rotator cuff (RC) surgery patients, and to compare it with similar studies carried out in other countries., Methods: A web-based, voluntary, cross-sectional survey with 27 closed multiple-choice questions was developed and submitted to Italian-based physiotherapists in order to assess their clinical practice., Results: Data from 1160 questionnaires were then analysed. Thirty-five percent of respondents ( n  = 413/1160) reported that they commence passive range of motion from the first postoperative week, while 49.2% ( n  = 571/1160) start during the second or third week. The majority of respondents ( n  = 603/1160, 52.0%) introduce active mobilisation between the fourth and the sixth week after surgery and 41.1% ( n  = 477/1160) introduce overhead movements between the fourth and the sixth week after surgery., Discussion and Conclusions: When managing the postoperative rehabilitation of RC surgery patients, Italian physiotherapists' practice is congruent with the guidelines published by American Society of Shoulder and Elbow Therapists (ASSET) and also with other UK surveys. However, while Italian physiotherapists manage immobilisation periods, active and passive mobilisation and the return to sport activities, according to evidence-based best practice guidelines, there is less consistency with respect to physical exercise, patient follow-up and referral.IMPLICATIONS FOR REHABILITATIONItalian physiotherapists' practice with patients following rotator cuff (RC) repair complies with evidence-based practice guidelines regarding immobilisation periods, passive and active mobilisation, and return to sport activities.There is less consistency between reported/declared practice and available evidence concerning physical exercise, patient follow-up, and referral.Physiotherapist with Orthopaedic Manipulative Physical Therapy (OMPT) training is more aligned with the current literature compared to physiotherapists without specific training, in terms of managing rehabilitation programmes, period of immobilisation and therapeutic exercise.More careful adherence to the international guidelines is recommended, in order to manage patients following RC repair in accordance with the evidence and to achieve the best possible outcomes.

Objective: The aim of this study was to evaluate the clinical impact of a 12-wk home-based digitally assisted rehabilitation program after arthroscopic rotator cuff repair against conventional home-based rehabilitation., Design: The digital therapy group performed independent technology-assisted sessions complemented with 13 face-to-face sessions, and the conventional therapy group had conventional face-to-face physical therapy (30 sessions). Primary outcome was functional change between baseline and 12 wks, measured through the Constant-Murley score. Secondary outcomes were the change in the QuickDASH Scale and shoulder range of motion., Results: Fifty participants enrolled; 41 completed the 12-wk program (23 digital therapy group vs. 18 conventional therapy group), and 32 (15 vs. 17) were available for the 12-mo follow-up assessment. No differences were found between groups regarding study endpoints at the end of the 12-wk program. However, follow-up results revealed the superiority of the digital therapy group for QuickDASH (P = 0.043), as well as an interaction between time and group in the Constant-Murley score (P = 0.047) in favor of the digital therapy group., Conclusions: The results demonstrate that digital therapeutics can be used to achieve similar, if not superior, short- and long-term outcomes as conventional approaches after arthroscopic rotator cuff repair, while being far less human resource intensive than conventional care.Level of evidence: II., Competing Interests: MM, SL, DC, CC, and PC are employees at SWORD Health. FDC is the Chief Medical Officer of SWORD Health and owns stock in the company. JL and GF received a scientific councilor honorarium from SWORD Health. VB is the Chief Executive Officer of SWORD Health and owns stock in the company. RS declares that he has no conflict of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Recovery of therapeutic or functional ambulatory capacity in patients with rotator cuff injury is a primary goal of rehabilitation. Wearable powered exoskeletons allow patients to perform repetitive practice with large movements to maximize recovery, even immediately after the acute event. The aim of this paper is to describe the usability, acceptability and acceptance of a hybrid exoskeleton for upper-limb passive rehabilitation using the System Usability Scale (SUS) questionnaire. This equipment, called ExoFlex, is defined as a hybrid exoskeleton since it is made up of rigid and soft components. The exoskeleton mechanical description is presented along with its control system and the way motion is structured in rehabilitation sessions. Seven patients (six women and one man) have participated in the evaluation of this equipment, which are in the range of 50 to 79 years old. Preliminary evidence of the acceptance and usability by both patients and clinicians are very promising, obtaining an average score of 80.71 in the SUS test, as well as good results in a questionnaire that evaluates the clinicians' perceived usability of ExoFlex.

Objective: To assess the effect of early active shoulder movement after rotator cuff repair, compared to delayed active shoulder movement, on clinical outcomes, rotator cuff integrity, and return to work., Study Design: Intervention systematic review., Literature Search: We searched 14 databases in November 2017 and updated the search in December 2018 and February 2020., Study Selection Criteria: We included comparative studies that assessed the effect of early active shoulder movement versus delayed active shoulder movement following rotator cuff repair., Data Synthesis: Means and SDs were used to calculate weighted mean differences and 95% confidence intervals for outcomes of interest. The sensitivity analysis included only randomized controlled trials and was performed when heterogeneity among studies was statistically significant., Results: Eight studies with a total of 756 participants (early active shoulder movement, n = 379; delayed active shoulder movement, n = 377) were included. There was high-certainty evidence favoring early active movement for forward flexion (6 weeks), abduction (6 weeks), and external rotation (6 weeks and 3 and 6 months) postsurgery. There was moderate-certainty evidence of worse Western Ontario Rotator Cuff Index score (6 weeks) for the early active movement group, and no difference in rotator cuff integrity between the early and delayed active movement groups. There were no group differences for all other outcomes., Conclusion: Patients who commenced active shoulder movement early after rotator cuff repair had greater shoulder range of motion and worse shoulder-specific quality of life after surgery than patients who delayed active shoulder movement. However, the group differences did not appear to be clinically important, and rotator cuff integrity was similar. J Orthop Sports Phys Ther 2021;51(7):331-344. Epub 15 May 2021. doi:10.2519/jospt.2021.9634 .

Rotator cuff tears are the most common cause of shoulder disability and can cause significant pain and dysfunction. This systematic review summarizes the latest research on rehabilitation following arthroscopic rotator cuff repair. Studies were eligible for inclusion if they pertained to postoperative rehabilitation following arthroscopic rotator cuff repair and were published between 2003 and 2019 with a level of evidence of 1 or 2. Two blinded reviewers screened, graded, and extracted data from articles and recommendations on various aspects of rehabilitation were summarized. A total of 4067 articles were retrieved from the database search and 22 studies were included for data extraction. We noted similar outcomes between early and delayed mobilization following surgery. Reviewed articles support the use of supervised physical therapy, bracing in 15 degrees external rotation, and adjunctive transcutaneous electrical nerve stimulation for pain management. Early isometric loading improved outcomes in 1 study. Evidence is lacking for exercise prescription parameters and postoperative rehabilitation of the subscapularis., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To evaluate the feasibility of a multi-centre randomised controlled trial to compare the clinical and cost-effectiveness of early patient-directed rehabilitation versus standard rehabilitation following surgical repair of the rotator cuff of the shoulder., Design: Two-arm, multi-centre pilot and feasibility randomised controlled trial., Setting: Five National Health Service hospitals in England., Participants: Adults ( n  = 73) with non-traumatic rotator cuff tears scheduled for repair were recruited and randomly allocated remotely prior to surgery., Interventions: Early patient-directed rehabilitation ( n  = 37); advised to remove their sling as soon as able and move as symptoms allow. Standard rehabilitation ( n  = 36); sling immobilisation for four weeks., Measures: (1) Randomisation of 20% or more eligible patients. (2) Difference in time out of sling of 40% or more between groups. (3) Follow-up greater than 70%., Results: 73/185 (39%) potentially eligible patients were randomised. Twenty participants were withdrawn, 11 due to not receiving rotator cuff repair. The between-group difference in proportions of participants who exceeded the cut-off of 222.6 hours out of the sling was 50% (80% CI = 29%, 72%), with the early patient-directed rehabilitation group reporting greater time out of sling. 52/73 (71%) and 52/53 (98%) participants were followed-up at 12 weeks when withdrawals were included and excluded respectively. Eighteen full-thickness re-tears were reported (early patient-directed rehabilitation = 7, standard rehabilitation = 11). Five serious adverse events were reported., Conclusion: A main randomised controlled trial is feasible but would require allocation of participants following surgery to counter the issue of withdrawal due to not receiving surgery.

Objective: To investigate acceptability, barriers to adherence with the interventions, and which outcome measures best reflect the participants' rehabilitation goals in a pilot and feasibility randomised controlled trial evaluating early patient-directed rehabilitation and standard rehabilitation, including sling immobilisation for four weeks, following surgical repair of the rotator cuff of the shoulder., Design: Nested qualitative study., Setting: Five English National Health Service Hospitals., Subjects: Nineteen patient participants who had undergone surgical repair of the rotator cuff and 10 healthcare practitioners involved in the trial., Method: Individual semi-structured interviews. Data were analysed thematically., Results: Four themes: (1) Preconceptions of early mobilisation; many participants were motivated to enter the trial for the opportunity of removing their sling and getting moving early. (2) Sling use and movement restrictions; for some, sling use for four weeks was unacceptable and contributed to their pain, rather than relieving it. (3) Tensions associated with early mobilisation; clinical tensions regarding early mobilisation and the perceived risk to the surgical repair were apparent. (4) Processes of running the trial; participants found the trial processes to be largely appropriate and acceptable, but withholding the results of the post-operative research ultrasound scan was contentious., Conclusion: Trial processes were largely acceptable, except for withholding results of the ultrasound scan. For some participants, use of the shoulder sling for a prolonged period after surgery was a reported barrier to standard rehabilitation whereas the concept of early mobilisation contributed tension for some healthcare practitioners due to concern about the effect on the surgical repair.

Background: Some unusual rotator cuff (RC) tears are located in more proximal tendinous portions, with substantial remnant tissue attached to the footprint. The two options for surgical repair are sacrificing or preserving the remnant tissue. We introduce a surgical repair technique that preserves as much of the remnant footprint as possible., Surgical Technique: A double-loaded suture anchor is inserted into the subchondral bone at the medial portion of the RC footprint; the lateral remnant tissue is preserved. Each strand is shuttled and repassed through the medial portion of the tendon in a mattress fashion using a suture hook device. Then, multiple no. 1 PDS sutures are passed through the medial and lateral stumps and left untied. Strands from the suture anchor are first tied in a double mattress fashion. Then, the repair is completed by tying the remaining no. 1 PDS sutures., Conclusions: We propose a remnant-preserving RC repair technique for transtendinous RC tears with sufficient tissue remaining within the RC footprint. This technique appears advantageous in terms of re-establishing an environment that promotes tendon healing after repair.

Purpose: Ultrasound elastography has been used to evaluate the skeletal muscle stiffness as a biomarker for sarcopenia assessment. However, there is no consensus with respect to the size and location of the region of interest in assessing such fat infiltrated muscle. The objective of this study was to determine which cross-sectional area should be measured in torn disuse muscle with fat infiltration to accurately measure muscle activity using real-time tissue elastography (RTE)., Methods: Twenty-seven patients, whose rotator cuff muscle with torn tendon was successfully repaired, were followed by programmed rehabilitation. RTE measurements of the supraspinatus muscle were obtained during muscle contraction before and one-year after surgery so that the activity value was defined as the difference between elastography measurements at rest and elastography measurements during contraction. Given that the patients with successfully repaired and completed rehabilitation showed an increased activity value, the sensitivity for three regions of interest; posterior portion of the anterior-middle subregion (AM-p), anterior region (AR), and whole cross-sectional area of the supraspinatus (whole) were compared with the number of patients showing an increase in activity values as sensitivity analysis., Results: The sensitivity showing an increase in activity values was 74.1% for the AM-p area, 70.4% for the AR area, and 81.5% for the whole area. Intraclass correlation coefficient 1,3 was 0.87-0.97 for the AM-p area, 0.88-0.98 for the AR area and 0.92-0.99 for the whole area., Conclusion: The whole cross-sectional area is suitable to measure muscle activity in muscle with fat infiltration. The results in this study will provide some beneficial information when ultrasound elastography is used for the assessment of sarcopenia muscle with fat infiltration., Competing Interests: The authors declare that they have no competing interests., (© 2021 Yuri et al.)

Synopsis: Progressive resistance exercise, in isolation or in combination with other noninvasive therapies such as therapeutic touch, is the first-line approach to managing nontraumatic rotator cuff-related shoulder pain (RCRSP). Resistance exercise may be effective for people with RCRSP secondary to improving mechanical features of the shoulder, including strength, kinematics, and muscle timing and activation. However, strength gains are often small and clinically unimportant when measured during clinical trials. In this Viewpoint, we argue that clinicians should (1) continue to prescribe resistance exercise when managing RCRSP, and (2) embrace the broad biological mechanisms underpinning the efficacy of resistance exercise. Any benefit is governed by more than simple mechanical changes. The clinical message must go beyond the idea that the patient's weak, deconditioned, or frail shoulder is the basis of his or her pain, and all the patient needs to do is to get strong. J Orthop Sports Phys Ther 2021;51(4):156-158. doi:10.2519/jospt.2021.10199 .

Although it is well known that repairing large or massive tears under tension may have an adverse effect on healing of the repaired tendons, only few studies have addressed this issue in medium-sized isolated supraspinatus full-thickness tear. The purpose of this study was to compare the clinical outcomes and structural integrity of arthroscopic rotator cuff repair with tension versus without it. This study retrospectively investigated 90 patients who underwent arthroscopic repair in a single-row for medium-sized isolated supraspinatus full-thickness tear. The patients were assigned to either repaired under tension (Group A, n = 38) or repaired without tension (Group B, n = 52) groups. Functional outcomes were assessed using the patient reported subjective values and the active range of motion (ROM). Postoperative radiographic evaluation was performed 6 months after the surgery to assess the structural integrity of the repaired tendons. Changes in the subjective shoulder scores from initial to 2 years after surgery showed no statistical significance between the two groups. The ROMs measured at initial and 2 years after surgery also showed no statistical difference between the two groups. Postoperative radiological evaluations found a significantly higher re-tear rate in Group A (28.9%, 11/38) than in Group B (9.6%, 5/52). The torn cuff tendons that were repaired under tension as retraction with limited mobility had significantly higher re-tear rate despite having immobilized for 6 weeks after surgery, but their clinical outcomes showed no significant difference from the outcomes of repaired tendons without tension.

Background: There have been no published randomized clinical trial to assess the clinical outcomes between the articular-sided and bursal-sided tears. Therefore, a comparative analysis of evaluating and comparing the functional outcomes following arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tearsis essential., Methods: This study is a present randomized controlled trial which is conducted in our hospital. Consecutive patients with symptomatic articular-sided or bursal-sided partial-thickness rotator cuff tears underwent arthroscopic repair between June 2020 and January 2022. The institutional review board approved the study proposal (with number 10012030), and informed consent was obtained from all patients. Inclusion criteria were existence of an articular- or bursal-sided tear involving <50% of the tendon thickness-confirmed intraoperatively and treated with arthroscopic debridement with or without other decompression surgery (acromioplasty/distal clavicle resection)-and a minimum follow-up of 2 years. All patients followed the same postoperative rehabilitation program. The patients were assessed at baseline preoperatively, and at 1 year and 2 years postoperatively. Outcome parameters were measured at each respective follow-up, which included active range of motion in forward flexion and abduction of the affected shoulder, pain score as measured on the Numeric Pain Rating Scale, as well as outcome scores in terms of the Constant-Murley Score, and Oxford Shoulder Score., Results: Table 1 and Table 2 describe the data indicators that this article wants to evaluate and collect., Conclusions: We hypothesize that both groups of patients will show improvement in range of motion, functional outcome scores, and pain at 2 years, and that results would be similar between the two groups., Trial Registration: This study protocol was registered in Research Registry (researchregistry6496)., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Kinesiotaping (KT) has been widely used in clinical practice. Current evidence is insufficient to support the use of KT for treating rotator cuff-related shoulder pain (RCRSP), as its mid- and long-term effects have not been investigated., Hypotheses: Individuals using KT will achieve faster improvements in symptoms and functional limitations compared with those not using it. They will also present a greater increase in pain-free range of motion (ROM) and acromiohumeral distance (AHD) at the end of the treatment., Study Design: Randomized controlled trial (NCT02881021)., Level of Evidence: Therapy, level 1b., Methods: A total of 52 individuals with RCRSP, randomly assigned to 1 of 2 groups (experimental: KT; control: no-KT), underwent a 6-week rehabilitation program composed of 10 physical therapy sessions. KT was added to the treatment of the KT group. Symptoms and functional limitations were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (primary outcome); Brief Pain Inventory (BPI); and Western Ontario Rotator Cuff (WORC) index at baseline, 3 weeks, 6 weeks, 12 weeks, and 6 months. AHD, pain-free ROM, and full ROM were measured at baseline and at week 6. The effects of KT were assessed using a nonparametric analysis for longitudinal data., Results: No significant group × time interactions (0.112 ≤ P ≤ 0.726) were found for all outcomes. Time effects were observed as both groups showed significant improvements for all studied outcomes (DASH, BPI, and WORC, p < 0.0001; AHD, p = 0.017; pain-free ROM, p < 0.0001; and full ROM abduction, p ≤ 0.0001)., Conclusion: Whereas symptoms, functional limitations, ROM, and AHD improved in both groups, the addition of KT did not lead to superior outcomes compared with exercise-based treatment alone, in the mid and long term, for individuals with RCRSP., Clinical Relevance: Clinicians should not expect supplementary mid- or long-term gains with KT to reduce pain, improve shoulder function and ROM, or increase AHD if a rehabilitation program focusing on shoulder neuromuscular control is concurrently provided as treatment for individuals with RCRSP.

Postoperative exercise has been found able to accelerate bone-tendon (B-T) healing. In this study, we systematically compared tendon-to-bone healing in mice subjected to postoperative treadmill exercise and free cage recovery in a murine rotator cuff repair model. Specifically, C57BL/6 mice underwent unilateral supraspinatus tendon (SST) detachment and repair were randomly allocated into treadmill group and control group. Treadmill group received daily treadmill running initiated from postoperative day 7 while the control group was allowed free cage activity. Mice were euthanized at postoperative 4 and 8 weeks for synchrotron radiation micro-computed tomography (SR-μCT), histology and biomechanical tests to investigate the effect of treadmill running on B-T healing. The results indicated that treadmill running initiated at day 7 postoperatively was able to accelerate B-T healing, as evidenced by better tendon-to-bone maturation and increased mechanical property. Recent studies show that peripheral neuropeptides are closely associated with musculoskeletal tissue repair. We furtherly conducted quantitative reverse transcription-polymerase chain reaction and immunofluorescence staining to investigate the temporal-spatial expression of calcitonin gene-related peptide (CGRP), substance P (SP), and peripheral neuropeptide Y (NPY) to verify whether they are related to rotator cuff healing. Our results show increased expression of CGRP, SP, and NPY at the healing site under the effect of mechanical stimulation. In conclusion, delayed postoperative exercise with moderate strength appears to accelerate the early phase of B-T healing, a process that may prove to be linked to increased expression of periphery neuropeptides known to play a role in tissue healing., (© 2020 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.)

Outcomes after rotator cuff repair (RCR) typically are poorer for workers' compensation (WC) than for patients with private insurance. This study examined augmentation of the traditional rehabilitation protocol with an online exercise program. Between March 2016 and July 2018, 48 WC patients who underwent RCR were introduced to a digital rehabilitation program (application). Patients were divided into patients who used the application along with traditional physical therapy (PT) (group 1) and patients who underwent only traditional PT (group 2). Patient performance was assessed using standardized patient-reported outcome measures (PROMs), return-to-work (RTW) status, number of PT sessions, and complication/revision rate. Patients were monitored for a minimum of 1 year postoperatively. A significant improvement in RTW period was noted for group 1 patients, who resumed modified duty 10 weeks earlier than group 2 patients. A positive trend also was noted for return to full duty, with group 1 resuming full duty 7 weeks before group 2. There were no complications or reoperations in group 1 compared with 4 (16%) complications in group 2. The 2 groups underwent the same average number of PT sessions (27 sessions). Patient-reported outcome measures were captured only for group 1, which demonstrated average postoperative improvement of 3 points on a visual analog scale and 32.5 points in American Shoulder and Elbow Surgeons scores. Incorporating an online exercise program within the traditional rehabilitation protocol for WC patients undergoing RCR resulted in earlier return to work and was associated with better pain relief, greater return of function, and lower complication rate. [ Orthopedics . 2021;44(2):e197-e202.].

Background: Traumatic full-thickness rotator cuff tears are typically managed surgically, followed by rehabilitation, but the load progression to reach an optimal clinical outcome during postoperative rehabilitation is unknown., Purpose: To evaluate whether there was a superior effect of 12 weeks of progressive active exercise therapy on shoulder function, pain, and quality of life compared with usual care., Study Design: Randomized controlled trial; Level of evidence, 1., Methods: Patients with surgically repaired traumatic full-thickness rotator cuff tears were recruited from 2 orthopaedic departments and randomized to progressive active exercise therapy (PR) or limited passive exercise therapy (UC [usual care]). The primary outcome was the change in the Western Ontario Rotator Cuff Index (WORC) score between groups from before surgery to 12 weeks after surgery. Secondary outcomes included changes in the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire score, pain, range of motion, and strength. Adverse events were registered during the intervention period., Results: A total of 82 patients were randomized to the PR (n = 41) or UC (n = 41) group. All 82 patients (100%) participated in the 12-week assessment and 79 in the 1-year follow-up. At 12 weeks, there was no significant difference between the groups in the change in the WORC score from baseline adjusted for age, sex, and center (physical symptoms: P = .834; sports and recreation: P = .723; work: P = .541; lifestyle: P = .508; emotions: P = .568). Additionally, there was no between-group difference for the secondary outcomes including the WORC score at 1 year and the DASH score, pain, range of motion, and strength at 12 weeks and 1 year. Both groups showed significant improvements over time in all outcomes. In total, there were 13 retears (16%) at 1-year follow-up: 6 in the PR group and 7 in the UC group., Conclusion: PR did not result in superior patient-reported and objective outcomes compared with UC at either short- or long-term follow-up (12 weeks and 1 year)., Registration: NCT02969135 (ClinicalTrials.gov identifier).

Purpose: To evaluate surgical techniques and clinical outcomes of arthroscopic superior capsular reconstruction (SCR) for the treatment of massive irreparable rotator cuff tears., Methods: A systematic review was registered with PROSPERO and performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. The PubMed, Scopus, and Cochrane databases were searched. Studies investigating SCR with reported surgical techniques were included. Animal studies, cadaveric studies, review studies, and letters to the editor were excluded. The technical aspects of the surgical techniques for SCR were analyzed in each article, which included graft type, glenoid fixation method, greater tuberosity fixation method, graft passage technique, suture management, margin convergence, concomitant procedures, and postoperative rehabilitation protocol. Clinical outcomes, when available, were also analyzed., Results: We screened 365 articles, of which 29 described surgical techniques for SCR. According to the Modified Coleman Methodology Score, 24 articles were rated as poor (score < 55), 4 were rated as fair (score between 55 and 69), and 1 was rated as good (score between 70 and 84), with an average score of 25.8 ± 20.9. The most commonly performed technique for SCR used the following: an acellular dermal allograft, 2 biocomposite suture anchors for glenoid fixation, transosseous-equivalent double-row suture anchor fixation for greater tuberosity fixation with 2 biocomposite medial-row anchors and 2 biocomposite lateral-row anchors, the double-pulley technique combined with an arthroscopic grasper and/or pull suture to pass the graft into the shoulder, the performance of both anterior and posterior margin convergence, and a native rotator cuff repair when possible. Only 8 studies reported clinical outcomes, and they showed that SCR provides significant improvement in patient-reported outcomes, significant improvement in shoulder range of motion, variable graft failure rates, low complication rates, and variable reoperation rates. There were no studies comparing outcomes among the various surgical techniques., Conclusions: Many surgical techniques exist for arthroscopic SCR. However, no superior technique was shown because there were no studies comparing clinical outcomes among these various techniques., Level of Evidence: Level V, systematic review of Level III, IV, and V studies., (Copyright © 2020 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Background: Continuous interscalene brachial plexus block (CISB) is well known to reduce postoperative pain and to improve patient satisfaction. However, the effect of CISB on the quality of postoperative recovery is unknown. We Compared the quality of recovery from arthroscopic rotator cuff repair in patients who received CISB or single interscalene brachial plexus block (SISB)., Methods: This prospective non-randomized controlled trial with propensity score matching enrolled 134 patients undergoing arthroscopic surgery for rotator cuff repair. Each patient received an interscalene block before surgery. One group had a catheter insertion 30 min after the end of surgery and started patient-controlled regional analgesia (PCRA, n = 49). The other group received intravenous patient-controlled analgesia (IV-PCA, n = 85). The primary outcome was the quality of recovery (QoR-40) score. Also, postoperative analgesia, sleep quality, and postoperative complications were evaluated., Results: The two groups had similar QoR-40 score on postoperative day-1 (POD1), but the PCRA group had a significantly greater QoR-40 score on POD2 (156.0, IQR: 143.0, 169.0 vs. 171.0, IQR: 159.0, 178.0; p < 0.001). The IV-PCA group received more analgesics during the 2 days after surgery, especially during night-time, and had a higher prevalence of sleep disturbances. The time to first additional analgesics request was significantly longer in PCRA group (14 hours, 95% CI: 13-16 vs. 44 hours, 95% CI: 28-not applicable). The incidence of postoperative nausea and vomiting significantly lower in the PCRA group (16.3% vs 46.9%, p = 0.002)., Conclusion: CISB showed a higher quality of recovery score than SISB with IV-PCA in arthroscopic rotator cuff repair, probably related to the effective analgesia, improved sleep quality, and reduced opioid-related complications.

Background : Rotator cuff (RTC) dysfunction incidence ranges from 7% to 25% in the general population with a high recurrence rate. RTC musculature plays a significant role in dynamic stability of the glenohumeral joint with damage to these structures associated with proprioceptive impairments. Impaired proprioception has been linked to increased injury risk in other body regions; however, similar relationships with the upper extremity have not been extensively evaluated. The purpose of this case report is to present a preliminary, yet clinically feasible approach for using a laser for proprioceptive assessment and treatment in patients with RTC dysfunction. Case description : Patient 1 was a 21-year-old female with right shoulder pain from injury at work as a waitress where she lifted a heavy tray of plates. Patient 2 was a 48-year-old male with gradual and insidious onset of right shoulder pain during recreational baseball. Examination findings indicated contractile tissue involvement in both patients. Reaching and throwing tasks requiring accurate proprioceptive function were essential for return of each patient to their functional tasks. Laser proprioception testing was performed every 2 weeks with proprioceptive training provided as a supplement to other interventions. Outcomes : Over 4 weeks, improvements in objective laser proprioceptive test results were observed for both patients (Patient 1 = 6.0 cm; Patient 2 = 5.5 cm) in conjunction with active range-of-motion and self-report measures for pain intensity and function. Discussion : This case report describes a clinically feasible approach to testing and treating upper extremity proprioceptive deficits after RTC injury. Future research is required to establish reliability and validity of these methods.

BACKGROUND The aim of this study was to assess the clinical effectiveness of scapula training exercises on shoulder function after surgery for rotator cuff injury. MATERIAL AND METHODS Forty-six patients with rotator cuff injury after surgery were randomized into the experiment group or control group. Both groups were treated with conventional therapeutic exercise and physical therapy, and scapular training exercise was added to the experiment group. Patient status was evaluated by Constant-Murley scale (CMS), visual analogue scale (VAS), and the active range of motion (ROM) of the shoulder before and after 6 weeks and 12 weeks of treatment. RESULTS After 6 weeks and 12 weeks of treatment, all evaluations of the 2 groups were significantly improved as compared with those before treatment (P0.05). After 12 weeks of treatment, all items in the experimental group were significantly improved compared to the control group (P<0.05). CONCLUSIONS The combination of conventional rehabilitation interventions and scapular training exercise were an effective treatment of the shoulder dysfunction. Moreover, increased Scapula training exercise had better effect on the improvement of shoulder function.

BACKGROUND The aim of this study was to assess inflammatory cytokines levels in synovial fluid (SF) before and after electroacupuncture (EA) treatment and to explore whether these biomarkers are associated with function of rotator cuff tear (RCT) patients. MATERIAL AND METHODS We recruited 54 patients with RCT and separated them into an EA group and a control group. The SF biomarker levels were detected at baseline and at 6-week and 6-month follow-up. The symptomatic severity was evaluated by visual analog scale (VAS), Constant-Murley score, and American Shoulder and Elbow Surgeons score (ASES). We also investigated the correlation between symptomatic severity and biomarker levels in SF of the shoulder joint. RESULTS The reductions in VAS and improved functional score (ASES and Constant-Murley score) were significantly different between the 2 groups, and SF biomarker concentrations were significantly lower in the EA group. IL-1ß levels were significantly negatively correlated with Constant-Murley score (r=-0.73, P=0.04) and ASES score (r=-0.59, P<0.001) and positively correlated with VAS scores (r=0.81, P=0.004). IL-6 levels were significantly negatively correlated with Constant-Murley score (r=-0.67, P=0.03) and positively correlated with VAS score (r=0.7, P=0.01). MMP-1 levels were significantly negatively correlated with ASES score (r=-0.57, P<0.001). CONCLUSIONS The biomarkers in SF were directly associated with shoulder pain and shoulder function in rotator cuff tear. EA, as a safe and effective conservative therapy, obviously decreased the level of inflammatory cytokines in RCT patients, accompanied by a reduction in shoulder pain and improved function.

Background: The benefit of supervised physiotherapy after rotator cuff surgery is unclear. The aim of this randomized controlled trial was to assess the effectiveness of supervised physiotherapy after arthroscopic rotator cuff reconstruction., Methods: Eighty patients with full-thickness supraspinatus tendon tears were randomly assigned to either supervised physiotherapy or home exercises only. The primary outcome measure was the Constant score at 12 months after surgery., Results: A total of 70 patients were available for analyses at 1-year follow-up. There were no statistically significant differences in the primary outcome between the treatment groups., Conclusion: Supervised physiotherapy after arthroscopic rotator cuff reconstruction does not provide additional benefit compared with home exercises alone at 1-year follow-up., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Either pain or contracture may limit shoulder passive range of motion (PROM) in patients with rotator cuff disease, and an appropriate treatment may be determined according to its cause. If there is no change in PROM under general anesthesia, contracture, rather than pain, may be the underlying condition. Our goal was to devise a physical examination that would help discriminate between pain and contracture in limited PROM patients with rotator cuff tear.This is a STROBE-compliant cross-sectional study. Patients with rotator cuff tears (N = 28) were scheduled for arthroscopic repair. The main outcome measure was PROM, including flexion, external rotation (ER), and abduction obtained by a blinded examiner before and after the induction of general anesthesia, and the abduction/ER ratio was calculated. In order to perform a subgroup analysis, patients were divided into 2 groups, one where abduction difference after the general anesthesia was 8°≤ (n = 22) and the other 8°> (n = 6).Patients' average age (62.6 ± 7.2 years), symptom duration (13.0 ± 10.0 months), intensity of shoulder pain on a visual analog scale (4.8 ± 2.1), and Constant-Murley functional score (63.4 ± 8.9); the ratio of gender (male: female = 12:16); and the arthroscopic findings were recorded. According to the correlation analysis, the abduction/ER ratio before general anesthesia was correlated best with the change in PROM after general anesthesia (correlation coefficient -0.74, P < .001); the correlations for abduction and flexion were -0.69 and -0.57, respectively (P < .001 and .002, respectively). The age, gender, height, weight, duration of symptoms, trauma history, visual analog score for shoulder pain, Constant-Murley functional score, size of rotator cuff tear, and biceps pathology did not differ significantly between the 2 groups in the subgroup analysis (P > .05). The only significant difference between the 2 groups was in the synovitis status (P = .04).Patients with greater abduction/ER ratio before anesthesia exhibited fewer PROM changes after anesthesia. The abduction/ER ratio was strongly and inversely correlated with PROM changes, allowing physicians to choose an appropriate treatment for limited PROM in patients with rotator cuff tears.

Background: Single-row (SR) and double-row (DR) techniques are 2 kinds of widely used approaches for the arthroscopic repair of rotator cuff. This retrospective clinical trial was performed to address the question of whether a DR rotator cuff anchor repair gives results superior to a SR anchor repair in clinical outcome scores and complication rates., Methods: This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. We retrospectively reviewed our database, which was collected prospectively. From 2014 to 2017, 264 patients underwent arthroscopic rotator cuff repair by an experienced single shoulder surgeon with the SR and DR techniques. This study was approved by the institutional review board in our hospital and was registered in the Research Registry. Outcome measures included Constant-Murley score, muscle strength, patient satisfaction, passive range of motion, and retear rates., Results: The hypothesis was that the DR technique would achieve better functional scores and fewer complications as compared to the SR technique in treatment of rotator cuff tears.

Background: Video-based rehabilitation programs, which are also used in the treatment of neurological disorders, could be a beneficial treatment option for patients who cannot receive treatment., Purpose: To determine the efficacy of video-based rehabilitation program in the conservative treatment of partial rotator cuff tears in comparison to a physiotherapist-supervised rehabilitation program., Study Design: A randomized controlled clinical trial., Methods: Thirty-three voluntary patients with partial rotator cuff tear were randomized into two groups: video-based rehabilitation (VBR) group and physiotherapist-supervised rehabilitation (PSR) group, for a common 6 weeks rehabilitation program. After drop outs, thirty participants (mean ± SD age, 50.60 ± 8.54 years; 10 female) were finally completed the trial. Active shoulder range of motion, pain, functional status, and health-related quality of life of the patients were assessed before and after treatment. Also, treatment satisfaction level was assessed at the end of the treatment., Results: There was statistically significant improvement in terms of active shoulder range of motion values (mean differences at 95% confidence interval for abduction: 30.75-51.37 in the VBR group, 34.20-54.45 in the PSR group, P = .001 in both groups) and secondary outcome measures within both groups (P < .05). However, there were no statistically significant differences in terms of all outcome measures between groups (P > .05). The level of satisfaction from treatment in the PSR group was higher than that in the VBR group., Conclusion: A video-based rehabilitation program is an effective option in terms of shoulder range of motion, pain, functionality, and quality of life and has a comparable success level with a PSR program in the conservative treatment of partial rotator cuff tears., (Copyright © 2019 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Case: A 69-year-old man fell from a height, resulting in direct axial loading while both shoulders were fully abducted. He was referred to the surgical ward, and both shoulders were reduced by closed reduction using the traction-countertraction maneuver. After little improvement of complaints of pain in the right shoulder over 45 days, magnetic resonance demonstrated traumatic rupture of the supraspinatus., Conclusion: Inferior dislocation (luxation erecta) is an uncommon event, with bilateral dislocation being even rarer. Treatment should be initiated urgently via closed reduction or, if this is not possible, through open reduction. The long-term prognosis is favorable after appropriate treatment.

Objectives: To perform a systematic review of clinical practice guidelines (CPGs) and semantic analysis of specific clinical recommendations for the management of rotator cuff disorders in adults., Data Sources: A systematic bibliographic search was conducted up until May 2018 in Medline, Embase, and Physiotherapy Evidence Database, or PEDro, databases, in addition to 12 clinical guidelines search engines listed on the Appraisal of Guidelines for Research and Evaluation (AGREE) website., Study Selection: Nine CPGs on the management of rotator cuff disorders in adults or workers, available in English or French, and published from January 2008 onward, were included and screened by 2 independent reviewers., Data Extraction: CPG methodology was assessed with the AGREE II checklist. A semantic analysis was performed to compare the strength of similar recommendations based on their formulation. The recommendations were categorized in a standardized manner considering the following 4 levels: "essential," "recommended," "may be recommended," and "not recommended.", Data Synthesis: Methodological quality was considered high for 3 CPGs and low for 6. All CPGs recommended active treatment modalities, such as an exercise program in the management of rotator cuff disorders. Acetaminophen or nonsteroidal anti-inflammatory drug prescriptions and corticosteroid injections were presented as modalities that may be recommended to decrease pain. Recommendations related to medical imagery and surgical opinion varied among the guidelines. The most commonly recommended return-to-work strategies included intervening early, use of a multidisciplinary approach, and adaptation of work organization., Conclusions: Only 3 CPGs were of high quality. The development of more rigorous CPGs is warranted., (Copyright © 2020 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.)

Background: Correcting pseudoparalysis of the shoulder due to massive rotator cuff tear is challenging. The most reliable treatment for restoring active shoulder elevation is debatable. Therefore, the purpose of this systematic review was to evaluate the success of various treatment options for reversing pseudoparalysis due to massive rotator cuff tear., Methods: A search was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of the MEDLINE database, Cochrane database, Sportdiscus, and Google Scholar database for articles evaluating shoulder pseudoparalysis due to massive rotator cuff tears., Results: Nine articles evaluating reverse total shoulder arthroplasty (RTSA), superior capsular reconstruction (SCR), and rehabilitation programs were included in the study. Though there was variability, the definition of pseudoparalysis was active forward elevation (AFE) less than 90° with preserved passive range of motion (ROM). Reversal of pseudoparalysis was defined as restoration of AFE greater than 90°. The overall rate of reversal of pseudoparalysis across studies was similar for RTSA (96% ± 17%) and SCR (94% ± 3%). However, there was a difference in average improvement in AFE for RTSA (56° ± 11°) and SCR (106° ± 20°). A progressive rehabilitation program described improvements in a single study with 82% reversal of pseudoparalysis., Conclusion: The available Level IV evidence suggests that RTSA and SCR reliably reverse pseudoparalysis in most patients with massive, irreparable rotator cuff tears. However, the dissimilar improvements in ROM suggest that a more consistent definition of pseudoparalysis is warranted. Future randomized controlled trials are needed to determine the best treatment approach for patients with massive irreparable rotator cuff tears., (Copyright © 2020 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Objectives: The Getting it Right: Addressing Shoulder Pain (GRASP) trial is a large-scale, multicentre, 2×2 factorial randomised controlled trial investigating clinical and cost-effectiveness of a progressive exercise programme versus best-practice advice, with or without corticosteroid injection, for treating people with rotator cuff disorders. Here we describe the development, implementation and details of the physiotherapy-led interventions., Methods: Medical Research Council guidance for developing complex interventions were used, taking into account clinical guidelines, expert and patient opinion, research evidence, current practice variation, and deliverability. A stakeholder meeting of 26 experts, clinicians, researchers, and patient representatives was used to design key components of the interventions. Stakeholders prioritised strengthening posterior rotator cuff muscles and using practical, easy-to-do exercises. The interventions were designed to be deliverable across the UK National Health Service., Results: Progressive exercise consists of up to six sessions with a physiotherapist over 16 weeks. The best-practice advice consists of one face-to-face session with a physiotherapist with substantially greater reliance on self-management. Both interventions include self-management advice, home-exercise instruction, and behaviour-change strategies to target exercise adherence. All participants receive a Participant Information Booklet. The best-practice advice intervention is a self-guided system of progressively challenging exercises, with demonstration videos and written materials. The progressive exercise intervention has a wider range of exercise options, and greater flexibility for tailoring, progression, supervised practice and feedback., Conclusion: GRASP has recruited 708 participants and will provide high quality evidence to inform management of people with shoulder pain due to a rotator cuff disorder. Results are anticipated in 2020., Trial Registration Number: ISRCTN16539266; EudraCT number:2016-002991-28., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The objective of the present study was to compare the efficacy between supervised and unsupervised rehabilitation after rotator-cuff (RC) repair in terms of clinical outcomes, visual-analog-scale (VAS) score, range of motion (ROM), and risk of retear., Material: a comprehensive search of Pubmed, CINAHL, Cochrane, EMBASE, Ovid, and Google Scholar databases through a combination of the following keywords with logical Boolean operators: "informed", "uninformed", "unsupervised", "supervised", "rehabilitation", "physical therapy", "physical therapies", "postoperative period", "physical-therapy techniques", "physical-therapy technique", "exercise", "exercise therapy", "rotator cuff", "rotator-cuff tear", and "rotator-cuff repair". For each article included in the study, the following data were extracted: authors, year, study design, sample size and demographic features, RC tear characteristics, clinical outcomes, ROM, VAS score, retear rate, and time of follow-up. Meta-analysis was performed in terms of VAS score., Results: Four randomized control trials with 132 patients were included. One study demonstrated significant improvement in VAS, active ROM, and the activity of the muscle's motor units at stop and during maximal effort in supervised patients. Another one showed lower retear rates in the supervised group. The remaining two randomized controlled trials did not reveal any significant differences between supervised and unsupervised rehabilitation in terms of clinical outcomes. Moreover, higher costs were described for supervised rehabilitation. The VAS was not significantly different in the two groups (9.9 compared with 8.25, p = 0.23)., Conclusions: although several publications address the problem of RC lacerations, there is a paucity of evidence in the literature regarding the effectiveness of supervised and unsupervised rehabilitation protocols. This systematic review and meta-analysis showed no significant differences between the two types of rehabilitation in terms of VAS scores, while outlining the pros and cons of each protocol.