Rotator cuff tear
What are Rotator Cuff Tears
The wide range of motion of the shoulder is allowed by the variety of rotational moments of the cuff muscles. In particular, the rotator cuff muscle’s action must be precisely coordinated to obtain the desired movement.
The rotator cuff is a group of muscles and tendons that surround the shoulder joint, keeping the humeral head firmly within the shallow socket of the shoulder. More specifically, the rotator cuff is made up of the supraspinatus, infraspinatus, teres minor, and subscapularis. When one or more of these tendons or muscles become damaged, it is called rotator cuff tear (RCT).
Rotator cuff tears are the most common cause of shoulder pain [1]; tears may occur as the result of a sudden force or acute injury, or gradually over time and consequently its incidence increases with age.
Biomechanics and Treatment
The rotator cuff has an important role in the stability and function of the glenohumeral joint. It provides a stabilizing effect to the shoulder, because of compression of the humeral head against the glenoid cavity.
In order for the joint to remain stable, the cuff creates a force coupled around the glenohumeral joint with coordinated activation of adjacent muscles, which work together to contain the otherwise intrinsically unstable glenohumeral joint and prevent proximal migration of the humerus. Once this muscular balance is lost, increased translations or subluxation of the humeral head may result, leading to changes in the magnitude and direction of the joint reaction forces at the glenohumeral joint [3]. These mechanical changes may then result in a number of clinical presentations of shoulder dysfunction, disease and pain.
A rotator cuff tear can be treated operatively or non-operatively, depending on the severity of the injury.
Conservative treatments include rest, ice, injections and physical therapy and are usually recommended as an initial treatment or in cases of partial tears. A large variety of surgical procedures are otherwise indicated for severe tears.
Rotator Cuff Tear Treatment with SPM:
A rehabilitation program associated to RCT is highly recommended both in conservative treatment and in the post-surgical phase.
There is evidence that electrical muscle stimulation treatment has a positive effect on the rotator cuff muscles in both of these cases [1].
Muscle strengthening generated by electrostimulation has been shown to improve the clinical outcome and the production of external rotational force of the shoulder after rotator cuff repair surgery [2].
Attributed to its dynamic interaction, and patented muscle activation stimulation (MAS), the device can be used for stabilizing the glenohumeral joint in all the phases of Rotator Cuff Tear rehabilitation, allowing the patients to improve muscle recruitment patterns.
Rotator cuff Tear stimulation protocol
What is the RCT stimulation Protocol
The RCT Protocol is available on MySPM App and it consists of a sequence of 9 exercises of varying intensity and duration distributed in 3 levels of increasing difficulty.
The aim of the rehabilitation sessions is to stimulate hypoactive muscle groups throughout the motion exercises established in the protocol and it is indicated for:
- reparable rotator cuff tear treated nonoperatively
- prehabilitation to strengthen non-damaged muscles
- rotator cuff tendinopathy
- rehabilitation after rotator cuff repair
Electrode positioning for RCT Protocol
To make sure that the motion exercises will be effective, the electrodes must be positioned correctly in the area of the nerve supplying the hypoactive muscles:
– The first electrode should be placed medially to the margo medialis scapulae to stimulate the scapula retractors (M. trapezius pars transversa, Mm. rhomboidei).
– The second electrode should be placed inferior and lateral to the posterolateral angle of the acromion to stimulate the posterior and middle deltoid
Duration of treatment
A minimum 3 sessions of treatment per week over a period of 4-8 weeks is suggested. Longer periods of treatment can be indicated.
How do the exercises in the protocol work?
The RCT protocol includes nine exercises of varying intensity and duration.
Each exercise is structured for increasing difficulty using the force of gravity as a variable to modify the workload on the stabilizing muscles of the shoulder.
The majority of the exercises should be done in front of a gymnastic wall bar.
In some exercises the use of elastic bands and a low weight ball is required to increase the resistance work.
This protocol has been developed in collaboration with:
Dr. Jean-David Werthel
(Chirurgie orthopedique et traumatology, Hôpital Ambroise Paré)
Mohammed Bekhtaoui
(Service de rééducation fonctionnelle, Hôpital Ambroise-Paré)
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SUPPORTING LITERATURE
[1] Mj, P., Green, S., Ma, M., Sj, S., Deitch, J., Mcbain, B., Lyttle, N., & Buchbinder, R. (2016). Electrotherapy modalities for rotator cuff disease (Review) SUMMARY OF FINDINGS FOR THE MAIN COMPARISON. 6, 256. https://doi.org/10.1002/14651858.CD012225.www.cochranelibrary.com
[2] Reinold, M. M., Macrina, L. C., Wilk, K. E., Dugas, J. R., Cain, E. L., & Andrews, J. R. (2008). The effect of neuromuscular electrical stimulation of the infraspinatus on shoulder external rotation force production after rotator cuff repair surgery. American Journal of Sports Medicine, 36(12), 2317–2321. https://doi.org/10.1177/0363546508322479
[3] Longo, U. G., Berton, A., Papapietro, N., Maffulli, N., & Denaro, V. (2012). Biomechanics of the rotator cuff: European perspective. Medicine and Sport Science, 57, 10–17. https://doi.org/10.1159/000328870
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