Home based unsupervised rehabilitation protocol following rotator cuff repair has good outcomes: A prospective study

Journal of Clinical Orthopaedics | Vol 6 | Issue 2 |  July-Dec 2021 | page:12-15 | Rohan A Habbu


Author: Rohan A Habbu

[1] Department of Upper Limb Surgery, Prime Health Clinic Ground floor, Ram Janki Apts Subhash Road, Vile Parle East, Mumbai 400057, India

Address of Correspondence
Dr. Rohan A Habbu,
Department of Upper Limb Surgery, Prime Health Clinic Ground floor,
Ram Janki Apts Subhash Road, Vile Parle East, Mumbai 400057, India
E-mail: dr_habbu@yahoo.com


Abstract

Background: Rehabilitation after rotator cuff repair achieves good results but it involves time and costs. A simple home based program will reduce costs, time to travel and chance of exposure in a pandemic scenario. The objective of the study was to assess outcomes of home based rehabilitation protocol following rotator cuff repair.
Methods: This was a prospective study of 42 patients who underwent rotator cuff repair followed by an unsupervised home based rehabilitation protocol. The tears were identified using clinical examination and Magnetic Resonance Imaging. The cuff repair was done with mini open incision technique. The patients were taught an exercise protocol, which they did by themselves at home. There was no daily supervision by the treating surgeon or a physiotherapist. The study measured pain scores, return to work, range of motion and failures at one year.
Results: Mean duration of followup was 14 months. Visual Analogue Score for pain improved from preoperative mean 7.5 to followup mean 1.3. Disability of the Arm, Hand and Shoulder score, measured in 26 patients improved from preoperative mean 33.2 to followup mean 4.5. Range of motion improved in 39 patients. Cuff strength was normal in 39 patients. 37 patients returned to full work by three months. There were three failures with one patient developing significant stiffness and two patients showing a retear. The retear was seen in patients with large retracted tears and the repair was done under tension.
Conclusion: Home based exercise protocol for postoperative rehabilitation in rotator cuff repairs can achieve good results in carefully selected patients. The study does not recommend this for large tears with difficult repairs. Since the patients are doing the postoperative rehabilitation at home, this reduces the costs, time lost in travel and exposure to external factors.
Keywords: Rotator cuff, mini open repair, unsupervised rehabilitation, motion


References

1. Beaudreuil J, Dhénain M, Coudane H, Mlika-Cabanne N. Clinical practice guidelines for the surgical management of rotator cuff tears in adults. Orthopaedics & Traumatology: Surgery & Research 2010; 96: 175–179.
2. Huisstede BM, Koes BW, Gebremariam L, Keijsers E, Verhaar JA. Current evidence for effectiveness of interventions to treat rotator cuff tears. Manual therapy 2011; 16: 217–230.
3. Hayes K, Ginn KA, Walton JR, Szomor ZL, Murrell GA. A randomised clinical trial evaluating the efficacy of physiotherapy after rotator cuff repair. Aust J Physiother 2004;50:77-83.
4. Roddey TS, Olson SL, Gartsman GM, Hanten WP, Cook KF. A randomized controlled trial comparing 2 instructional
approaches to home exercise instruction following arthroscopic full-thickness rotator cuff repair surgery. J Orthop Sports Phys Ther 2002; 32: 548-559.
5. Büker NA, Akkaya S, Akkaya N. Comparison of the results of supervised physiotherapy program and home-based exercise program in patients treated with arthroscopic-assisted miniopen rotator cuff repair. Eklem Hastalik Cerrahisi 2011; 22(3):134-139.
6. Lee BG, Cho NS, Rhee YG. Effect of two rehabilitation protocols on range of motion and healing rates after arthroscopic rotator cuff repair: aggressive versus limited early passive exercises. Arthroscopy 2012; 28(1): 34-42.
7. Baumgarten KM, Vidal AF, Wright RW. Rotator cuff rehabilitation. A level 1 and level 2 systematic review. Sports Health 2009;1(2):125-130.
8. Holmgren T, Oberg B, Sjöberg I, Johansson K. Supervised strengthening exercises versus home-based movement
exercises after arthroscopic acromioplasty: a randomized clinical trial. J Rehabil Med 2012; 44(1): 12-18.
9. Andersen NH, Sojbjerg JO, Johannsen HV, Sneppen O. Selftraining versus physiotherapist-supervised rehabilitation of the shoulder in pa- tients treated with arthroscopic subacromial decompression: a clinical randomized study. J Shoulder Elbow Surg 1999; 8: 99–101.
10. Lisinski P, Huber J, Wilkosz P, Witkowska A, Wytrazek M,Samborski W et al. Supervised versus uncontrolled rehabilitation of patients after rotator cuff repair-clinical and neurophysiological comparative study. Int. J Artif Organs 2012;35: 45–54.
11. Longo UG, Berton A, Ambrogioni LR, Lo Presti D, Carnevale A, Candela V et al. Cost-Effectiveness of Supervised versus Unsupervised Rehabilitation for Rotator-Cuff Repair: Systematic Review and Meta-Analysis. Int J Environ Res
Public Health 2020;17:2852.
12. Song SJ, Jeong TH, Moon JW, Park HV, Lee SY, Koh KH. Short-term Comparison of Supervised Rehabilitation and
Home- based Rehabilitation for Earlier Recovery of Shoulder Motion, Pain, and Function after Rotator Cuff Repair. Clinics in Shoulder and Elbow 2018; 21(1): 15-21.
13. Gallagher BP, Bishop ME, Tjoumakaris FP, Freedman KB. Early versus delayed rehabilitation following arthroscopic
rotator cuff repair: A systematic review. Phys Sportsmed 2015;43(2): 178-187.

How to Cite this article: Habbu RA. Home based unsupervised rehabilitation protocol following rotator
cuff repair has good outcomes: A prospective study. Journal of Clinical Orthopaedics July-Dec 2021;6(2):12-15.

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