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The role of anterior deltoid reeducation in patients with massive irreparable degenerative rotator cuff tears

Rotator Cuff Tear, Anterior Deltoid, Physical Therapy
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Added on September 29, 2016

With all the advances that have been made in orthopedic surgery, rehabilitation, and medical management of musculoskeletal issues, a very common problem that still presents a challenge to physicians is the full thickness rotator cuff tear in the medically unfit patient – in other words, patients who are not medically able to undergo surgery to repair their torn rotator cuff. Individuals with a full tear to the rotator cuff often have severe limitations in being able to raise the affected arm to and above shoulder level, and often require surgery to reattach the torn tendon to the its insertion at the humerus in order to achieve normal muscular function and control of the joint. Ivy Rehab actively works with orthopedic physicians to find evidence-based solutions to orthopedic problems. Cue this journal article from the Journal of Elbow and Shoulder Surgery. This article specifically looks at medically unfit, elderly patients with massive, non-traumatic rotator cuff tears. Often these patients have multiple medical comorbidities that make surgery to risky. This article tests a training protocol for the anterior deltoid muscle to improve biomechanics of the glenohumeral joint which should improve active range of motion (AROM).

The study looked at recent biomechanical research that rethinks the function of the anterior deltoid muscle. Research shows that despite popular belief this muscle likely functions to prevent the humeral head from moving superiorly keeping it in the glenoid fossa. This is very important in a shoulder that is unstable secondary to a rotator cuff tear. By keeping the humeral head securely in place, the patient is able to move their shoulder with improved biomechanics.

The exercises utilized in this study are included as part of the Reading Shoulder Unit. The exercise progression begins with the patient lying supine. They are asked to lift their injured upper extremity directly above them. They are then asked to maintain that position using their anterior deltoid muscle to stabilize the joint. Next the patient begins moving their upper extremity superiorly/inferiorly within a "comfortable arc". As the patients condition improves the arc should become larger. The patient is instructed to perform these exercises 3-5 times a day for 6 weeks.

In the next step in this progression, a light weight (can of corn) should be added. Once again the "comfortable arc" should become larger as the patients comfort improves. As confidence increases with this exercise, the patient should progress from supine to sitting in a reclined position. They should repeat the previous motion in this position causing them to lift against gravity. As this becomes easier, the patient is progressed to the standing position. These exercises should be repeated for at least 6 more weeks.

The study showed that this rehabilitation protocol helped improve AROM of the glenohumeral joint in the majority of the patients who participated in this study. Of the 17 patients who participated in this study, 14 of them showed dramatic improvements in shoulder AROM. The average AROM in forward elevation for the group went from 40 degrees at the start of the study (or raising the hand to about the level of the naval), to 160 degrees (or raising the hand fully overhead)! With this improvement in ability to raise the arm comes significant improvements in being able to use the arm for normal daily activities. Thus this protocol outlined in this article can be very useful in helping patients whose primary goal is to regain function in light Activities of Daily Living. You can download the full article via the link below. Ivy Rehab is currently employing this protocol in collaboration with orthopedic physicians at our Willingboro, New Jersey clinic in order to collect pilot data on patients who fit this demographic. We are eager to demonstrate the results to our partnering physicians. If you or a loved one are having shoulder difficulty and limited use of your arm because of it, don't give up hope. Ask about physical therapy and see the results for yourself!

The above is a summary of the linked article "The role of anterior deltoid reeducation in patients with massive irreparable degenerative rotator cuff tears".






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