Supervised versus Uncontrolled Rehabilitation of Patients after Rotator Cuff Repair-Clinical and Neurophysiological Comparative Study

Abstract

PURPOSE: The purpose of this study was the evaluation of the effectiveness of supervised rehabilitation in comparison to uncontrolled exercise therapy after surgical reconstruction of rotator cuff interrupted tendons. METHODS: Twenty two patients with comparable level of disability after the same type of surgery were randomly divided into two equal groups. The first group took part in a supervised therapy and the second one performed simple exercises without supervision. Clinical and neurophysiological examinations were performed prior to rehabilitation and after 20 and 40 days of treatment. The evaluation included the assessment of the pain level with visual analog scale, active range of motion with gonio-meter, activity of muscle's motor units at rest and during maximal effort with electromyography and transmission of motor fibers in brachial plexus with electroneurography (M-wave stimulation studies). RESULTS: In the group of supervised patients the active range of movement changed significantly from 26.4º to 101.5º on average for flexion with adduction while flexion with abduction improved from 21º to 95.5º. Pain sensation changed from 6.4 to 3.2. The mean resting electromyogram amplitude decreased to the greatest degree from 80.9 µV to 36.8 µV in trapezius muscle while maximal effort electromyogram amplitude increased in this muscle from 381.8 µV to 790.9 µV. The mean values of amplitudes in electroneurographical suprascapular nerve examinations increased from 536.4µV to 1691µV. No significant differences at P=0.05 were found in these parameters recorded in the patients performing uncontrolled exercises. CONCLUSION: The supervised exercise therapy is more effective than uncontrolled one after the rotator cuff surgical reconstruction.