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Background General scapular exercises have been included in traditional postoperative rehabilitation for rotator cuff tears, but patients with concomitant scapular dyskinesia do not have identical scapular muscle imbalances, and general scapular exercises make it difficult to improve scapular movement. We hypothesized that identifying weak scapular muscle groups and strengthening training would improve scapular movement. Methods A total of 60 rotator cuff tear patients with scapular dyskinesia were included in the study, 20 in the experimental group and 40 in the control group. Patients in the control group received traditional rehabilitation following rotator cuff repair, while patients in the experimental group performed additional selective scapular muscle rehabilitation exercises. Constant-Murley Score (CMS), shoulder mobility, VAS scores, SF-12 scores, and scapular motion were assessed in both groups at 16 weeks postoperatively. Results At 16-week follow-up, the experimental group showed better CMS (87.2 ± 4.4 vs. 83.9 ± 4.8) and shoulder anteflexion (137 ± 13.0 vs. 127.9 ± 12.2°) and abduction mobility (133.1 ± 15.4 vs. 121.4 ± 13.8°) compared to the control group. The experimental group had better improvements in scapular upward rotation (42.8 ± 11.7 vs. 35.3 ± 9.6°) and anterior tilt (12.9 ± 4.2 vs. 6.4 ± 2.0°) during shoulder anteflexion versus the control group. During shoulder abduction, the experimental group had better improvements in scapular anterior tilt (12.8 ± 3.3 vs. 9.1 ± 3.0°) versus the control group. Conclusions This study provides an additional exercise program targeting the scapular muscle groups for postoperative rehabilitation in rotator cuff tear patients with scapular dyskinesis. By identifying imbalanced muscles through electromyographic testing, and performing selective muscle strengthening exercises, better shoulder mobility and scapular motion performance can be achieved. Trial registration (Chinese Clinical Trial Registry ( https://www.chictr.org.cn ), ChiCTR2400087465, July 29, 2024, prospectively registered.)

Background Degenerative rotator cuff tears are common and are often treated with surgical repair. Randomised trials have not shown a clear advantage to surgery over non-surgical treatment, but there have been no published placebo-controlled trials investigating rotator cuff repair. This study aims to compare arthroscopic shoulder surgery with rotator cuff repair to surgery without rotator cuff repair (placebo) for improving shoulder pain and function in people with shoulder pain and full-thickness degenerative rotator cuff tears. Methods The study is a multicentre two-parallel arm, blinded, individually randomised controlled trial (RCT). Participants will be people aged 40–75 years (inclusive) with more than 6 months of shoulder pain, a degenerative (non-traumatic) full thickness rotator cuff tear 1 to 4 cm in length for whom surgery is recommended and repair of the tear is the main reason for surgery. The intervention is arthroscopic surgery (including—as indicated—bursectomy, debridement, acromioclavicular joint resection, acromioplasty and biceps tenodesis or tenotomy) with rotator cuff repair. The control is the same arthroscopic shoulder surgery without rotator cuff repair. Participants will be randomised to cuff repair or no cuff repair in a 1:1 ratio intra-operatively, after all other surgical procedures have been performed. Participants, follow-up surgeons, physiotherapists, study staff and statisticians will be blinded. Post-surgical rehabilitation will be usual care for rotator cuff repair in both groups. The primary outcome will be shoulder pain and function measured using the Western Ontario Rotator Cuff Index at 6 months post-surgery. Discussion The ARC trial will provide low bias evidence on a common surgical procedure: rotator cuff repair for degenerative tears. Trial registration The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000789965) on 5 August 2020 and the WHO International Clinical Trials Registry Platform (universal trial number U1111-1251-6599).

Background Massive degenerative rotator cuff tears (MRCTs) represent a persistent challenge in shoulder surgery. While arthroscopic rotator cuff repair (ARCR) remains a widely accepted treatment with good functional outcomes, it is associated with a risk of retear and progression to cuff tear arthropathy. Reverse shoulder arthroplasty (RSA) has emerged as a viable alternative, particularly in cases where the reparability of the cuff is uncertain, offering pain relief and functional improvement. However, the optimal treatment approach for repairable MRCT in patients aged 60 to 80 years remains debated. This trial aims to assess whether RSA provides non-inferior outcomes to ARCR in patients with degenerative MRCTs, with a particular focus on function, pain, and quality of life. Methods This is a prospective, randomized, controlled, non-inferiority trial. A total of 145 patients with symptomatic, repairable MRCT will be enrolled and randomized in a 1:1 ratio to undergo either ARCR or RSA. The primary outcome is the American Shoulder and Elbow Surgeons (ASES) score at 24 months postoperatively. Secondary outcomes include ASES at 6 weeks and 6 months; Visual Analog Scale (VAS) for pain; Single Assessment Numeric Evaluation (SANE); Constant score; range of motion (ROM) in flexion, extension, and internal/external rotation; repair integrity (ultrasound for ARCR, radiographs for RSA); and complication rates. PROMs will be assessed at baseline, 1.5, 6, and 24 months. All adverse events and complications will be systematically recorded. Discussion This trial will provide robust comparative data to assess whether RSA is non-inferior to ARCR at two years postoperatively in terms of shoulder function and patient-reported outcomes in patients with repairable MRCT. The results aim to support evidence-based decision-making in clinical practice. Trial registration The protocol was approved by the Ethics Committee Board (CCER 2023–00111) in March 2023 and by ClinicalTrial.gov (NCT05807854).

Introduction Pain management and prevention of muscle atrophy are key rehabilitation challenges following arthroscopic rotator cuff repair (ARCR). Despite the potential muscle atrophy-reducing and analgesic effects of neuromuscular electrical stimulation (NMES), evidence supporting its use in post-ARCR rehabilitation remains limited. This study aimed to evaluate the clinical efficacy of home-based NMES intervention for promoting early functional recovery after ARCR. Methods A total of 63 ARCR patients were randomized into the NMES group ( n  = 32) and MENS (Micro-current electrical nerve stimulation) group ( n  = 31), both receiving a 6-week home-based intervention (5 sessions weekly, 30 min per session) following surgery. The NMES group used neuromuscular electrical stimulation equipment, while the MENS group used identical devices without current output. The primary outcome was the Constant-Murley Shoulder (CMS) score, with secondary outcomes including resting and active visual analog scale (VAS) pain scores, deltoid muscle thicknes, shoulder range of motion (ROM), muscle strength, and Tampa Scale for Kinesiophobia scores. Assessments were conducted preoperatively, at 6 weeks, and 3 months postoperatively. Results At 6 weeks postoperatively, the NMES group exhibited a significantly higher CMS than the MENS group (76.10 ± 9.43 vs. 71.22 ± 9.2 p  = 0.032), along with superior active pain relief (active VAS: 4.1 ± 0.9 vs. 3.4 ± 0.7 p  = 0.003), greater forward flexion ROM (151.7 ± 11.3 vs. 141.8 ± 13.6 p  = 0.003), and thicker deltoid muscle thickness (1.02 ± 0.06 vs. 0.91 ± 0.06 p  < 0.001). The NMES group also demonstrated lower TSK scores (31.06 ± 6.69 vs. 35.42 ± 7.76 p  = 0.020) and greater adductor strength (40.9 ± 16.7 vs. 33.5 ± 12.2 p  = 0.048). By 3 months postoperatively, intergroup differences persisted only in abductor ROM, muscle strength, and deltoid thickness, with no significant disparities in other measured indices. Conclusions Home-based NMES effectively accelerates functional recovery, enhances pain management, and mitigates kinesiophobia within 6 weeks post-ARCR, with partial maintenance of these benefits at the 3-month follow-up. This intervention offers a safe adjunctive strategy for early rehabilitation, particularly suited to patients requiring rapid functional restoration; however, long-term efficacy remains to be confirmed.To evaluate the acceptability of MyCheck for asymptomatic sexually transmissible infections (STIs) testing. Trial registration (Chinese Clinical Trial Registry ( https://www.chictr.org.cn ), No. ChiCTR2400088194, 13/08/2024)

Background Rotator cuff tear is a common cause of shoulder disability and results in patients predominantly complaining of pain and loss of motion and strength. Traumatic rotator cuff tears are typically managed surgically followed by ~ 20 weeks of rehabilitation. However, the timing and intensity of the postoperative rehabilitation strategy required to reach an optimal clinical outcome is unknown. Early controlled and gradually increased tendon loading has been suggested to positively influence tendon healing and recovery. The aim of this trial is therefore to examine the effect of a progressive rehabilitation strategy on pain, physical function and quality of life compared to usual care (that limits tendon loading in the early postoperative phase) in patients who have a rotator cuff repair of a traumatic tear. Methods The current study is a randomized, controlled, outcome-assessor blinded, multicenter, superiority trial with a two-group paralleled design. A total of 100 patients with surgically repaired traumatic rotator cuff tears will be recruited from up to three orthopedic departments in Denmark, and randomized to either a progressive early passive and active movement program or a limited early passive movement program (usual care). The primary outcome measure will be the change from pre-surgery to 12 weeks post-surgery in the Western Ontario Rotator Cuff Index questionnaire. Secondary outcomes include the Disabilities Arm, Shoulder and Hand questionnaire (DASH), range of motion, strength and tendon healing characteristics from ultrasound measurements at 12 months follow up. Discussion We hypothesized that patients who receive the progressive rehabilitation strategy will benefit more with respect to pain reduction, physical function and quality of life than those who receive care as usual. If this is confirmed our study can be used clinically to enhance the recovery of patients with traumatic rotator cuff tear. Trial registration ClinicalTrials.gov, NCT02969135 . Registered on 15 November 2016.

Objective Rotator cuff tears are one of the most common causes of chronic shoulder pain and disability. They significantly affect the quality of life. Reduced pain and improved function are the goals of conventional therapy, which includes relative rest, pain therapy, physical therapy, corticosteroid injections and surgical intervention. Tendons have a relative avascular nature; hence, their regenerative potential is limited. There is some clinical evidence that the application of autologous platelets may help to revascularize the area of injury in rotator cuff pathologies. Patients and methods This prospective randomized controlled study was done to evaluate the results of subacromial injection of platelet-rich plasma (PRP) versus corticosteroid injection therapy in 40 patients with symptomatic partial rotator cuff tears. All patients were assessed before injection, 6 weeks, 3 and 6 months after injection, using the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), the Constant–Murley Score (CMS), the Simple Shoulder Test (SST) and a Visual Analog Scale (VAS) for pain. An MRI was performed before and 6 months after the injection for all the included patients and was graded on 0–5 scale. Results Both injection groups showed statistically significantly better clinical outcomes over time compared with those before injection. There was a statistically significant difference between RPP group and corticosteroid group 12 weeks after injection, regarding VAS, ASES, CMS and SST in favor of the RPP group. MRI showed an overall slight nonsignificant improvement in grades of tendinopathy/tear in both groups, however, without statistically significant differences between the two groups. Conclusion PRP injections showed earlier better results as compared to corticosteroid injections, although statistically significant better results after 6 months could not be found. Therefore, subacromial RPP injection could be considered as a good alternative to corticosteroid injection, especially in patients with a contraindication to corticosteroid administration. Level of evidence II.

BackgroundThe management of massive, irreparable rotator cuff tears (RCT) is challenging and associated with high failure rates. There are no current consensus or definitive guidelines concerning the optimal surgical treatment for this devastating condition. This study was designed to confirm the long-term safety and efficacy of the biodegradable inflatable InSpace™ system in patients with massive reparable or irreparable RCTs.MethodsIn this open-label, single arm, prospective study, subjects with massive RCT underwent subacromial implantation with the biodegradable spacer. Follow-up visits were scheduled according to routine clinical practice. Shoulder function was evaluated using Total Constant Score (TCS).ResultsTwenty-four patients were treated and assessed. Four patients had partial tears, and in three of them RC repair was performed. These patients were not included in the efficacy analyses. Of the participating subjects who reached the 5-year follow-up, 84.6% of the patients showed a clinically significant improvement of at least 15 points in their score, while 61.54% showed at least 25 points of improvement. Only 10% of the treated patients showed no improvement or worsening in the shoulder score comparing to their baseline. An overall improvement in the total CS commencing at 3 months and sustained by 6 months through to 5 years of follow-up (P < 0.0001) was demonstrated.ConclusionsWe conclude that in this initial cohort, arthroscopic implantation of InSpace™ system represented an effective alternative to the existing arthroscopic procedures in patients with painful massive RCT refractory to conservative management. Further randomized controlled trials comparing the clinical and functional outcomes after implantation of the InSpace™ device are warranted.

Purpose The purpose of the study was to compare the safety and efficacy of autologous mesenchymal stem cells (MSCs) embedded in a xenogenic scaffold for repairing the supraspinatus tendon. Methods This was a randomized, double-blind and placebo-controlled trial evaluating patients with full-thickness rotator cuff tears (Eudra-CT, 2007–007630-19). Effectiveness was evaluated using the Constant score and a visual analogue pain scale (VAS). Constant score has four domains including pain (15 possible points), activities of daily living (20 possible points), mobility (40 possible points), and strength (25 possible points). Scores range from 0 points (most disability) to 100 points (least disability). The structural integrity of the repaired tendon was assessed by magnetic resonance imaging (MRI) according to Patte and Thomazeau classification criteria. The primary study end point was an improvement in the Constant score by 20 points at one year compared to initial assessment. Results The trial was stopped due to adverse effects observed in both groups. Only thirteen patients were included and analyzed. The Constant questionnaire showed a significant improvement in the MSC treatment group compared with the preoperative data (p = 0.0073). Secondary outcome measures were similar in both groups. Conclusions Our study showed preliminary inconclusive clinical outcomes in the patients treated with MSCs. Adverse events revealed the need for further approaches using scaffolds of a different nature or perhaps no scaffolds, in the context of small joints. Trial registration Eudra-CT, 2007-007630-19 . Registered on 30 January 2008. Level of evidence A Level 1 of evidence treatment study.

Rotator cuff disease treatment typically involves manual therapy and exercise as part of physical therapy. This study aims to investigate the effects of Mulligan and Maitland mobilization methods on pain, functionality, quality of life, and proprioception in individuals with rotator cuff lesions. This was a single-blinded randomized clinical trial. The study included 45 individuals with rotator cuff lesions. Participants were randomly divided into three groups: conventional exercise, Maitland mobilization, and Mulligan mobilization. All participants were assessed pretreatment and post treatment using the Visual Analog Scale, Disabilities of the Arm, Shoulder, and Hand, Rotator Cuff Quality of Life, range of motion (ROM), and proprioception. All parameters, except proprioception, improved significantly in all three groups post treatment (p < 0.05). Mulligan group (MG) and Maitland mobilization group (MMG) had higher improvements to the conventional exercise group (CG) in terms of flexion ROM (p = 0.05, effect size = 0.22), abduction ROM (p = 0.02, effect size = 0.26), Disabilities of the Arm, Shoulder, and Hand (p < 0.001, effect size = 0.56). Also, the MG group had greater improvements to the MMG and CG groups in terms of Rotator Cuff Quality of Life/symptoms (p < 0.001, effect size = 0.43), job (p < 0.001, effect size = 0.61), lifestyle (p < 0.001, effect size = 0.42), emotional parameters (p < 0.001, effect size = 0.29). MG was more effective than the MMG in Visual Analog Scale activity (p < 0.001, effect size = 0.32), external rotation (p = 0.012, effect size = 0.19), and abduction ROM (p = 0.002, effect size = 0.26). However, no improvement in proprioception was observed across all groups (p > 0.05). This study concluded that, in addition to conventional treatment, both Mulligan and Maitland mobilization therapy effectively improve range of motion, functionality, and quality of life. •All groups showed improvements in pain, ROM, functionality, and QoL.•MG outperformed the exercise group in pain, functionality, ROM, and QoL.•MMG outperformed the conventional exercise group in functionality, ROM, and QoL.•MG outperformed MMG in functionality, ROM, and QoL.•No improvement was observed in the proprioception parameter across all groups.

Treatment of rotator cuff (RTC) tears commonly involves manual therapy, exercise, and injection methods. These treatments are typically administered together as components of a physical therapy intervention. However, it is not known which intervention is more effective. The objective of this study was to examine the impact of mobilization with movement (MWM) mobilization, a technique from Mulligan approaches, and corticosteroid (CS) injection on pain, functionality, and proprioception in cases of RTC tears. This was a single-blinded randomized clinical trial. Participants with RTC tears (n = 60) were divided into Mulligan mobilization (MM) and CS groups. The participants in the MM group performed mobilization with movement and a conventional exercise program; the CS group received a CS injection in addition to conventional exercises. The Visual Analog Scale, The Disabilities of the Arm, Shoulder, and Hand questionnaire, active range of motion (AROM), and joint position sense (JPS) were evaluated. The outcomes were analyzed using effect size, minimum clinically important difference, minimal detectable change, Wilcoxon test, and Mann-Whitney U test. Both groups significantly improved in all measured outcomes at 3 weeks. The MM group showed significantly better (p < 0.05, Cohen d range 0.82-3.2) results in pain, AROM (Flexion, abduction, extension, external rotation, internal rotation), and proprioception (30° and 60° of flexion and abduction). Between-group differences in AROM were also clinically meaningful as they exceeded their MDC90 and minimum clinically important difference values. Although both of these treatment methods may be successful in the short-term management of chronic RTC, the MM approach combined with conventional exercises seems to be a more effective approach for improving shoulder pain, function, and proprioception in this patient population. NCT05933382 •CS and MWM techniques are effective treatments for individuals with RTC tear.•The MWM technique has more advantages in the improvement of JPS and AROM.•The MWM technique, without side effects, could benefit those with RTC tear.