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Post-operative rehabilitation following surgical interventions for rotator cuff injury
Rotator cuff injuries of the shoulder account for a significant portion of the soft tissue injuries in the upper extremity. Tendinopathy and tears of the rotator cuff tendon are common presentations in sports medicine, causing significant pain and restricted movement of the arm, compromising patients’ daily activities, participation in sport and exercise, and ability to work. Arthroscopic rotator cuff repair is the most popular surgical treatment for rotator cuff pathology. In Australia, approximately 14,000 rotator cuff repairs are carried out each year, with an estimated cost of $A250 million. For patients with long-standing rotator cuff dysfunction, advanced joint arthropathy, recurring tears and failed repairs, reverse total shoulder arthroplasty (rTSA) is an end stage surgical solution which has demonstrated good outcomes.
Post-operative rehabilitation is a critical part of the treatment paradigm following surgery addressing rotator cuff injury. Specific exercises to improve mobility and strengthen of the rotator cuff are commonly prescribed after rotator cuff repair, however, debate and uncertainty currently exists regarding the period of post-surgical immobilisation, the amount of load permitted at the repair site throughout the early post-operative stages, and when and how to safely graduate this progressive loading stimulus. Furthermore, while the popularity of rTSA is increasing, optimal postoperative rehabilitation is unknown and research regarding the long-term outcomes of patients following rTSA is scarce.
The research will initially involve two observational studies investigating electromyographical (EMG) activity in the musculature around the glenohumeral joint, during activities of daily living and rehabilitation exercises commonly used in the clinical setting after rotator cuff surgery. Data obtained from these studies will be used to develop two “optimal” rehabilitation protocols for rotator cuff repair and rTSA respectively and measure them against conservative care in two randomised control trials.
The implications from this research project will advance the clinical knowledge and practical application of exercise rehabilitation after shoulder surgery to enhance post-operative success rates, improve functional outcomes and accelerate recovery of muscle function