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Rotator Cuff Repair – Remote Rehabilitation

28/07/2020
Physiotherapy

Rotator cuff disease is reported to be the most common cause for shoulder pain, with increasing rates of surgery over the last decade.Most people with an impingement or small tear can return to good function without surgery, however for those who do undergo surgery, intense surgical care and physiotherapy pre and post-operatively is necessary for reducing recurrent tears and restoring full function.2

The early stages of Rotator Cuff rehabilitation aim to protect the repair and reduce pain, discomfort and inflammation. This is followed by progressive restoration of function and passive, assisted-active and active range of motion.2

TENS or Transcutaneous Electrical Nerve Stimulation is an effective modality for managing pain without the side effects that some medications can have. TENS machines are generally portable, convenient, and affordable, and patients can begin treatment under the supervision of a healthcare professional (potentially even via a telehealth consultation) before continuing use independently. They are therefore excellent tools to help manage pain and rehabilitation from home.

Another type of electrical nerve stimulation, NMES (Neuro-Muscular Electrical Stimulation or muscle stim) is also useful for rotator cuff rehab. NMES devices primarily stimulate muscle tissue and have been shown to be an effective adjunct in reducing muscle weakness and inhibition that occurs immediately post-injury and post-operatively.3 Compex is the market leading, feature-rich brand for NMES devices, although some TENS devices such as the Chattanooga Cefar TENS are also capable of delivering NMES

Beyond managing pain and swelling, regaining range of motion, strength and motor control in the shoulder, trunk and distal upper limb is key to a successful outcome following shoulder surgery. As experts in exercise prescription, many physios will have their preferred exercise protocol, and this is often guided by the surgeon’s advice.

For range of motion exercises, low cost and simple options such as shoulder pulleys can be used effectively from your patients home. This video from the Physical Therapy Advisor establishes passive and active-assisted ROM exercises using an over-the-door shoulder pulley.

Strengthening of the rotator cuff, periscapular, and other shoulder muscles can be accomplished through the use of resistance exercise bands. Door anchors and hand grips make performing these exercises easier, more comfortable and safer. Using the correct strength of resistance band is important to ensure and appropriate load, as well as progressing the patient to a stronger band when appropriate.

While treating patients remotely currently presents a challenge to the Allied Health industry, there is a great range of resources online and products that can assist you in rehabilitating your patient. DJO has recently released a comprehensive Video Gallery which also contains a range of videos for the treatment of Rotator Cuff Pathologies. Click here to view the Video Gallery.

Do you need additional assistance or product support? Our DJO representatives are still accessible via video and would be happy to assist! Contact us here.

References:
1. Neuromuscular Electrical Stimulation (NMES) for Improving Outcomes Following Total Knee Arthroplasty (TKA) – Full Text View – ClinicalTrials.gov. Clinicaltrials.gov. (2020). Retrieved 17 April 2020, from https://clinicaltrials.gov/ct2/show/NCT03044028.
2. Sgroi, T. A., & Cilenti, M. (2018). Rotator cuff repair: post-operative rehabilitation concepts. Current reviews in musculoskeletal medicine11(1), 86–91. https://doi.org/10.1007/s12178-018-9462-7
3. Reinold, M., Macrina, L., Wilk, K., Dugas, J., Cain, E., & Andrews, J. (2008). The Effect of Neuromuscular Electrical Stimulation of the Infraspinatus on Shoulder External Rotation Force Production after Rotator Cuff Repair Surgery. The American Journal Of Sports Medicine36(12), 2317-2321. https://doi.org/10.1177/0363546508322479