Favorable Clinical Outcomes After Humeral Head Depressor Muscle Coactivation Training With EMG for Patients With Arthroscopic Rotator Cuff Repair: A Randomized Controlled Trial

Overview

Journal Sports Health

Publisher Sage Publications

Specialty Orthopedics

Date 2024 Mar 19

PMID 38499998

Authors

Caner Kararti

Anil Ozudogru

Hakki Cagdas Basat

Ismail Ozsoy

Affiliations

Soon will be listed here.

Abstract

Background: The coactivation (Co-A) of shoulder muscles that contribute to humeral head depression can lead to mechanical unloading of the subacromial structures during abduction and thus can be beneficial for patients with arthroscopic rotator cuff repair (ARCR). The present study aims to examine the effectiveness of humeral head depressor muscle Co-A (DM-Co-A) training on clinical outcomes in a sample of patients with ARCR.

Hypothesis: We hypothesized that DM-Co-A training with medioinferior vector during glenohumeral exercises can improve clinical results in the rehabilitation of ARCR.

Study Design: Randomized controlled single-blind study.

Level Of Evidence: Level 1B.

Methods: A total of 27 patients who underwent ARCR after a medium-sized rotator cuff tear and completed their Phase 1 training with ≥80% compliance were included. Together with 14 weeks of conservative treatment (6 weeks of Phase 2 training and 8 weeks of Phase 3 training), synchronized "DM-Co-A Training" was applied to the treatment group with an electromyography (EMG) biofeedback (EMG-BF) device. Patients in the treatment group were asked to voluntarily activate the humeral head depressor muscles guided by visual and auditory feedback of the EMG-BF device during the Phase 2 and Phase 3 conservative treatment exercises performed by the control group. Demographic characteristics of the participants were recorded. Visual analog scale and universal goniometer were used to assess pre- and posttreatment pain severity and joint range of motion, respectively. The Disabilities of Arm, Shoulder and Hand Questionnaire, Revised Oxford Shoulder Score, Modified Constant-Murley Shoulder Score, and the Western-Ontario Rotator Cuff Index were used to assess functionality.

Results: There was a clinically meaningful improvement in pain severity, active ROM excluding internal rotation, and functionality in the treatment group compared with the control group ( < 0.05).

Conclusion: A 14-week duration DM-Co-A with EMG may be beneficial in the postoperative rehabilitation of patients after ARCR.

References

Tashjian R, Deloach J, Porucznik C, Powell A . Minimal clinically important differences (MCID) and patient acceptable symptomatic state (PASS) for visual analog scales (VAS) measuring pain in patients treated for rotator cuff disease. J Shoulder Elbow Surg. 2009; 18(6):927-32. DOI: 10.1016/j.jse.2009.03.021. View

Bhatt C, Prajapati B, Patil D, Patel V, Singh B, Mehta C . Variation in the insertion of the latissimus dorsi & its clinical importance. J Orthop. 2014; 10(1):25-8. PMC: 3768243. DOI: 10.1016/j.jor.2013.01.002. View

Ekeberg O, Bautz-Holter E, Keller A, Tveita E, Juel N, Brox J . A questionnaire found disease-specific WORC index is not more responsive than SPADI and OSS in rotator cuff disease. J Clin Epidemiol. 2009; 63(5):575-84. DOI: 10.1016/j.jclinepi.2009.07.012. View

Dawson J, Rogers K, Fitzpatrick R, Carr A . The Oxford shoulder score revisited. Arch Orthop Trauma Surg. 2008; 129(1):119-23. DOI: 10.1007/s00402-007-0549-7. View

Overbeek C, Kolk A, De Groot J, Visser C, van der Zwaal P, Jens A . Altered Cocontraction Patterns of Humeral Head Depressors in Patients with Subacromial Pain Syndrome: A Cross-sectional Electromyography Analysis. Clin Orthop Relat Res. 2019; 477(8):1862-1868. PMC: 7000021. DOI: 10.1097/CORR.0000000000000745. View

Jeong Y, Yum J, Park S . Another Assessment of Fat Degeneration of Retracted Supraspinatus Muscle. Clin Shoulder Elb. 2020; 21(4):200-206. PMC: 7726405. DOI: 10.5397/cise.2018.21.4.200. View

Price D, McGrath P, Rafii A, Buckingham B . The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain. 1983; 17(1):45-56. DOI: 10.1016/0304-3959(83)90126-4. View

de Witte P, Henseler J, van Zwet E, Nagels J, Nelissen R, de Groot J . Cranial humerus translation, deltoid activation, adductor co-activation and rotator cuff disease - different patterns in rotator cuff tears, subacromial impingement and controls. Clin Biomech (Bristol). 2013; 29(1):26-32. DOI: 10.1016/j.clinbiomech.2013.10.014. View

El O, Bircan C, Gulbahar S, Demiral Y, Sahin E, Baydar M . The reliability and validity of the Turkish version of the Western Ontario Rotator Cuff Index. Rheumatol Int. 2006; 26(12):1101-8. DOI: 10.1007/s00296-006-0151-2. View

10.

Boudreau N, Gaudreault N, Roy J, Bedard S, Balg F . The Addition of Glenohumeral Adductor Coactivation to a Rotator Cuff Exercise Program for Rotator Cuff Tendinopathy: A Single-Blind Randomized Controlled Trial. J Orthop Sports Phys Ther. 2018; 49(3):126-135. DOI: 10.2519/jospt.2019.8240. View

11.

Lugo R, Kung P, Ma C . Shoulder biomechanics. Eur J Radiol. 2008; 68(1):16-24. DOI: 10.1016/j.ejrad.2008.02.051. View

12.

Ward S, Sarver J, Eng C, Kwan A, Wurgler-Hauri C, Perry S . Plasticity of muscle architecture after supraspinatus tears. J Orthop Sports Phys Ther. 2010; 40(11):729-35. PMC: 4321894. DOI: 10.2519/jospt.2010.3279. View

13.

Moosmayer S, Lund G, Seljom U, Haldorsen B, Svege I, Hennig T . At a 10-Year Follow-up, Tendon Repair Is Superior to Physiotherapy in the Treatment of Small and Medium-Sized Rotator Cuff Tears. J Bone Joint Surg Am. 2019; 101(12):1050-1060. DOI: 10.2106/JBJS.18.01373. View

14.

Iamsaard S, Thunyaharn N, Chaisiwamongkol K, Boonruangsri P, Uabundit N, Hipkaeo W . Variant insertion of the teres major muscle. Anat Cell Biol. 2012; 45(3):211-3. PMC: 3472149. DOI: 10.5115/acb.2012.45.3.211. View

15.

Andrade R, Araujo R, Tucci H, Martins J, Oliveira A . Coactivation of the shoulder and arm muscles during closed kinetic chain exercises on an unstable surface. Singapore Med J. 2011; 52(1):35-41. View

16.

Keener J, Wei A, Kim H, Steger-May K, Yamaguchi K . Proximal humeral migration in shoulders with symptomatic and asymptomatic rotator cuff tears. J Bone Joint Surg Am. 2009; 91(6):1405-13. PMC: 2686133. DOI: 10.2106/JBJS.H.00854. View

17.

de Witte P, van der Zwaal P, Visch W, Schut J, Nagels J, Nelissen R . Arm adductor with arm abduction in rotator cuff tear patients vs. healthy -- design of a new measuring instrument [corrected]. Hum Mov Sci. 2012; 31(2):461-71. DOI: 10.1016/j.humov.2011.08.007. View

18.

Meyer D, Wieser K, Farshad M, Gerber C . Retraction of supraspinatus muscle and tendon as predictors of success of rotator cuff repair. Am J Sports Med. 2012; 40(10):2242-7. DOI: 10.1177/0363546512457587. View

19.

van Kampen D, Willems W, Van Beers L, Castelein R, Scholtes V, Terwee C . Determination and comparison of the smallest detectable change (SDC) and the minimal important change (MIC) of four-shoulder patient-reported outcome measures (PROMs). J Orthop Surg Res. 2013; 8:40. PMC: 3842665. DOI: 10.1186/1749-799X-8-40. View

20.

Juul-Kristensen B, Larsen C, Eshoj H, Clemmensen T, Hansen A, Bo Jensen P . Positive effects of neuromuscular shoulder exercises with or without EMG-biofeedback, on pain and function in participants with subacromial pain syndrome - A randomised controlled trial. J Electromyogr Kinesiol. 2019; 48:161-168. DOI: 10.1016/j.jelekin.2019.07.009. View