1.Effects of elevation on shoulder joint motion: comparison of dynamic and static conditions
Takaki IMAI ; Takashi NAGAMATSU ; Junichi KAWAKAMI ; Masaki KARASUYAMA ; Nobuya HARADA ; Yu KUDO ; Kazuya MADOKORO
Clinics in Shoulder and Elbow 2023;26(2):148-155
Although visual examination and palpation are used to assess shoulder motion in clinical practice, there is no consensus on shoulder motion under dynamic and static conditions. This study aimed to compare shoulder joint motion under dynamic and static conditions. Methods: The dominant arm of 14 healthy adult males was investigated. Electromagnetic sensors attached to the scapular, thorax, and humerus were used to measure three-dimensional shoulder joint motion under dynamic and static elevation conditions and compare scapular upward rotation and glenohumeral joint elevation in different elevation planes and angles. Results: At 120° of elevation in the scapular and coronal planes, the scapular upward rotation angle was higher in the static condition and the glenohumeral joint elevation angle was higher in the dynamic condition (P<0.05). In scapular plane and coronal plane elevation 90°– 120°, the angular change in scapular upward rotation was higher in the static condition and the angular change in scapulohumeral joint elevation was higher in the dynamic condition (P<0.05). No differences were found in shoulder joint motion in the sagittal plane elevation between the dynamic and static conditions. No interaction effects were found between elevation condition and elevation angle in all elevation planes. Conclusions: Differences in shoulder joint motion should be noted when assessing shoulder joint motion in different dynamic and static conditions. Level of evidence: Level III, diagnostic cross-sectional study.
2.Does physiotherapy after rotator cuff repair require supervision by a physical therapist?: a meta-analysis
Masaki KARASUYAMA ; Masafumi GOTOH ; Takuya OIKE ; Kenichi NISHIE ; Manaka SHIBUYA ; Hidehiro NAKAMURA ; Hiroki OHZONO ; Junichi KAWAKAMI
Clinics in Shoulder and Elbow 2023;26(3):296-301
Background:
A supervised physiotherapy program (SPP) is a standard regimen after surgical rotator cuff repair (RCR); however, the effect of a home-based exercise program (HEP), as an alternative, on postoperative functional recovery remains unclear. Therefore, the purpose of this meta-analysis was to compare the functional effects of SPP and HEP after RCR.
Methods:
We searched electronic databases including Central, Medline, and Embase in April 2022. The primary outcomes included the Constant score, American Shoulder and Elbow Surgeons score, University of California Los Angeles shoulder score, and pain score. Secondary outcomes included range of motion, muscle strength, retear rate, and patient satisfaction rate. A meta-analysis using random-effects models was performed on the pooled results to determine the significance.
Results:
The initial database search yielded 848 records, five of which met our criteria. Variables at 3 months after surgery were successfully analyzed, including the Constant score (mean difference, −8.51 points; 95% confidence interval [CI], −32.72 to 15.69; P=0.49) and pain score (mean difference, 0.02 cm; 95% CI, −2.29 to 2.33; P=0.99). There were no significant differences between the SPP and HEP. Other variables were not analyzed owing to the lack of data.
Conclusions
Our data showed no significant differences between SSP and HEP with regard to the Constant and pain scores at 3 months after RCR. These results suggest that HEP may be an alternative regimen after RCR.Level of evidence: I.
3.Clinical results of conservative management in patients with full-thickness rotator cuff tear: a meta-analysis
Masaki KARASUYAMA ; Masafumi GOTOH ; Keiji TAHARA ; Junichi KAWAKAMI ; Kazuya MADOKORO ; Takashi NAGAMATSU ; Takaki IMAI ; Nobuya HARADA ; Yu KUDO ; Naoto SHIBA
Clinics in Shoulder and Elbow 2020;23(2):86-93
Background:
Several systematic reviews have reported on the conservative treatment of full-thickness rotator cuff tears; however, clinical results of this treatment still remain determined.
Methods:
PubMed, Cochrane Library, PEDro, and CINAHL databases were systematically searched for randomized clinical trials and observational studies. Two independent researchers reviewed a total of 2,981 articles, 28 of which met the criteria for inclusion in the study. Clinical outcome measures included Constant score, visual analog scale score for pain, range of motion, and short-form 36. The meta-analysis used a linear mixed model weighted with the variance of the estimate.
Results:
The meta-analysis showed a significant improvement after surgery. Pain score is 26.2 mm (1 month) to 26.4 mm (3 months) and 24.8 mm (12 months) (P<0.05); active abduction: 153.2º (2 months), 159.0º (6 months), 168.1º (12 months) (P<0.05); Constant score: 67.8 points (2 months) to 77.2 points (12 months) (P<0.05); short-form 36 “vitality” section: 57.0 points (6 months) and 70.0 points (12 months) (P<0.05).
Conclusions
Our data confirmed the effectiveness of conservative treatment in patients with full-thickness rotator cuff tears 12 months post-intervention. The results suggest that conservative treatment for patients with full-thickness rotator cuff tears should be the first line of treatment before considering surgery.