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Annotated BibliographyJosh BushROM rehabilitation after Arthroscopic Rotator Cuff Repair SurgeryWang C, Lin P, Lee Y, Chuang C, Tsay S, Chu C. Using a nurse invented T-Bar device in a rehabilitation program improved the range of motion for rotator cuff repair patients. Journal Of Clinical Nursing [serial online]. January 2012;21(1/2):121-128. Available from: Academic Search Complete, Ipswich, MA. Accessed January 12, 2015The main focus of this article was to investigate the effects on patient outcomes with the use of a T-bar during rehabilitation after arthroscopic rotator cuff repair surgery. The purpose of the work was to portray the reasoning behind the study and the idea of using a T-bar for rehabilitation. This article was aimed towards an audience of athletic trainers or physical therapists looking to incorporate a more efficient way to have patients passively move their shoulder through range of motion after rotator cuff repair. What the author concludes from the study, a conclusion which I agree with, is that using the non impaired arm to help the impaired shoulder through range of motion inhibits the ability to efficiently move the impaired shoulder through a full range of motion. The T-bar allows for the impaired shoulder to be passively translated through its full range of motion due to the rendition of a longer non impaired arm. This article was helpful with its pictures provided as well as its data documentation layout. Kim Y, Chung S, Kim J, Ok J, Park I, Oh J. Is Early Passive Motion Exercise Necessary After Arthroscopic Rotator Cuff Repair?.American Journal Of Sports Medicine [serial online]. April 2012;40(4):815-821. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed January 12, 2015.The main focus of this article was to discuss the possibility that passive range of motion rehabilitation may not be as important during the early stages of healing after arthroscopic rotator cuff surgery. The defending argument against early ROM rehabilitation is that longer immobilization enhances tendon repair and the quality of the tissue. The intended audience for this article would be for physical therapists working with post-operative rotator cuff repair looking to gain more ROM in the early stages of healing. What the author concluded was that early passive ROM did not significantly increase ROM but it did not hinder tissue repair. It states that passive ROM rehabilitation should depend on the patient’s level of comfort. I believe that even for small and medium thickness tears, if the patient is compliant, passive ROM should be worked into early rehabilitation.Koo S, Burkhart S. Rehabilitation Following Arthroscopic Rotator Cuff Repair.?Clinics In Sports Medicine?[serial online]. January 1, 2010;29(Post-Operative Rehabilitation Controversies in Athletes):203-211. Available from: ScienceDirect, Ipswich, MA. Accessed January 12, 2015.The Main focus of this article was to cover the rehabilitation process after arthroscopic repair of the rotator cuff. My purpose for choosing this article was that it hits on procedures to optimize range of motion and reduce the development of stiffness from immobilization after surgery. This article is aimed at the audience of physical therapists looking to utilize open chained stretching early in the rehab process for increases in ROM. The author concludes that starting with closed chained overstretches such as table slides and delaying open chain overhead stretches until 6 weeks post-surgery is optimal in reducing stiffness without increasing the risk of rupturing the healing tendons and muscles. I believe that any and all open chained stretching and exercising should be delayed until full progression through closed chain stretching and exercises is noted. When the distal segment of the target tissue is freely moving it increases the risk of injury. This article did not give a data table that showed direct progress during the study.Ellenbecker T, Cools A. Rehabilitation of shoulder impingement syndrome and rotator cuff injuries: an evidence-based review.British Journal Of Sports Medicine?[serial online]. April 2010;44(5):319-327. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed January 14, 2015.The main focus of this article was to emphasize the importance of an evidence based rehabilitation protocol when treating a shoulder impingement or rotator cuff pathology patient. My purpose for choosing this article is that it doesn’t just take into account one way of therapy that may or may not work for more than 70% of involved patients, but instead talks about different functions of the shoulder and ways to record progress to base an evidence based rehabilitation routine off of. What the author concluded was that it is important to take into consideration scapular dysfunction, pain, and rotator cuff weakness into consideration when developing the rehabilitation routine. What I found to be the most important is that, along with clinical tests, it is important to record range of motion with strength and pain improvements to ensure efficiency of the rehab program. This article includes helpful images to insist on some stretches and tests to apply routinely throughout rehab. Pabian P, Rothschild C, Schwartzberg R. Rotator cuff repair: considerations of surgical characteristics and evidence based interventions for improving muscle performance.?Physical Therapy Reviews?[serial online]. October 2011;16(5):374-387. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed January 14, 2015.The main focus of this article was to talk about the coordination between the physician as well as the therapist when it comes to the correct protocol of patient rehabilitation after rotator cuff surgery. The reason that I chose this article is because I feel as though rehabilitation should be based more off of the intentions and interventions of the surgery including depth of the tear, functional impairments before surgery, and the method of repair for the surgery. What the author concluded was that he believes that with better communication between the health care physician and the physical therapist could result in a more efficient rehabilitation protocol. What I found helpful in this article were the amount of considerations to make with rotator cuff repair, and ways to work with each. Pictures of the actual methods of repair were included for a better understanding of why adjustments should be made for each.Iosifidis M, Iliopoulos E, Melas I, Alvanos D, Kyriakidis A. Functional rehabilitation of the shoulder after arthroscopic repair of rotator cuff tears.?Muscles, Ligaments & Tendons Journal (MLTJ)?[serial online]. July 2, 2012;:84. Available from: Academic Search Complete, Ipswich, MA. Accessed January 14, 2015.The main focus of this article was to take into consideration the amount of time that must go into post rotator cuff arthroscopic repair rehabilitation and that there are many affecting factors that go into determining the time of rehabilitation. My reason for choosing this article is because it mentions ROM as an important one of those factors. It is important to look at pre-operative range of motion to determine the amount of work that will have to be done to return the shoulder’s ROM to within normal limits. What the author concluded was that with a better pre-operative range of motion came a shorter rehabilitation time. What I didn’t like about this article was that it didn’t contain data taken throughout the study and was only one page, which together limited my understanding of the results. Also, the information was very broad and included a case study that merely contained the time of rehabilitation without consideration of exact pre-operative ROM. Papalia R, Franceschi F, Denaro V, et al. Are platelet rich plasma injections effectiveness after arthroscopic rotator cuff tear repair?.Muscles, Ligaments & Tendons Journal (MLTJ)?[serial online]. July 2, 2012;:43. Available from: Academic Search Complete, Ipswich, MA. Accessed January 14, 2015.The main focus of this article is to further study the unsupported administration of successful injections of platelet rich plasma and its benefits on rotator cuff healing after arthroscopic rotator cuff repair. The reason that I chose this article was because results in range of motion rehabilitation were one of the areas of study for the effects of an injection rather than a different protocol of rehab. If the injection of platelet rich plasma had benefits on increasing progress and healing in rotator cuffs for range of motion alone, we would see great improvements in the rate of which the patient would be able to return to play or activities in daily life (ADL’s).I believe this faster return would occur because of the decrease in risk of reinjuring or pushing the tendons past a length that they are ready for can allow toleration of increased resistance training and therefor a quicker return. What I didn’t like about this article was that it was a very short summary of the study of 38 patients and didn’t give the data from each patient. The author concluded that the injection was not beneficial to rotator cuff healing. This article was aimed at physicians and physical therapists so they may decide if injections of platelet rich plasma would be beneficial to recovery. Brady B, Redfern J, Macdougal G, Williams J. The addition of aquatic therapy to rehabilitation following surgical rotator cuff repair: a feasibility study.?Physiotherapy Research International?[serial online]. September 2008;13(3):153-161. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed January 15, 2015.The main focus of this article was to define whether or not it would effective to utilize the addition of aquatic based rehab along with traditional land based rehab in the rehabilitation of post-operative rotator cuff tears. I chose this article because its main resource for determining whether or not aquatic rehab was beneficial was with range of motion measurements throughout the study. This article is aimed towards physical therapists or athletic trainers with the availability of a swimming or lave pool that may be utilized for therapy. It is also aimed at swimmers that would mentally perform better in a pool if that is where they are comfortable. The author concluded that the inclusion of aquatics bared little risk of injury and should be considered feasible to be included in the rehabilitation program of rotator cuff surgery patients. I liked this article because they included two groups for comparison and instead of totally taking out land based rehab techniques for the independent variable, they simply made it an addition to the traditional land based rehabilitation. Hyldahl S. Use of shoulder CPM and physical therapy for early rehabilitation following rotator cuff repair: a case report.?Orthopaedic Physical Therapy Practice?[serial online]. March 2010;22(1):24-29. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed January 15, 2015.The main focus of this article was to describe a way to return shoulder mobility to full range of pain free movement with the inclusion of continuous passive motion along with traditional physical therapy in the early stages of rehabilitation after rotator cuff repair surgery. The reason that I chose this article was because they were able to achieve full, pain free range of motion for the shoulder’s flexion, abduction, and external rotation by the fourth week of rehab after surgery. I did not have access to the entire PDF file of this article, but I would recommend looking into it because of its results. This article was aimed towards athletic trainers with patients that have severe pre-operative restriction in shoulder range of motion. This study should be utilized on a larger scale, instead of just on one case study of a 58 year old female. I believe that further analysis of early continuous passive motion could help others that have restricted pre-operative shoulder mobility. Ghodadra N, Provencher M, Verma N, Wilk K, Romeo A. Open, mini-open, and all-arthroscopic rotator cuff repair surgery: indications and implications for rehabilitation.?The Journal Of Orthopaedic And Sports Physical Therapy?[serial online]. February 2009;39(2):81-89. Available from: MEDLINE with Full Text, Ipswich, MA. Accessed January 15, 2015.The main focus of this article is to talk about both the indications and implications of rehabilitation after the different types of arthroscopic rotator cuff repair. The article was aimed towards both physicians and physical therapists who have great communication or should learn to have great communication in order to be able to determine an individualized rehabilitation program based on the size and build of the individual, procedure of the surgery, and size of the original tear. The reason I chose this article was because it talks about a rationalized rehabilitation plan that takes into consideration that minimal stress is put on the joint while completing range of motion and mobility exercises in the shoulder in the early stages of healing. Safe motion is important to keep an optimal healing environment for the rotator cuff. This article is not a study but more of a journal because they didn’t have any study groups or measurements. Ellenbecker T, Elmore E, Bailie D. Descriptive Report of Shoulder Range of Motion and Rotational Strength 6 and 12 Weeks Following Rotator Cuff Repair Using a Mini-Open Deltoid Splitting Technique.?Journal Of Orthopaedic & Sports Physical Therapy[serial online]. May 2006;36(5):326-335. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed January 15, 2015.The main focus of this study was to study range of motion in the shoulder, strength of the glenohumeral joint with internal and external rotation with one specific type of arthroscopic rotator cuff repair called the mini open deltoid splitting technique. The reason I chose this article is that it gives a detailed study about average range of motion and strength measurements taken at 6 and 12 weeks after mini open deltoid splitting arthroscopic rotator cuff repair surgery. This is aimed at athletic trainers and physical therapists that are looking for some baseline data to compare their patient’s progress to. One thing that I disagree with this way of using this information is that it is important to remember that all rehabilitation should be evidence based and adjusted to a patient’s individualistic needs. The author concludes that pre-operative work with ROM and strengthening of the rotator cuff allows for successful return of range of motion and strength after 12 weeks of rehab post-surgery.DasSarma S, Mallick A, Bhattacharyya M. Comparative study between hydrokinesio therapy and conventional physiotherapeutic modalities in perspective of rotator cuff impingement: a pilot study.?British Journal Of Sports Medicine?[serial online]. September 2, 2010;44(S1):i11. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed January 16, 2015.The main focus of this article was to turn the reader’s attention away from traditional rehabilitation for shoulder impingement therapy and inform about the possibility of adding hydrokinesio therapy in order to make improvements in pain and range of motion. This article does not deal with any group that previously had arthroscopic rotator cuff surgery of any time, but I chose it because the author saw significant improvements in range of motion measurements and pain free patient shoulder mobility. These findings could be interpreted for use on other patients that have restricted range of motion due to pain after rotator cuff surgery. This article is aimed at physical therapists or athletic trainers that have patients with suspected shoulder impingement problems in the rotator cuff due to the symptoms of pain and reduction in range of motion. This was a comparative study so the rehabilitation exercises, Rom measurements, and patient’s pain scale throughout the processes were not included. Wilcox R, Harris B, Arslanian L, Carrino J, Millett P. Functional outcomes following rotator cuff repair based on tissue quality: a pilot study.?Orthopaedic Physical Therapy Practice?[serial online]. March 2009;21(1):9-15. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed January 16, 2015.The main focus of this article was to determine if MRI results were effective in matching the diagnosis of a rotator cuff tear as intraoperative soft tissue assessment, as well as if post-operative improvements are correlated with the severity of the original tear before surgery, and finally whether or not the outcomes of arthroscopic rotator cuff surgery were different depending on the severity of the tear. This article is aimed at therapists and athletic trainers who have good communication with their physicians that may be able to determine the severity of the tear before surgery, so they can understand the functional outcomes that are to come. The author concluded that range of motion and manual muscle tests had improved scores the less severe the original tear was. There were differences in functional outcomes after surgery regarding the extent of the tear. This study used 10 subjects but didn’t include age, previous conditionals, size, or background data at all. I believe that in order to utilize this information to its fullest extent, the athletic trainer or physical therapist reading this article should understand that subjects that were dealt with.Klintberg I, Gunnarsson A, Svantesson U, Styf J, Karlsson J. Early loading in physiotherapy treatment after full-thickness rotator cuff repair: a prospective randomized pilot-study with a two-year follow-up.?Clinical Rehabilitation?[serial online]. July 2009;23(7):622-638. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed January 16, 2015.The main focus of this article was to present a study that looked to determine whether or not early loading and progressive rehabilitation styles would adversely affect rotator cuff range of motion and scores on manual muscle tests when compared to traditional styles of rotator cuff rehabilitation. This article is aimed at athletic trainers and physical therapists that look to speed up the rehabilitation process with willing subjects. The author concluded that loading the rotator cuff by the first day after surgery with muscle activation of the deltoid, posed no adverse effects when compared to the group that protected the rotator cuff from loading. This article included every piece of evidence needed to verify the study including background about the subjects, measurements every 3 weeks including baseline data, and graphs are charts for easy reader comparison between trials. Harris J, Ravindra A, Jones G, Butler R, Bishop J. Setting patients' expectations for range of motion after arthroscopic rotator cuff repair.?Orthopedics?[serial online]. February 2013;36(2):100. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed January 16, 2015.The main focus of this article was to prepare patients that are considering arthroscopic rotator cuff repair for functional outcomes after surgery for small, medium, and large tears. This was the first article that I found that was more aimed towards the patient as a reader rather than the rehabilitator or physician. The reason I chose this article was because it used range of motion as a measurement of functional outcomes and how and when patients should expect full range of motion depending on the severity of the original tear. The author concludes that with this information patients may be able to improve their satisfaction of arthroscopic rotator cuff repair because they will know what to expect coming out of surgery. The study group included 274 patients of all ages and were grouped according to grade of the tear, so with such a big group of study, patients can read this information with confidence that they will proceed with similar outcomes. Hayes K, Ginn K, Walton J, Szomor Z, Murrell G. A randomised clinical trial evaluating the efficacy of physiotherapy after rotator cuff repair.?Australian Journal Of Physiotherapy?[serial online]. June 2004;50(2):77-83. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed January 16, 2015.The main focus of this article to determine the better physiotherapy technique for the rehabilitation of the range of motion and muscle strength in the shoulder after arthroscopic rotator cuff surgery. The two compared trials were a supervised trial of detailed therapy and a home based regime of exercises that patients were told to complete, so this article was aimed at physicians and physical therapists that wish to determine if issuing a home exercise program will suffice for rehabilitation of the rotator cuff. The author concluded that a supervised rehabilitation program produces results that are not significantly better than a home based regime. The trial was randomized by blindly assigning individuals with different sizes of preoperative tears. I believe that in order to achieve the best results the size tears should be used in all aspects of the study. I conclude that no matter what the situation, the patient would thrive in a supervised environment where they may be able to ask questions and determine how much they want to push their mobility through range of motion at different stages of the rehab process. Mao C, Jaw W, Cheng H. Frozen shoulder: correlation between the response to physical therapy and follow-up shoulder arthrography.?Archives Of Physical Medicine & Rehabilitation?[serial online]. August 1997;78(8):857-859. Available from: CINAHL Plus with Full Text, Ipswich, MA. Accessed January 16, 2015.The main focus of this article was to determine the correlation between shoulder mobility/range of motion and joint space depicted by arthrography. The reason I chose this article is because frozen shoulder is a pathology common in patients that never rehab rotator cuff impingement or in patients that don’t properly restore range of motion after arthroscopic rotator cuff surgery. This article is aimed at physical therapists and athletic trainers rehabilitating a patient with frozen shoulder syndrome. The author concludes that frozen shoulder is treatable in the acute stage when joint space is able to be increased and the adhesions depleted. When the pathology is chronic, external rotation is able to be increased but the joint space is not significantly increased. After reading the article I understand that with improvements in joint capacity comes improvements in range of motion. I believe that a study that used patients with rotator cuff tears as well as frozen shoulder would assist more physical therapists with rehabilitating patients in extreme pain as well as restricted range of motion. van der Meijden, O. A., Westgard, P., Chandler, Z., Gaskill, T. R., Kokmeyer, D., & Millett, P. J. (2012). REHABILITATION AFTER ARTHROSCOPIC ROTATOR CUFF REPAIR: CURRENT CONCEPTS REVIEW AND EVIDENCE-BASED GUIDELINES.International Journal Of Sports Physical Therapy,?7(2), 197-218.This is a basic journal that cover the overview of all things rotator cuff rehabilitation from the timing of healing and different updates and improvements in techniques of shoulder rehab. The article is aimed at physical therapists, athletic trainers, as well as patients in order to understand that the success of restored range of motion and strength in the shoulder is determined by a healthy rehabilitation program as much as it is determined by a successful arthroscopic surgery. The author concludes with how scientific determination of the timing of healing is lightly supported by evidence, so it is important to have experience in using evidence based practice when determining an individualized rehab protocol. This article is based off of readily available literature dealing with rehabilitation after arthroscopic rotator cuff surgery. This is a repeated theme that I am seeing with just having to rely on evidence based practice to determine a successful rehabilitation regime for each patient. Hadjicostas P, Soucacos P, Theissen M, Thielemann F. The use of split deltoid-flap in the treatment of massive rotator cuff defects: a retrospective study of 61 patients.?Knee Surgery, Sports Traumatology, Arthroscopy?[serial online]. September 15, 2008;16(9):876-883. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed January 16, 2015.The main purpose of this article was to describe the difficulty for the orthopedic surgeon when it comes to massive and unrepairable rotator cuff tears. The reason I chose this article is because it mentions range of motion and its benefits of being restored with a proper rehabilitation program even after surgery on massive tears in the rotator cuff. The author concludes that positive results may still come from surgery on massive irreparable using the split deltoid flap technique when accompanied with an individualized rehabilitation program. The article includes complications that were ran into during the treatment of several patients during the study. Imaging as well as depictures of the process of the surgery were included in the article and I found that helpful in understanding surgery’s processes. Charts, graphs, and patient pictures were used to prove that range of motion may be improved after the split deltoid flap technique.Shakeri H, Keshavarz R, Arab A, Ebrahimi I. ORIGINAL RESEARCH. CLINICAL EFFECTIVENESS OF KINESIOLOGICAL TAPING ON PAIN AND PAIN-FREE SHOULDER RANGE OF MOTION IN PATIENTS WITH SHOULDER IMPINGEMENT SYNDROME: A RANDOMIZED, DOUBLE BLINDED, PLACEBO-CONTROLLED TRIAL.?International Journal Of Sports Physical Therapy?[serial online]. December 2013;8(6):800-810. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed January 16, 2015.The main purpose of this article was to define the effects of utilizing kinesiology tape to improve pain and range of motion in patients with shoulder impingement problems. The reason I chose this article even though it doesn’t deal with rotator cuff surgery or tears is because I believe that benefits found in this research can be used in post-operative arthroscopic rotator cuff repair patients. The article itself is aimed at athletic trainers and physical therapists interested in assisting pain free range of motion among their patient’s with restricted mobility in the shoulder due to pain or injury. The author concluded that pain and range of motion were immediately improved after applying the KT tape with little differences between improvements between study groups. The application includes activation of the deltoid and scapular muscles in order to assist in range of motion and I believe that this could be used if the physical therapist is using an early stage loading style of rehabilitation. The KT tape would assist in making this a pain free process. ................
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