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    188宝金博页面版: A Comprehensive Approach to Non-operative Rotator Cuff Rehabilitation

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    内容提示： MUSCULOSKELETAL REHABILITATION (NA SEGAL, SECTION EDITOR)A Comprehensive Approach to Non-operative Rotator CuffRehabilitationAaron Sciascia ? Daun KarolichPublished online: 19 January 2013? Springer Science + Business Media New York 2013Abstract One of the primary conditions targeted inrehabilitation of the shoulder is rotator cuff injury. Multiplenon-operative rehabilitation protocols have been describedfor the treatment of the spectrum of rotator cuff injury.Most protocols are implemented under the pret...

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    MUSCULOSKELETAL REHABILITATION (NA SEGAL, SECTION EDITOR)A Comprehensive Approach to Non-operative Rotator CuffRehabilitationAaron Sciascia • Daun KarolichPublished online: 19 January 2013? Springer Science + Business Media New York 2013Abstract One of the primary conditions targeted inrehabilitation of the shoulder is rotator cuff injury. Multiplenon-operative rehabilitation protocols have been describedfor the treatment of the spectrum of rotator cuff injury.Most protocols are implemented under the pretense oftreating areas local to the site of symptoms. However, acomprehensive approach aimed at identifying all possiblecontributing factors can aid the clinician in developingimpairment directed programs, which address the localdysfunction in addition to the distal contributions of injury.This approach focuses on def i cits distal to the site ofsymptoms and provides early intervention to rectifying theimpairments found in the body segments, which providethe foundation of support for the proper function of theshoulder segment. Correction of the alterations following akinetic chain and scapular-based program should beincluded as part of the comprehensive treatment plan forrotator cuff injuries.Keywords Rotator Cuff ? Rehabilitation ? Non-operativemanagementIntroductionIn the presence of tissue derangement such as labral androtator cuff injuries, symptoms can be reduced and functioncan be improved with non-operative treatment methods[1 •• , 2, 3 • , 4]. The implementation of activity restrictions,physical modalities, and/or therapeutic exercise canimprove demonstrated def i cits (muscle weakness, muscletightness, capsular restriction, etc.) as these are the modi-f i able components. However, it should be understood that anon-operative approach is dedicated towards addressingdemonstrated anatomical def i cits and not healing the actualtissue derangement.There is a high prevalence of rotator cuff injury with alarge majority of shoulder complaints being related toeither direct involvement of the rotator cuff muscles orsubacromial bursa [5]. Epidemiological studies havereported that 13–51 % of people over the age of 50 likelyhave a tear of at least 1 rotator cuff muscle but without themanifestation of symptoms or loss of function, and it hasbeen shown that the prevalence of rotator cuff tearsincreases with age [6 • , 7, 8 • ]. Similarly, at least 36 % ofsymptomatic shoulders have been shown to have rotatorcuff involvement [8 • ]. This information suggests that in thepresence of symptoms, loss of function cannot be entirelyattributed to an anatomical lesion in the rotator cuff nordoes the presence of a visualized lesion necessarily suggestthat therapeutic intervention is warranted due to the highrate of lesions found in asymptomatic shoulders. In theevent that rotator cuff injury has been diagnostically con-f i rmed and physical activity becomes altered (activities ofdaily living or work/athletic tasks), then therapeutic exer-cise may be benef i cial for attempting to restore the lostfunction as long as all contributing factors have beenconsidered. This paper will present a framework ofA. Sciascia (&)Lexington Clinic, Shoulder Center of Kentucky,1221 South Broadway, Lexington, KY 40504, USAe-mail: ascia@lexclin.comD. KarolichLexington Clinic Department of Physical Therapy,1221 South Broadway, Lexington 40504, KY, USAe-mail: dkaro@lexclin.com123Curr Phys Med Rehabil Rep (2013) 1:29–37DOI 10.1007/s40141-012-0002-x

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