Conservative treatment of rotator cuff tear in older patients: a role for the cycloergometer? A randomized study.

BACKGROUND: To date, there are no published data on the use of devices in the management of rotator cuff tear (RCT).

AIM: The aim of this study was to evaluate the effect of supervised arm cycloergometer training on pain during activities and shoulder functionality in patients with symptomatic full-thickness RCT.

DESIGN: This is a prospective randomized controlled pilot study.

SETTING: Outpatients of our Rehabilitation Unit.

POPULATION: In this pilot study, 40 elderly outpatients (>70 years) with RCT were randomized to two groups: cycloergometer (CYC) vs. control patients.

METHODS: All patients underwent a common outpatient rehabilitation exercise program consisting of ten 30-min sessions (5 sessions/week). At discharge, CYC patients received 15-min training with an arm cycloergometer and were invited to use the cycloergometer at home 20 min/twice a day. Control patients were invited to continue the standard exercises. During the 6-month study period CYC patients, but not control patients, received educational reinforcement monthly from the nurse of the telemedicine service. Outcomes assessed, between admission (T0) and 6-month follow-up (T6), were: pre to postpain during activities, active and passive ROMsum, ROM-painsum, revised Constant Total Score, and Health Assessment Questionnaire (HAQ).

RESULTS: At T6, CYC patients showed a significant improvement in all outcome measures with respect to T0 (all: P<0.001). CYC patients showed also significant improvement in passive forward elevation, abduction, and external rotation of shoulder, as well as in active ROMsum and ROM-painsum in all single shoulder movements, and significant improvement in the HAQ items: dressing/grooming, eating, hygiene, reach, and common daily activities. At T6 the CYC group had lower pain during activities (P<0.01) and higher revised constant total score (P<0.01), ROM-painsum (P<0.05) and active ROMsum (P<0.05) than control patients. Home cycloergometer use was inversely associated to pain during activities (P<0.01) and revised Constant Total Score (P<0.01) at T6.

CONCLUSIONS: A short program of shoulder passive exercises and cuff strengthening exercises followed by regular use of the cycloergometer for 6 months at home can reduce pain and improve shoulder functionality in RCT patients.

CLINICAL REHABILITATION IMPACT: Our findings indicate that the cycloergometer may be useful in patients with RCT when regularly used at home and suggest use of this mechanical device in rehabilitation programs for these patients.