Investigation of the Active Joint Position Sense Following Rotator Cuff Repair Surgery

Year 2024, Volume: 3 Issue: 2, 1 - 9, 30.10.2024

Leyla Eraslan , Ertugrul Aksahin , İrem Düzgün

Abstract

Purpose: Decreased active joint position sense (JPS) has been documented in patients with rotator cuff tears. However, there is limited information regarding whether proprioceptive impairments could be recovered after arthroscopic rotator cuff repair (ARCR) surgery. This study aimed to evaluate the shoulder active JPS following an ARCR surgery and compare the differences between the non-operated contralateral sides of the patients and the healthy controls.
Methods: Fifteen patients with ARCR surgery and fifteen healthy controls were included. The shoulder active JPS was assessed using the Laser-pointer-assisted Angle Reproduction Test at 90° of the forward flexion and abduction positions at the post-operative 3rd month in patients with ARCR surgery (both sides) and healthy controls (dominant side). Shoulder active range of movements (ROM) and pain intensity were also recorded.
Results: Active shoulder JPS was similar to the patients’ operated and non-operated sides and the dominant sides of the healthy controls at 90° of the forward flexion (p>0.05). However, it was significantly worse in the patients’ operated sides than in the non-operated sides at 90° of abduction (p=0.034). The ROMs were significantly worse in the ARCR patients' operated sides than in the non-operated sides and the healthy controls' dominant sides (p<0.05). Furthermore, pain intensity was not correlated with active JPS at 90° of forward flexion (r=-0.258; p=0.354) and 90° of abduction (r=-0.142; p=0.629).
Conclusion: This study reveals that active JPS may be restored in the third month following ARCR surgery.

Keywords

proprioception, active joint position sense, rotator cuff, repair

Ethical Statement

This study protocol was approved by the Hacettepe University Institutional Review Board (GO16/575-14)

References

• 1. Seitz AL, McClure PW, Finucane S, Boardman III ND, Michener LA. Mechanisms of rotator cuff tendinopathy: intrinsic, extrinsic, or both? Clinical Biomechanics. 2011;26(1):1-12.
• 2. Desmeules F, Boudreault J, Dionne CE, Frémont P, Lowry V, MacDermid JC, et al. Efficacy of exercise therapy in workers with rotator cuff tendinopathy: a systematic review. Journal of Occupational Health. 2016;58(5):389-403.
• 3. Dang A, Davies M. Rotator cuff disease: treatment options and considerations. Sports Medicine and Arthroscopy Review. 2018;26(3):129-33.
• 4. Matlak S, Andrews A, Looney A, Tepper KB. Postoperative rehabilitation of rotator cuff repair: a systematic review. Sports Medicine and Arthroscopy Review. 2021;29(2):119-29.
• 5. Van der Meijden OA, Westgard P, Chandler Z, Gaskill TR, Kokmeyer D, Millett PJ. Rehabilitation after arthroscopic rotator cuff repair: current concepts review and evidence-based guidelines. International Journal of Sports Physical Therapy. 2012;7(2):197.
• 6. Demirci S, Kara D, Yıldız Tİ, Eraslan L, Uysal Ö, Sevinç C, et al. Effects of Different Frequencies of Physical Therapy Visits on Shoulder Function After Arthroscopic Rotator Cuff Repair. Physical Therapy. 2023:pzad066.
• 7. Duzgun I, Baltaci G, Turgut E, Atay OA. Effects of slow and accelerated rehabilitation protocols on range of motion after arthroscopic rotator cuff repair. Acta Orthopaedica et Traumatologica Turcica. 2014;48(6):642-8.
• 8. Myers JB, Oyama S. Sensorimotor factors affecting outcome following shoulder injury. Clin Sport Med. 2008;27(3):481-90.
• 9. Duzgun I, Baltaci G, Atay O. Comparison of slow and accelerated rehabilitation protocol after arthroscopic rotator cuff repair: pain and functional activity. Acta Orthopaedica et Traumatologica Turcica. 2011;45(1):23-33.
• 10. Fortier S, Basset FA. The effects of exercise on limb proprioceptive signals. Journal of Electromyography and Kinesiology. 2012;22(6):795-802.
• 11. Balke M, Liem D, Dedy N, Thorwesten L, Balke M, Poetzl W, et al. The laser-pointer assisted angle reproduction test for evaluation of proprioceptive shoulder function in patients with instability. Archives of Orthopaedic and Trauma Surgery. 2011;131:1077-84.
• 12. Ager AL, Roy J-S, Roos M, Belley AF, Cools A, Hebert LJ. Shoulder proprioception: how is it measured and is it reliable? A systematic review. Journal of Hand Therapy. 2017;30(2):221-31.
• 13. Vafadar AK, Côté JN, Archambault PS. Interrater and intrarater reliability and validity of 3 measurement methods for shoulder-position sense. J Sport Rehabil. 2016;25(1).
• 14. Lephart SM, Jari R. The Role of Proprioception in Shoulder Instability. Operative Techniques in Sports Medicine. 2002;10(1):2-4.
• 15. Takahashi K, Shitara H, Ichinose T, Sasaki T, Hamano N, Hasegawa M, et al. Delayed detection of passive motion in shoulders with a rotator cuff tear. Journal of Orthopaedic Research®. 2022;40(6):1263-9.
• 16. Machner A, Merk H, Becker R, Rohkohl K, Wissel H, Pap G. Kinesthetic sense of the shoulder in patients with impingement syndrome. Acta Orthopaedica Scandinavica. 2003;74(1):85-8.
• 17. Gumina S, Camerota F, Celletti C, Venditto T, Candela V. The effects of rotator cuff tear on shoulder proprioception. International Orthopaedics. 2019;43:229-35.
• 18. Çalık M, Utlu DK, Demirtaş A, Canbora MK, Erdil ME, Düzgün İ. Is shoulder joint position sense affected in partial and full-thickness supraspinatus tears? International Orthopaedics. 2023;47(4):1021-9.
• 19. DeOrio J, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. Journal of Bone and Joint Surgery. 1984;66(4):563-7.
• 20. Thigpen CA, Shaffer MA, Gaunt BW, Leggin BG, Williams GR, Wilcox III RB. The American Society of Shoulder and Elbow Therapists' consensus statement on rehabilitation following arthroscopic rotator cuff repair. Journal of Shoulder and Elbow Surgery. 2016;25(4):521-35.
• 21. Hayes K, Walton JR, Szomor ZL, Murrell GA. Reliability of five methods for assessing shoulder range of motion. Australian Journal of Physiotherapy. 2001;47(4):289-94.
• 22. Clark P, Lavielle P, Martínez H. Learning from pain scales: patient perspective. The Journal of Rheumatology. 2003;30(7):1584-8.
• 23. Tashjian RZ, Deloach J, Porucznik CA, Powell AP. 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. Journal of Shoulder and Elbow Surgery. 2009;18(6):927-32.
• 24. Worsley P, Warner M, Mottram S, Gadola S, Veeger H, Hermens H, et al. Motor control retraining exercises for shoulder impingement: effects on function, muscle activation, and biomechanics in young adults. Journal of Shoulder Elbow Surgery. 2013;22(4):e11-e9.
• 25. Roy JS, MacDermid JC, Woodhouse LJ. Measuring shoulder function: a systematic review of four questionnaires. Arthritis & Rheumatology. 2009;61(5):623-32.
• 26. Forcin Favaro I, Martins J, Rossi DM, de Lima Boarati E, Felippe de Morais M, Oliveira AS. Laser-Pointer assisted angle reproduction test (LP-ART): reliability, performance, and correlation with shoulder pain and disability in patients with subacromial pain syndrome. Physiotherapy theory and practice. 2023;39(6):1287-96.
• 27. Düzgün İ, Şimşek İ, Yakut Y, Baltacı G, Uygur F. Assessing shoulder position sense using angle reproduction test in healthy individuals: A pilot study. Fizyoterapi Rehabilitasyon. 2011;22(3):240-4.
• 28. Weir JP. Quantifying test-retest reliability using the intraclass correlation coefficient and the SEM. The Journal of Strength and Conditioning Research. 2005;19(1):231-40.
• 29. Bruton A, Conway JH, Holgate ST. Reliability: what is it, and how is it measured? Physiotherapy. 2000;86(2):94-9.
• 30. Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. Journal of Clinical Epidemiology. 2007;60(1):34-42.
• 31. Hung Y-j, Darling WG. Shoulder position sense during passive matching and active positioning tasks in individuals with anterior shoulder instability. Physical Therapy. 2012;92(4):563-73.
• 32. Fabis J, Rzepka R, Fabis A, Zwierzchowski J, Kubiak G, Stanula A, et al. Shoulder proprioception–lessons we learned from idiopathic frozen shoulder. BMC musculoskeletal disorders. 2016;17(1):1-8.
• 33. Pötzl W, Thorwesten L, Götze C, Garmann S, Steinbeck J. Proprioception of the shoulder joint after surgical repair for Instability: a long-term follow-up study. The American Journal of Sports Medicine. 2004;32(2):425-30.
• 34. Walecka J, Lubiatowski P, Consigliere P, Atoun E, Levy O. Shoulder proprioception following reverse total shoulder arthroplasty. International Orthopaedics. 2020;44:2691-9.
• 35. Kamper SJ. Interpreting outcomes 3—clinical meaningfulness: linking evidence to practice. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(9):677-8.
• 36. Suprak DN. Shoulder joint position sense is not enhanced at end range in an unconstrained task. Human movement science. 2011;30(3):424-35.
• 37. Anderson VB, Wee E. Impaired joint proprioception at higher shoulder elevations in chronic rotator cuff pathology. Archives of Physical Medicine and Rehabilitation. 2011;92(7):1146-51.
• 38. Mörl F, Matkey A, Bretschneider S, Bernsdorf A, Bradl I. Pain relief due to physiotherapy doesn’t change the motor function of the shoulder. Journal of Bodywork and Movement Therapies. 2011;15(3):309-18.
• 39. Sole G, Osborne H, Wassinger C. The effect of experimentally-induced subacromial pain on proprioception. Manual therapy. 2015;20(1):166-70.