Predicting the Outcome of Exercise Therapy for Treatment of Rotator Cuff Tears

项目摘要 肩袖撕裂是一个重要的临床问题，导致30%的骨科医生就诊， 每年超过15万例外科手术肩袖撕裂好发于中老年 运动疗法通常用于治疗老年人，并可能导致严重疼痛、残疾和活动受限。 用于肩袖撕裂的初始治疗，通常可有效缓解症状。然而，它在25-50%的情况下失败 的病例，需要手术干预。运动疗法成功的因素 并不精确，购买可能包括肩袖撕裂的大小和位置，运动范围， 力量、疼痛程度和由于盂肱关节运动学异常而导致的重复负荷。因此整体 拟议项目的目标是进行一项前瞻性观察性队列研究，以描述 运动疗法的患者报告和结构性结果，以及确定这些预测因素 孤立性冈上肌撕裂患者的结局。我们将量化体内盂肱关节运动; 撕裂大小/位置（使用超声）、肌肉强度;以及受试者术前和术后患者报告的结局 在一个运动疗法项目之后。我们的初步数据表明：1）全厚度的位置 冈上肌腱的肩袖撕裂对撕裂的扩展有影响，2）运动疗法可以 提高手臂抬高过程中盂肱关节稳定性。该项目将实现三个具体目标： 目的1）确定预测标准化12- 15分钟后患者报告结果和泪液传播的因素。 一周监督的运动治疗计划。盂肱关节接触路径长度的能力;初始撕裂 尺寸;内部/外部活动范围和肌肉退化，以预测患者报告的结局和撕裂 将检查运动治疗后0、6和12个月的大小/传播;目的2）研究 撕裂位置对撕裂扩展和盂肱运动学的影响;目的3）确定 撕裂扩展和运动计划失败，以改善患者报告的结局和/或经历 两年内手术。由此产生的数据将用于设计未来的随机临床试验， 根据患者的情况，确定患者最初是否应接受非手术治疗或手术治疗- 报告的和临床医生测量的参数以及诊断时的生物力学测量值。的 这项研究的长期目标是制定个性化的治疗计划，以改善结果 同时减少护理的时间和费用。肩袖撕裂后肩关节功能的恢复对于 保持健康、积极的生活方式，特别是在人口老龄化的情况下。

Project Summary Rotator cuff tears are a significant clinical problem, resulting in 30% of all visits to orthopaedic surgeons and over 150,000 surgical procedures per year. Rotator cuff tears occur frequently in the middle-to-late aged population and can cause severe pain, disability and activity limitations Exercise therapy is typically prescribed for initial treatment of rotator cuff tears, and is often effective at relieving symptoms. However, it fails in 25-50% of cases, requiring surgical intervention. The factors contributing to a successful outcome of exercise therapy are not precisely known, buy may include the size and location of the rotator cuff tear, range of motion, strength, pain level, and repetitive loading due to abnormal glenohumeral kinematics. Therefore, the overall goal of the proposed project is to conduct a prospective observational cohort study to describe the effects of exercise therapy in terms of patient-reported and structural outcomes, as well as to identify predictors of these outcomes in patients with an isolated supraspinatus tear. We will quantify in vivo glenohumeral joint motion; tear size/location using ultrasound, muscle strength; and patient-reported outcomes in subjects before and after an exercise therapy program. Our preliminary data have shown that: 1) the location of full-thickness rotator cuff tears in the supraspinatus tendon has an effect on tear propagation and 2) exercise therapy can improve in vivo glenohumeral joint stability during arm elevation. The project will address three specific aims: Aim 1) Identify factors that predict patient-reported outcomes and tear propagation after a standardized 12- week supervised exercise therapy program. The ability of glenohumeral joint contact path length; initial tear size; internal/external range of motion and muscle degeneration to predict patient-reported outcomes and tear size/propagation at 0, 6 and 12 months after exercise therapy will be examined; Aim 2) Investigate effects of tear location on tear propagation and glenohumeral kinematics; Aim 3) Determine the relationship between tear propagation and failure of the exercise program to improve patient-reported outcomes and/or undergo surgery within two years. The resulting data will be used to design future randomized clinical trials to determine whether patients should initially undergo non-operative or surgical treatment, based on patient- reported and clinician-measured parameters as well as biomechanical measurements at time of diagnosis. The long-term goal of this research is the development of individualized treatment plans for improving outcomes while reducing time and expense of care. Restoration of shoulder function after rotator cuff tear is essential for maintaining a healthy, active lifestyle, particularly in our aging population.