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

项目摘要 肩袖撕裂是一个重大的临床问题，导致30%的骨科医生就诊和 每年超过15万例外科手术。肩袖撕裂多见于中老年人群 会导致严重的疼痛、残疾和活动受限，通常会开运动疗法 用于肩袖撕裂的初步治疗，通常在缓解症状方面有效。然而，它在25%-50%的情况下失败了 需要手术干预的病例。影响运动疗法成功的因素 都不确切知道，购买可能包括肩袖撕裂的大小和位置，活动范围， 力量，疼痛程度，和重复负荷，由于异常的关节-肱骨运动学。因此，总体来说， 拟议项目的目标是进行一项前瞻性观察队列研究，以描述 根据患者报告的结果和结构性结果进行运动治疗，并确定这些结果的预测因素 单纯性冈上肌撕裂患者的预后。我们将在活体内量化关节运动； 使用超声波、肌肉力量和患者报告的受试者在治疗前和治疗前的泪水大小/位置 在一次运动治疗计划之后。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传播有影响，2)运动疗法可以 在手臂抬高的过程中提高活体关节的稳定性。该项目将解决三个具体目标： 目的1)确定预测患者报告的结果和泪液传播的因素 每周指导的运动治疗计划。肩关节接触路径长度；初始撕裂能力 大小；内部/外部活动范围和肌肉退化预测患者报告的结果和撕裂 将在运动治疗后0、6和12个月检查大小/繁殖；目的2)调查 泪液位置对泪液传播和肩关节运动学的影响；目的3)确定两者之间的关系 泪液传播和锻炼计划的失败改善患者报告的结果和/或经历 在两年内做手术。所得数据将用于设计未来的随机临床试验，以 根据患者的情况，确定患者最初应该接受非手术治疗还是手术治疗 报告和临床医生测量的参数以及诊断时的生物力学测量。这个 这项研究的长期目标是开发个体化治疗计划，以改善结果 同时减少护理时间和费用。肩袖撕裂后肩关节功能的恢复 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.