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Online ISSN 1827-1707
Rockwood C. A., Wirth M. A., Rosipal C. E., Marchant D. C.
Department of Orthopaedic Surgery University of Texas Health Science Center San Antonio, TX, USA
The elderly patient with a chronic, painful shoulder secondary to a full or partial defect in the rotator cuff is a difficult problem for the treating physician. The consideration of surgical treatment measures, which may be utilized in the younger patient population, may not be appropriate as a first-line management option in this older patient group. For the older patient, 60 years and over, with a complete or partial defect in the rotator cuff, we advocate the administration of a physician directed, home-based rehabilitation program as an effective, reliable method of attaining significant improvement in clinical status. The specific, supervised rehabilitation program, orthotherapy, has previously been described in the literature. It consists of a gentle, progressive rehabilitation program that is divided into four distinct phases. After the acute shoulder pain has been diminished, the patient is started on phase 2 of the program, a gradual, progressive shoulder stretching program involving the remaining rotator cuff musculature, deltoid and the scapular stabilizers. Only when the patient achieves a functional passive range of motion of the shoulder, is phase 3 commenced - a gentle progressive strengthening exercise program. It is essential that, at the successful completion of the stretching and strengthening program, a fourth maintenance phase is continued at least twice a week on an indefinite basis. This involves continued utilization of the stretching and strengthening exercises. It is important to note that there is no utilization of physical or occupational therapists at any stage during the administration of this home-based rehabilitation program. It is our belief that these influences do not significantly contribute to a positive outcome and may indeed be detrimental to the objectives of this program. It is the experience of the senior author that following the administration of this home-based rehabilitation program, good to excellent results are achieved in 60% to 80% of this challenging patient group.