return to play after rotator cuff repair

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Alessandro GianniniGruppo Medico Isokinetic, FIFA Medical Centre of Excellence, Torino

Torino, 28 Novembre 2015 Return to sport after surgery for rotator cuff repair

RTP where we are?Let's start talking about shoulder.starting from the knee

22When I started to prepare this talk I immediately clashed with part of the most significant scientific data

RTP where we are?

Return to the same competitive level: 42% in non professional player 81% in professional playerACL reconstruction

Rotator Cuff Repair

Return to the same competitive level: 66% in non professional player 49.9% in professional playerIncorporating routine screening for psychological responses that could hinder returning to sport into standard postoperative rehabilitation programmes may help clinicians identify athletes at risk of not returning to sport One of the hypotheses to explain this is that certain psycological factors that are not usually evaluated couldplay a role in the return to sport

33When I started to prepare this talk I immediately clashed with part of the most significant scientific data

RTP where we are?Lests go more in depth with this systematic review When studies report results in terms of pain relief or range of motion, the results are nearly all very good, even though most patientes do no return to play at the same level

44When I started to prepare this talk I immediately clashed with part of the most significant scientific data

RTP where we are?Lests go more in depth with this systematic review This is important information because it shows that a professional player cannot count on surgical repair of the rotator cuff to retun him or her to a sport career at the same level No difference between full tear and partial tear

55When I started to prepare this talk I immediately clashed with part of the most significant scientific data

Why is RTP so difficult?The only way to mimic the forces of a baseball throw is to actually throw a ball. Axe M et al . Sports Health, 2009What is the magic behind the throwing?

66When I started to prepare this talk I immediately clashed with part of the most significant scientific data

More than just a game

We are not the fastest animal in nature...and surely not the strongest one.

..but we are the best throwers!

77When I started to prepare this talk I immediately clashed with part of the most significant scientific data

The magic of throwing

Internal rotation around long axis of the humerus is the larget contributior to projectile velocityThis rotation can exceed 9,000/secIs the fastest motion that human body producesMaximum angular velocity during 100m running (in the hip) is around 800/sec

No muscles in human body is able to generate so much rotation powerInverse dynamic shows, the shoulder produce a large period of negative work

88When I started to prepare this talk I immediately clashed with part of the most significant scientific data

How can it be possible?Many things to consider.

Kinetic chain

V4

V3

V2

V1Vg=V1+V2+V3+V4

99When I started to prepare this talk I immediately clashed with part of the most significant scientific data

Energy storageHow can it be possible?

the mass moment of inertia around the long axis of humerus cause the forearm and hand lag behind the accelerating torso

1010When I started to prepare this talk I immediately clashed with part of the most significant scientific data

Energy storage

During the arm-cocking phase, the throwers humeri externally rotation exceed by 57 the active ROM Elastic energy can account for more than 50% of internal humeral rotation work doneAs the cocking phase begins, large torques are generated by rapid rotation of the torsoThe positioning of the shoulder and elbow at this time increase the mass moment of inertia

1111When I started to prepare this talk I immediately clashed with part of the most significant scientific data

Implications for rehabilitation

1212When I started to prepare this talk I immediately clashed with part of the most significant scientific data

Phase 2-3: Special considerationsRecovery of strength

Ismoetric HHD:0-0: ER/IR ratio >75%90-0: ER/IR ratio 90-100%90-90: ER/IR ratio 60-85%Byram et al. AJSM 2010

Most of the work is done eccentricaly. We need to test EccIR? Cools et al. KSSTA 2015Recovery of pain free ROM

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